Playing Out "What If" Scenarios
One of the best ways to begin the advance work of caregiving is to play out "what if" scenarios, while your parents or family members are not yet facing them. Imagining hypothetical situations is not nearly as stressful as the "real deal", and people are much less defensive since they’re not being forced to make an all-or-nothing decision on the spot.
How to Talk About Advance Planning Documents
Some parents hesitate to talk about wills and other legal documents because it's a sign that their role in the family is changing and diminishing. They might interpret the discussion as a signal that their health is declining, and they will soon become more dependent. Some feel that it's just bad manners to talk about their personal finances or yours.
You can approach this discussion with your elderly loved ones in a practical manner, minimizing emotions, and highlighting the benefits of being prepared. At the same time, assuring them that your love and respect hasn’t changed.
Power of Attorney, Durable Health Care Power of Attorney, Will, Living Will and POLST
These five documents are very important tools when it comes to planning ahead so your loved ones can remain in control of their independence and living options. Get legal consultation and learn more about them.
2. Determining What Kind of Care is Needed to Remain at Home
The majority of people want to continue living at home for as long as possible. Nobody wants to live out the rest of their lives in a hospital or nursing home, even if you tell them that it’s for their own good. Nowadays, there are a number of community and home health services, telehealth devices, and universal design features that make living at home easier. It is now possible for people to enjoy staying at home as they age, and still effectively manage their chronic conditions.
Identifying Caregiving Needs and Tasks
Rarely is there a shortage of topics when it comes to identifying caregiving needs among older relatives. Social workers use extensive assessment tools to identify the needs of older clients, and the level of help they require. You'll hear geriatric professionals reference two basic categories: activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Once you've identified the care needs required to enable your parent or loved one to remain independent, you'll then be in a position to explore solutions that address each need. It's good to be clear about the results you want to achieve. For example, it should be safe and acceptable to both the person receiving the care and family members providing or arranging it. It should also be affordable and not endanger the well-being of either caregiver or care receiver.
3. Understanding Who Does What in Homecare
It's not surprising that most people prefer to be cared for in the comfort and dignity of their own homes. Many healthcare treatments that were once offered only in a hospital or a doctor's office can now be done at home. Homecare is usually less expensive, more convenient, and can be just as effective as the care you get in a hospital or skilled nursing facility.
Home health provides skilled services, including nursing care and physical, occupational, speech and respiratory therapy. The agency will send a licensed professional to assess home health needs, and develop a complete care plan which you can review and approve. These services are usually short-term, as in the case of a person recovering from surgery or other health issues.
Personal Care/Private Duty Homecare
A personal care/private duty homecare agency provides services that do not require a licensed professional or a physician's prescription. A homecare worker can help a person with activities such as remembering to take medications, preparing meals, transferring from a chair, toilet or bed, bathing, getting dressed, light housekeeping or transportation to and from doctor's appointments.
Hospice care brings together medical care, pain management, and emotional and spiritual support for terminal patients and their families. Eighty percent of hospice care is provided in the patient's home. However, there are also in-patient hospice facilities.
The Pennsylvania Homecare Association's "Bringing Care Home" video introduced us to a geriatric care manager, who can be a valuable resource as you navigate and choose the resources available for your loved one. A geriatric care manager is a health and human services specialist, who works with families and others to provide assistance to those who are caring for aging parents or other loved ones.
4. Finding Other Care Options
We understand why our aging or sick loved ones prefer to stay at home, but sometimes, staying at home is no longer beneficial for them. When this happens, as difficult as it is to make the decision, you must be ready to look at other care options. You must determine what's the best and most appropriate care for your parent or loved one, given their needs and resources.
Adult day services, also called adult day care centers, are non-residential facilities that specialize in providing activities for older adults with cognitive (thinking) and/or physical disabilities. Many people with or who have loved ones with Alzheimer's disease or other form of dementia choose this option.
Living Independence for the Elderly (LIFE) Program
The Living Independence for the Elderly (LIFE) program offers medical and supportive services to enable older Pennsylvanians to maintain their independence in their homes for as long as possible. LIFE is a managed care program which provides a comprehensive, all-inclusive package of services.
Personal care homes are residential facilities that offer personal care services, assistance, and supervision to four or more persons. Sometimes, they are advertised as "assisted living residences" or "boarding homes." A personal care home must have a license in order to operate in Pennsylvania.
Assisted Living Facilities
Assisted living facilities provide residents with services that assist them in the performance of daily tasks, such as providing meals, housekeeping, laundry, and medication reminders. They may also assist with grooming, bathing, managing bills, and providing transportation. You'll often hear these services referred to as activities of daily living (or ADLs).
Continuing Care Retirement Communities (CCRCs)
Part independent living, part assisted living, and part skilled nursing home, Continuing Care Retirement Communities (CCRCs) offer a tiered approach to the aging process, accommodating residents' changing needs.
Skilled Nursing Facilities or Nursing Homes
In some progressive cases, it is possible that your parent or loved one will eventually need this level of care, when staying at home is no longer safe or healthy for them. Skilled nursing facilities, also known as nursing homes, provide 24-hour nursing care for residents who demand much higher levels of care than those residing in assisted living facilities.In some progressive cases, it is possible that your parent or loved one will eventually need this level of care, when staying at home is no longer safe or healthy for them. Skilled nursing facilities, also known as nursing homes, provide 24-hour nursing care for residents who demand much higher levels of care than those residing in assisted living facilities.
