Caregiving for Seniors

I live in a senior community. Many of the realities of senior living are positive. But some of the realities of senior living are tough. A couple of stories about caregiving for seniors that I’ve heard in just the last few weeks. . .

My husband is driving me crazy. He’s been getting worse and worse. He follows me around the house from morning til night, repeating the same question that he asked 5 minutes ago. He’s making it hard for me to get anything done. And it’s impossible for me to leave him home alone!

Another story, overheard from another conversation:

Well, I finally have to do it. The pain is just too much. So I’ll be getting hip surgery – next week actually. The doc says I won’t be able to stand or get around very well for quite a while. I guess I’ll have to find somebody to take me to appointments. Oh, and I’ll need somebody to walk the dog. . .

When I heard this last story, I knew it was a recipe for real trouble!

Without some sort of plan, these neighbors may be heading straight into an emergency!

Amazingly, that very day I got a solid referral to a woman who runs an in-home care agency – right here in town. The timing was perfect. After I met with her, I knew I wanted to share some of what I learned about caregiving for seniors.

So a special shout-out to Kamara Viau,
owner of Acti-Kare of Irvine
She helped me jump confidently right into this new topic!

Here are some of the questions I asked about home health care and caregiving for seniors at that first meeting. The answers come from Kamara and from my own follow-up research.

“What exactly does in-home care include?”

As you might expect, there are different levels of home care. The levels seem mostly related to the skills required of the caregiver.

• For example, if you are recovering from surgery, you may need someone to instruct you about your therapy, and make it clear what you can or should not do. You may need help managing medicines. This level of care, typically called “recovery care,” requires skilled nursing training. . . and naturally, is often the most expensive. It may not last very long.
• At the other end of the spectrum, as caregiver to an aging husband or wife, you yourself may need “respite care.” Just having a trusted health care worker to act as companion for your mate for a few hours could be a real godsend.

Many services lie in between these extremes. The home health caregiver may plan and prepare meals, do light housekeeping and laundry, help with bathing and dressing, etc.

“How do you decide what care YOU want, or need?”

The process starts with a consultation, or assessment. It should be handled by a specialist with medical background and experience in caregiving for seniors. (Ask about that background! Turns out Kamara is a trained dietician with years of experience in a nursing home setting.) The consultation will be based on two things: the medical and mental health of the person to be cared for, plus how much help he or she needs in performing the Activities of Daily Living, or ADLs.

There are standard industry lists of over 25 ADLs. They include things like bathing, preparing and eating meals, standing from sitting, using the telephone, managing medications, paying bills, etc. Get a head start on understanding ADLs by downloading a copy of a full list here.

For some programs, not being able to manage just 2 or 3 of the activities of daily living says you’re in jeopardy! (Wow. Most seniors I know have a problem with at least 1 ADL – like putting on socks!)

“What sort of contract can I expect?”

Following the consultation, you can expect a customized and comprehensive written plan of care. The plan of care is the contract.

It identifies exactly what the caregiver will do, how often, what days of the week, etc. (Most agencies have a minimum 4 hour shift.) Your plan of care should make it clear how visits are documented, what happens if you need a substitute caregiver, etc. It also includes how you will pay for the service.

Naturally, with earthquakes on my mind, I asked specifically about the responsibility of the caregiver in an emergency.

The plan of care should include specific instructions for the caregiver about what to do and whom to call in an emergency. Kamara said that her caregivers also receive special training preparing them for a widespread disaster like an earthquake. Included in that training: “Discuss ways to keep yourself and your clients safe in an emergency. Be prepared to accompany/guide the client away from areas that are no longer considered safe.”

If you are interviewing agencies (and you should interview several), slip in a question about emergencies that might be likely in your part of the country!

“So how much can I expect to be charged for caregiving services?”

The average hourly rate for a licensed caregiver can vary depending on your location, the skill level you require, how many hours per week you need the person, etc. A variety of sources agreed that the hourly rate for a home health aide in California ranges from $23 to $36 per hour.

“Where can I get help paying the bill?”

• Medicare. Medicare may cover care if a doctor certifies that the patient requires skilled nursing care, physical therapy or other professional therapy, and the care is provided by properly licensed professionals. Assistance with ADLs, however, probably will NOT be covered.
• Medicaid. At the same time, low-income programs such as Medicaid may cover skilled nursing as well as personal care or homemaker services – again, as long as they are “medically needed” and “provided by a licensed agency.” State income requirements differ, so start on homework now if you think you may be able to take advantage of Medicaid. And be aware that some states may have waiting lists for this care. The sooner you get on the list, the better.  
• Private long-term health care insurance. Do you have a long-term health care policy? Dig in to see just what in-home caregiving services will be covered. LTC policies typically are designed to cover care in a facility, but they often will cover in-home care support based on factors such as not being able to perform a specified number of ADLs. Everything is based on how each policy is written! 
• Your own savings. Many people will recoil when they think of a $30 hourly cost with a weekly minimum. “Just can’t afford it.” However, if you want to stay independent and in your own home, planning for the cost of home care may be exactly what you want to do.

“What if the caregiver isn’t a good fit?”

If the consultation was thorough, your caregiver should start off with the skills and understanding you’re looking for. You should have the opportunity to give regular feedback, too, on how everything is going.

The feedback process and options for changing caregivers should be included as part of that initial consultation. Remember, you’re the customer here so you should have the final say.

Final thoughts for people caring for a loved one at home.

Is your current home situation causing you anxiety or stress? Are you are feeling trapped? Perhaps guilty that you aren’t doing enough? Is caring for someone else impacting your OWN mental and physical health?

Would help from a professional caregiver lessen that tension? You may only need a little help now. But you’re likely to need more help later. The more you know about in-home care and caregivers, the more choices you’ll have.

I hope this Advisory will help. It doesn’t have all the answers, but it can get you started.

Virginia
Your Emergency Plan Guide Team

P.S. Don’t forget my checklist of the Activities of Daily Living. Discuss it with family and with a potential caregiver. Click here to download the list of ADLs for free.