Finding Freedom at Home

Finding Freedom at Home CoverWe talk to people all the time who are exploring care options for an aging parent. Often times, they don’t know where to turn for information or referrals. Then, to add to their anxiety, the more they discover is available, the decisions become increasingly difficult.

Which home care agency can professionally take care of the comprehensive non-medical needs of my mother? Is it okay to use this home health or hospice agency? Which assisted living facility best matches my dad’s personality and standard of living? Is my mom living with me a good option?

I recently published “Finding Freedom at Home: The Ultimate Guide to Home Care.” My hope is that this book will be a practical resource for families as they are exploring care options for an aging parent.

If you agree that many families need a practical resource to help them navigate these waters, tell them about “Finding Freedom at Home: The Ultimate Guide to Home Care.” They can find it on Amazon.

Together, we can help educate people about their options. Receiving care in your home is NOT the alternative to institutionalization. To the contrary, everything other than remaining in their home with appropriate services and supports should be viewed as the alternatives.

Care Calls – Wellness Checks on Older Adults

Care Calls – Wellness Checks on Older Adults

Wow!  When we announced our new service of daily care calls, we really did not anticipate the response to our Care Calls.  It’s been overwhelming! 

We’ve also had some great questions that we want to clear up for you. 

Is it a “robo-call? – No!  We don’t have any robots on staff and don’t see any real value in automated calls.  Every single one of our calls is made by a real person in our Care Center.  Nothing says “personal service” like an automated phone call and who likes talking to a robot anyway?

What happens when things are not okay? – If our Care Center representative discovers that there are immediate needs or there is reason for concern, we notify the key contact(s). If emergency assistance is needed, we alert emergency response personnel immediately.

Who would need a service like this? – We’ve found that sometimes family is concerned about an aging parent, but there is no need for in-home caregiving assistance or the parent will not accept it. This service can be especially helpful for people recently discharged from a hospital or rehabilitation center.

Who is making the calls? – Our Care Center is CSAA Five Diamond certified. We have dozens of trained representatives who place the Care Calls. Supervisors are on the floor at all times and representatives who speak a variety of languages are always on duty.

How much does it cost? – There are automated “robo-calls” out there that charge $15-$50 per month. My own mother would pay that much to NOT have a robot call her and ask her to push a button if she is okay. We charge $150/month for up to three calls every day. We are repeatedly told that having a live, trained person who is able to talk to your loved one and offer an objective assessment of the situation when need be is worth a couple dollars per call.

How do I refer? – Simply call or email us and we can easily get your referral set up with this service. We’ll ask what times we should call, get some basic health information and key contact information, and we’re set.

What is your service area? – We serve home care clients in central Arkansas but are serving Care Call clients statewide.

Home Care Isn’t an Alternative?

At home care for an aging loved one is not an “appropriate” or “suitable” alternative to either assisted living or nursing home care.  To the contrary, any and every option other than remaining at home should be viewed as an alternative to what the vast majority of people desire.

Dorothy had it right.  There’s no place like home.

In fact, remaining at home with appropriate services and supports can truly be empowering.  Home care can empower the person receiving care to remain as independent as possible in the setting of their choice.  It can empower family and friends, transforming time with their aging loved one into quality time, largely free of the daily concerns and worries.  And it can empower health care professionals in that it gives another perspective and recorded notes on how their patient is doing.  This can be a tremendous resource as their patient’s physical and cognitive health is evaluated or treated.

There are countless reasons why home care is off the charts and institutionalization barely registers when older adults are asked where they want to age.  The following are just a few.

Who doesn’t want independence?  This is, perhaps, the greatest advantage for receiving care in one’s own home.  It can be difficult to adjust to a regimented lifestyle in a facility, but at home you can set your own schedule, choose what and when to eat, and how and when to bath.  Even those with the greatest need for assistance report that home care can empower continued independence.

Being at home is simply more comfortable for most people than being in an unfamiliar place.  At home, we have our photographs, books, bed, bath, kitchen, telephone, pets and all the things we’re accustomed to.  Everything is in its place, which in studies has proven to be an effective emotional healer.  Even if you can take a few select items from home to a facility, and even if it is made as “home-like” as possible, it still cannot provide the comforts of your real home.