5. Making Homes Safe and Livable
Given a choice, nine out of 10 people would choose to remain at home, and spend the rest of their lives there, regardless of their condition. This is especially true for a generation that takes great pride in owning their homes. Living on their own, whether it's in an apartment or a house, represents independence and self-reliance - two hallmark traits of the older generation. It's no wonder that even when illness or physical disabilities befall your loved ones, they’d fight for their right to stay at home. The challenge is enabling them to do so safely, and making sure they don’t become isolated or trapped.
Designing a Fall Safe Home
A "fall-safe" home is one that has been set up to avoid falls, a major cause of injury in older adults. Every year, one in three women 65 years of age and older, and one in three men 80 to 84 years old, experiences a fall. Fractures and broken hips - could be life-altering, as they strip people of their mobility and independence. Worse yet, half of the injuries caused by falls result in death. The good news is that following just a few senior safety measures in our checklist can go a long way towards elderly fall prevention.
Using Assistive Devices
The assistive devices industry has created thousands of products to make the activities of independent living easier for seniors. Yet, far too many people don't know that assistive technology exists, or that assistive devices are available. Here's what you need to know.
Durable Medical Equipment
Medicare refers to devices and items that provide independence for individuals with an illness or injury, that can withstand repeated use in the home, and serve a medical purpose as durable medical equipment (DME).
Personal Emergency Response System (PERS)
Personal emergency response systems (PERS) give older adults and other at-risk individuals around-the-clock access to assistance at the press of a button. If your parent or loved one lives alone, PERS enable continued independence, while at the same time allowing both of you to feel secure in knowing that in case of a fall or accident, emergency assistance can be easily summoned.
Technology for Better Healthy Living
Technology is going gray and that's a good thing. Technology can enable your parent or loved one to live at home even they have health concerns. There are devices that can detect a fall and dispatch help even when the patient is unconscious, help restore balance and even prevent a fall, stimulate the brain and keep it sharp, dispense medications on time each day, and allow patients to receive email from the grandkids without using a computer.
Keeping Your Home From Looking Like A "Sick Room"
When someone is chronically ill, it's very easy for the bedroom to look and feel like a "sick room” which doesn't help anyone feel better. Make every effort to keep the patient’s room cheerful to improve the mood and outlook of the patient. It can do wonders for health improvement.
6. Paying for Care
There are several options available to help pay for long-term home care, and lighten your family's financial burden while enabling your loved one to remain at home.
Medicaid is a jointly-funded, federal/state healthcare program for lower income residents. In 2012, the income limit for an individual applying for Medicaid was $2,094 per month. For a couple, the limit was $3,033 per month. If one spouse is applying for Medicaid and the other is not, joint income can be shifted to help the applicant qualify.
Medicare is health insurance for people 65 years and older, and for younger people with certain disabilities. It also covers anyone regardless of age, if they suffer from permanent kidney failure – also known as End-Stage Renal Disease (ESRD) - which requires dialysis or a kidney transplant.
According to the Veterans Health Care Eligibility Reform Act, any veteran who wants to receive Veterans Administration healthcare services can enroll.
Long-term care policies usually offer one or all of the following kinds of care: home health care, personal care/private duty homecare, respite care or nursing home care.
A reverse mortgage is essentially a loan against your parent's home that doesn't have to be paid back for as long as they occupy it. With this option, the value of the property can be turned into cash, and your parent can then afford the remodeling needed, and any long-term care services that are not covered by Medicare. When your parent moves, sells the home, or dies, the money is then paid back.
Caregiving Tax Credits and Deductions
Tax deductions for caregiving expenses can be deductible.
7. Other Resources to Explore
Tracking down services and identifying financial resources that make living at home possible and affordable is no easy task. Especially when it comes to getting through the Medicare maze, or navigating long-term care insurance. Yet, it's definitely worth the effort as a little bit of research can yield much-needed resources.
Pennsylvania Homecare Association - We're just one call or click away!
The Pennsylvania Homecare Association is a statewide organization of more than 500 home health, hospice and homecare providers.
My Learning Center is a collection of more than 40 free, online training videos for family caregivers. Topics include Alzheimer's and dementia care, seniors and aging, infection control and safety, and handling emergencies. Each video ranges from five to 25 minutes, and features first-hand accounts of families, seniors, caregivers and experts - on the issues caregivers face each day.
Area Agencies on Aging (AAA) receive funding from states and the federal government, through the Older Americans Act. They act as your county's centralized advocate, for issues facing older people and chief planners for aging services in your community. They also act as a major provider and subcontractor of aging services, dedicated to giving older adults the option to live at home and remain in their communities.
The National Council on Aging (NCOA) offers a helpful screening service that will help you find and enroll in federal, state, local, and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.
The Internet is amazing, if not overwhelming, when it comes to finding information on just about every topic imaginable. As baby boomers age and become Internet savvy, websites on aging are popping up faster than the speed of light. A simple keyword search on "care-giving" will pull up millions of hits. Browsing these websites can help you gain more knowledge about the challenges you’re facing, and can provide answers to most of your questions.