Jo Nelson, R.N. asked:
As baby boomers watch the years fly by, one of their biggest concerns is sorting through the many problems of caring for their elderly parents. When is it no longer safe for our elderly parent to stay home alone? How can we maintain our jobs, our home, our children, and care for our parents all at the same time? What resources are available to help? How do we approach the subject with them? How can we help them keep their independence and dignity? How do we deal with the stress of it all?
As our parents age, we need to stay diligent and aware of changes in their mental orientation and ability to care for themselves. Are they just a little forgetful at times, or is it something more worrisome than that? If they are able to take their medications without being reminded, bathe alone, dress without assistance, prepare meals every day, and they are not experiencing frequent falls or sudden illnesses, they are probably safe to be at home alone. There are monitoring systems and personal emergency alert systems that can provide added security by making help available to them in the event of an accident or sudden illness.
However, if you notice that your parent’s health is declining, that they have increased weakness or weight loss, if they have had frequent falls, if they are not taking their medications, not eating properly, and not able to do their personal care without help, it may be time to look into other options. Sometimes the increased care is all they need to regain their strength and be able to continue living at home, avoiding placement in a nursing facility or some other major life change.
Finding the help you need is another obstacle. Knowing who to go to for help may seem to be an overwhelming task, but there are many resources available to seek information and counsel. Private duty organizations, home health agencies, and hospices are all viable places to start if you want to help your parent stay at home.
The Indiana Association for Home Care and Hospice (IAHHC) has a listing of all local agencies, both for private pay and agencies that accept Medicare and/or insurance payor sources. You can find them on their web site: www.ind-homecare.org.
When investigating which private agency to use, make sure they are licensed appropriately and that they do criminal background checks on all their employees. Their staff should be bonded and insured, and you should not have any of the burden for carrying worker’s compensation, tax liabilities, or social security. A new law beginning in January of 2006 requires all private duty, non-medical services to be licensed through the state of Indiana. Make sure the agency you choose has gone through this licensing process, and you will be safer in trusting that they have taken all the appropriate steps in ensuring good care for your loved one.
There are many financial resources available to help pay for private duty care, such as reverse home mortgages. The Veterans Administration can give you valuable information on benefits for veterans who need care at home and have served at least one day in the service during war time. These benefits are also available for spouses of veterans. Look on the web for more information regarding financial concerns; there’s plenty of information available. You can also contact private duty agencies and request assistance in finding funds that are available.
Private duty agencies can provide any kind of non-medical care needed to assist the client in staying at home. They will provide personal care assistance, medication reminders, cleaning, cooking, laundry, running errands, and transportation to appointments, and a variety of other services. They are usually available twenty four hours a day, including holidays and week ends, and do not require any doctor’s orders to initiate the care.
Home health care requires a doctor’s order for services to begin, and the patient must be certified to be on “home bound status”. This means that they can only leave home to visit the doctor, go to church, or to the beauty or barber shop. A nurse will visit on a regular basis, and a home health aide will assist with personal care. Some home health agencies also provide physical therapy, social services, speech therapy, and occupational therapy as well. Most home health care agencies are not available in the evening hours, on week ends, or on holidays. The majority of home health agencies accept insurance and Medicare payments.
Hospice care also requires a doctor’s order, and the patient must have a life-limiting disease with expectations of six months or less to live. Patients can be re-certified for hospice every sixty days, and may live much longer than six months and still be in hospice care. Hospice care also provides nursing and home health aide services, along with extra
support to the family and patient during this difficult time. Comfort measures are a priority in the plan of care, and they have a variety of services such as social services, pastoral care, and volunteer services as well. Medicare and insurance usually are accepted. There will always be a hospice nurse on call twenty four hours a day to assist with any emergencies or special problems during times when the office is closed.
Sometimes the best plan is a combination of home health or hospice along with private duty care. Many seniors are resistant to accepting any kind of help at first, and will require continual reassurance effort to help them maintain as much independence as possible.
When addressing these issues, never “speak down” to your loved one. Remember, even though roles are changing, they still deserve to be honored and respected. Sometimes calling a care giver “the maid” or “the butler” rather than a “caregiver” or “home health aide” will help them accept the situation with a little less anxiety. It’s all in the attitude that it’s presented to them – help them feel a sense of control in the situation whenever possible. Try to help them understand that these changes are happening in their home because you love them and want them to be able to stay at home as long as possible and not have to live in a facility to get the help they need.
Don’t forget to schedule time for yourself during this intensely demanding season of your life. By succumbing to false guilt or unreasonable demands, you may be setting yourself up for a disaster later. Take time to enjoy your immediate family, your hobbies, and leisure time as well. Join in with other caregiver groups for extra support – you can find them at churches or on the web. You’ll be safeguarding your own ability to handle this long term role as a caregiver with a healthy mind, body, and spirit.