Unlike the sometimes restricted visiting hours at hospitals and nursing homes, home provides a place where family and friends can be close to the person at all hours, whenever needed.  It isn’t necessary to schedule a side room for Thanksgiving; you can sprawl out in your parent’s home as you please.  Nothing says “I’ve been institutionalized” like having to tell family and friends that visiting is limited to such and such hours.  This isn’t the case in your home.

Research has shown that recovery can be faster at home than in a skilled nursing and rehabilitation center, particularly if there is good quality, skilled home health care available.  Many occupational therapists prefer home settings as compared to the artificial settings in an institution because that is where the normal activities of daily living will take place.  Faster recovery can mean a quicker return to normalcy.

Older adults enjoy a much better quality of life which many families have said helped to extend the lives, health & happiness of their loved ones. They are in a familiar environment around their family in both their home and community in which they’ve lived for many years. This is particularly true with individuals living with Alzheimer’s or other related dementia.

Is home care a suitable alternative?  Absolutely not.  Home care is the first choice of most older adults.  Assisted living facilities or institutionalization in a skilled nursing facility are the alternatives.

I Don’t Need and I Don’t Want Any Help – Reason #3, Money

We’ve all heard it – “I don’t need any help” or “I don’t want anybody in my home”.

Even when everybody involved believes assistance is needed, sometimes it is just simply rejected.

Why?

We previously covered the reason of “pride” and “independence” and today we’re looking at money.

Money

Money, or the lack thereof, can be a very real impediment to receiving needed services.  People in need of home care services and supports typically fall into three groups relative to money: those who have the resources to pay for services, those who do not, and those who are on the line.

Those who do not and who have very little income or assets might qualify for Medicaid services – ElderChoices, for example.  Those who are on the line can be a challenge.  It is possible that they might qualify for other assistance from the VA (Aid & Attendance), grants, or even a reverse mortgage in some cases.

The first group has the financial resources to pay.  If they are able and if they recognize the need, they will pay for services.  As you might know, the families Home Helpers serves are 100% private pay (including those with Long Term Care insurance).  However, the ability to pay for services does not necessarily result in quality service.

Our experience is that this group of people might have a concern of outliving their savings.  This is a valid concern, but should not result in cutting corners with regard to care.  Care Plans should be structured to ensure flexibility and carefully tailored to respect budgets while meeting the most pressing needs.

One pitfall we routinely see is families seeking assistance from independent contractors.  They see the “sticker price” of an independent contractor that might be as much as $5 less per hour than Home Helpers.  It’s what they might not consider that can open them up for substantial liability and risk.

Sadly – though commonly – caregivers who are independent contractors might not realize the implications of being hired directly by a client.  If the client has outlined a service schedule, the required work, etc., it is a pretty clear that an employer/employee relationship has been established.

When a worker receives a paycheck, he/she must pay appropriate taxes, to include Social Security, Medicare, both state and federal unemployment, and both state and federal payroll taxes.

As the employer, the consumer (the person in need of care) is responsible for compliance.  The government could sue the consumer (or their estate) for back taxes, including both interest and penalties.  When this situation has existed for many months or even years, the tax responsibility could be substantial.  Beyond simply collecting back taxes, interest and penalties, the government could also pursue both civil and criminal penalties.

The situation is no brighter for the worker.  With no payment into Social Security, they could become financially vulnerable in older age.

I Don’t Need and I Don’t Want Any Help – Reason #2, Independence

We’ve all heard it – “I don’t need any help” or “I don’t want anybody in my home”.

Even when everybody involved believes assistance is needed, sometimes it is just simply rejected.

Why?

We previously covered the reason of “pride” and today we’re looking at Independence.

Independence

I’ve told countless families that outside of NASCAR enthusiasts, “taking the keys away” is less about driving and more about the loss of independence. The thought of losing one’s independence is frightening, whether that loss is through an inability to drive safely or any number of other activities of daily living. Even more, many older adults have seen their peers lose their independence and it does not conjure happy thoughts.

With these people (and I think “these people” is ALL of us), services and supports should be tailored to empower continued independence, or as much independence as is possible under the circumstances.

Here’s a real example from a family Home Helpers has served. Ms. Smith suffered a stroke, had a fall, and was no longer able to drive. Frankly, nothing bothered her more than fighting the traffic and she was well aware that her driving skills were not the best even before the stroke. Even so, she enjoyed getting out and especially liked entertaining. Our services were designed to provide transportation for her regular appointments (including numerous social outings), housekeeping and helping her get ready for dinner parties. Home Helpers empowered her to retain as much independence as possible and maintain her quality of life. She actually commented to me about how much easier it was now that she had help.

Sometimes it is not as much about “what” service is provided as it is how it is described. Words matter. Instead of describing a service as “full assist with bath,” consider saying something along the lines of, “we’ll help to make your bath safe so that you’re refreshed and ready for the day.”

Always respect an older adult’s dignity and pride, and when there is an expressed concern with loss of independence, go out of your way to assure them that this is not your intent. Rather, your intent is to empower their continued independence by helping out in a few areas.

I Don’t Need Any Assistance – Pride

We’ve all heard it – “I don’t need any help” or “I don’t want anybody in my home”.

Even when everybody involved believes assistance is needed, sometimes it is just simply rejected.

Why?

After talking to hundreds of families and assessing a variety of situations, I think there are only a few reasons why someone in need of assistance rejects it – Pride, Loss of Independence, and Money.

This is the first of three short emails about these reasons.

Pride

Many older adults come from a time when receiving assistance was frowned upon and you should pull yourself up from your bootstraps. Pride can result in those with hearing impairments refusing to consider hearing aids, those who are unsteady walking refusing to use a cane or walker, and the list can go on and on.

Sometimes, the refusal has less to do with the type of assistance and more to do with who is providing it. It’s fairly common for me to hear from a family we serve that Home Helpers is able to do something that they can’t. I’m rarely surprised at this and if you think about it, it makes sense. I would not relish the thought of one of my sons bathing me or changing my briefs, but one of our trained and experienced caregivers can help out in such a way as to preserve dignity and honor.

A strategy I’ve learned is that it is more helpful to focus on the benefits of assistance or support rather than focus on the deficit. For example, that hearing impaired person might really enjoy hearing a granddaughter’s piano recital, or the unsteady one might appreciate making it onto the sidelines of a grandson’s soccer game. Focus on the benefits and the empowerment achieved through the services or supports while respecting the older adult’s pride.

I tell families all the time that one of the most important aspects of our service is ensuring the right match. When the right caregiver with the right experience and the right training and, perhaps most importantly, the right personality is matched with an older adult we serve, the outcome can be almost magical. Not only can life be added to each day, but I firmly believe that days can be added to life.

Geriatric Care Managers

From time to time, we are asked about Geriatric Care Management.  In most cases, the question is posed by someone out-of-state who is concerned about the wellbeing of a parent.

They might express it differently, but the underlying questions typically fall into a few categories.  Is it safe for mom/dad to remain in their home, and if not, can we make it safe?  Or, what living and/or care arrangements would we recommend?

Without a doubt, the leading reason why families call is concern. 

It might be that a parent is in declining health or is unable to safely perform basic activities of daily living.  Or, there could have been an incident that has abruptly changed the situation, such as a fall, injury or illness.  Whatever the case, the family is concerned and is seeking assistance with his or her parent.

Occasionally, there is concern that a parent has become unengaged in enjoyed activity, such as attending church gatherings.  In these cases, the concern is for a continued standard of living.  The objective is to maintain or regain the highest quality of life possible.

Fee structures vary widely when you hire a Geriatric Care Manager. 

Frequently, there is an initial assessment that could range from $200 to $500.  This is a comprehensive evaluation of all aspects of the situation, including physical and mental health, environmental considerations, support networks, etc.  From information gathered, an initial Care Plan can be drafted.  Typical hourly rates might range from $100 to $200 per hour and could be segmented into portions of an hour.  The fees are largely dependent on the experience and expertise of the Geriatric Care Manager and what the scope of service is.

In some cases, Long Term Care insurance policies cover some or all of the expense associated with Geriatric Care Management.  Check the fine print and consult your claims representative to determine coverage.

So what do Geriatric Care Managers do?  What is the value?

The best Geriatric Care Managers explore the entire situation.  They look at the “big picture” that includes all aspects of your parent’s life, and also very closely at his/her individual situation (physical, cognitive and emotional).  Based on information gathered, a comprehensive Care Plan is drafted that addresses all concerns and presents a road to greater quality of life.  From there, they can coordinate and supervise execution of the plan.  A good Geriatric Care Manager can coordinate service to meet a host of concerns:

  • Make recommendations with regard to the best living arrangements
    • Aging in place in their own home (far and away the preference of most older adults)
    • Independent or Assisted Living Facilities
    • Skilled Nursing Facilities
    • Special Care Units
  • Ramps or home access or safety considerations
  • Schedule and accompany to medical appointments
  • Coordinate private duty homecare assistance with day-to-day activities
    • Bathing and personal hygiene
    • Meal preparation
    • Transferring
    • Dressing and feeding
    • and other home care needs
  • Coordinate transportation to visit friends or to appointments
  • Arrange grocery shopping
  • Facilitate medication reminders
  • Arrange cognitive screening or tests
  • Arrange for pet care
  • Organize the household
  • Pick up prescriptions
  • And much more…

To be sure, a good Geriatric Care Manager will analyze the situation and offer their best advice for the road ahead.  The service can be invaluable to family members in search of timely and relevant guidance.

What should you look for in a Geriatric Care Manager?

First and foremost, the manager selected should have a passion for serving older adults.  Clearly, you should want the service from someone with experience and expertise.  If someone calls herself a Geriatric Care Manager but does not have documented and verifiable experience and expertise, steer clear.  What you should look for is someone trained in and expert at conducting assessments who can transition into the role of manager to coordinate needed services and supports.  They should have a passion for older adults and the expertise to make life easier for everyone involved.  Just as you want your auto mechanic to know every intricate detail about your car in order to ensure its optimum performance, you should seek the same with a Geriatric Care Manager.

Where does Home Helpers fit into the mix?

In central Arkansas, there are only two or three independent Geriatric Care Managers and we have worked with all of them.  Our intent is not to disparage their service one bit; in fact, we have referred people to them.

Home Helpers is a mature organization with more a combined three decades of proven experience working with and serving older adults.  We are recognized experts in our field.

Before we commence services with a family, we always conduct a thorough assessment, exploring the issues described above.  From there, we draft a flexible and comprehensive Care Plan.  When there are areas of need beyond our scope, we arrange for or coordinate those services or supports.

In short, though our primary support is private duty home care, we often and routinely provide services indistinguishable from those of a Geriatric Care Manager.

Bottom Line

If you believe you need the assistance of a Geriatric Care Manager, contact Home Helpers first.  We will conduct a no-obligation comprehensive assessment free of charge.  If there is a need for and Home Helpers is the best match for home care, we can certainly help.  If not, we will present a plan with options to you so that you can make the most informed decision regarding care for your loved one.

Should I Get Long Term Care Insurance?

The adult children of clients we serve routinely ask me if they should get Long Term Care insurance. I am not an insurance agent. I don’t market any insurance. Even so, I am more than willing to share my experience. Typically, the adult children see either the benefits of having Long Term Care insurance or the need for it. Let me explain.

It used to be that Long Term Care insurance was known as “nursing home insurance.” In short, it was insurance that would pay for a skilled nursing facility. Period. As consumer demand shifted and evolved over time, policies did as well. It is uncommon for me to see a policy anymore that does not pay for private duty home care.

The reason for the changes in policy coverages through the years is clear. Most everybody wants to age in place rather than be relocated to a facility. Don’t get me wrong, there are some marvelous facilities in central Arkansas that I would gladly reside in, but the reality is that most people would prefer to stay at home if at all possible.

Having Long Term Care insurance keeps you in control of where you receive services and from whom. It can better allow you to maintain as much independence as possible in the setting of your choice.

A common theme I hear is that Long Term Care insurance is too expensive. It’s true. It is not inexpensive. However, I remind people who have it that they might recoup a full year’s premium for every month of service, and at that rate it can make perfect financial sense. Even better, some of the newer policies convert into a life insurance policy in the event it is never used.

Home Helpers serves many people with Long Term Care insurance with policies from Genworth, Bankers Life, John Hancock, UNUM, Northwestern Mutual, etc. We’re comfortable with the claims processes and reporting guidelines.

As a standard course of discharge when a patient requires assistance once they return home, we encourage discharge planners to ask about coverage. If their patient has it, we could certainly make their lives easier at home and potentially even reduce hospital readmissions due to the person doing too much too soon.

Should you get Long Term Care insurance? That is a question better addressed with your financial advisor or insurance agent. If you are interested, I’d be more than happy to recommend some very knowledgeable agents. Shoot me an email and I’ll reply with a few names and numbers.

Loneliness and Older Adults

Philosophers say that you die alone. Research indicates that you might die earlier if you live a life of loneliness. We are all aware of the emotional pain associated with loneliness. It can be especially devastating to an older adult.

A recent study found that loneliness was a predictor of both functional decline and death. The researchers found that “loneliness is a common source of distress, suffering, and impaired quality of life in older persons.”

Having served hundreds of families, I’ve found that when discussion is focused on assistance we provide for baths, dressing/undressing, transferring, etc., there is interest and relief that help is available. I am by no means discounting those services. Nobody wants to be afraid to get in the bathtub so there is certainly appreciation for that assistance. However, demeanors change when we shift to other areas.

We are always humbled and honored when given the opportunity to re-inject life into a lonely situation. Almost without exception, I have found that simply having someone to share a meal or enjoy a game of Scrabble with can have tremendous positive effects on a person’s wellbeing. When I mention that we might also explore outings to the farmers market, an exhibit at the Arts Center or Clinton Library, or just a trip to Hobby Lobby, they absolutely light up. The key is in listening for what they are interested in and empowering them to regain that life.

Clearly, all outings are not appropriate for everyone and we recognize that. For many, simply enjoying the company of our caregiver puts a smile on their face.

I used to say that Home Helpers can’t add any days to your life, but we can add life to your days. In light of this new research linking loneliness with functional design and death, perhaps we can do both.

Gifts for Caregivers

Black Friday is behind us, but you might still have caregivers on your shopping list.  Caring for a loved one can be the most challenging task we face.  Unlike the person who is difficult to shop for because she “has everything,” caregivers need special attention.  Consider the following gift ideas for family caregivers.

House Cleaning Service

Housekeeping can get pushed to the back burner when a family caregiver is burning the candle at both ends.  Arrange a house cleaning service with my friends at Cottage Care.  This can be a welcomed indulgence or a regular service to keep things clean and tidy.

Entertainment Gift Card

Sometime, all that a family caregiver needs is just a little time to turn off their cares, even if it’s just for a few hours.  You can get gift cards for restaurants, movie theaters, and a host of other fun places at most grocery stores.  Make it personal and offer to be there with their loved one or arrange for service with Home Helpers.

Spa Day

A service that is totally self-indulgent is a rarity to someone who normally thinks of others first.  Caregivers are often so busy meeting everyone else’s needs that they overlook their own.  A day of pure indulgence away from daily duties would be much appreciated: massages, facials, manicures and pedicures make a perfect gift.

Netflix or Amazon

When getting away isn’t feasible, or desired, pay for Netflix or Amazon.  These are terrific resources for readers or those who enjoy a good movie as time permits.  A family caregiver will greatly appreciate the opportunity to enjoy a favorite book or movie.

Coupon for Respite

Create a Respite Coupon and offer to stay with their loved one for an afternoon or evening.  Just like the Gift Cards, this will provide a few hours of “me” time for the caregiver.  Even better, make a stipulation that the Coupon MUST be used during the most difficult time of day.

A Book of Encouragement

There are scores of books that are encouraging for caregivers.  Here are just a few:

Walking Together Through Illness: Twelve Steps for Caregivers and Care Receivers

The Overwhelmed Woman’s Guide to…Caring for Aging Parents

Spiritual Care: A Guide for Caregivers

Twice Blessed: Encouragement for the Caregiver and the Carereceiver

Coping With Your Difficult Older Parent : A Guide for Stressed-Out Children

A Note on Employees

Typically, employees of skilled nursing facilities, assisted living, and home care agencies are prohibited from accepting gifts.  I can’t speak for others, but with Home Helpers, the best gift you can give your caregiver is a letter of appreciation.  Write how you appreciate your caregiver and send the letter to Home Helpers.  Home Helpers routinely rewards caregivers with Client Satisfaction bonuses.

When do you consider Private Duty Home Care?