| It always makes me sad to hear the families of an | | | | Medicare Home Health is free but can only be |
| elder say “Mom made me promise to never | | | | accessed if ordered a physician. Medicare will only |
| put her in a nursing home”. That is simply a | | | | authorize the free home health services if specific |
| promise that most families today cannot keep. If a | | | | events have happened such as a recent |
| caring son or daughter finds that they have to break | | | | hospitalization lasting three or more days, or a recent |
| that promise, they may feel guilty for the rest of | | | | change in health status, etc. Medicare will send a |
| their lives. Mom probably asked for that promise | | | | Registered Nurse to evaluate the elder and that |
| because the nursing homes she remembers were | | | | nurse decides if other professionals such as physical |
| dark, institutional places which would be considered | | | | therapists, social workers, dieticians, etc. should |
| substandard in America today. Today’s family | | | | perform evaluations. Each professional will determine |
| structure and the financial challenges of elder care, | | | | what services they will render and for how long. |
| make facility living a very common choice. When an | | | | Medicare services are temporary in nature and are |
| elder shows signs of not being able to perform the | | | | not offered on a full time basis. The average visit by |
| basic activities of daily living, families or concerned | | | | the nurse, aide and therapist is less than one hour |
| professionals must step in. It is actually against most | | | | each. Even Medicare home health aides only stay long |
| state laws for a professional to be aware of an elder | | | | enough to bathe and dress the patient. |
| in trouble without taking some reasonable action to | | | | Private Duty Home Health can be arranged on a full |
| secure their safety. There are many indicators that | | | | time, part time or live- in basis. Many Long Term Care |
| an elder is no longer safe at home alone. The basic | | | | Insurance policies will pay for home health care. The |
| litmus test is to ask yourself is: “Could this | | | | amount of care one can get and the duration of the |
| person save him or herself if their home were on | | | | services varies depending upon which policy they |
| fire? Would they be able to call 911 and communicate | | | | purchased. If someone does not have insurance, |
| their exact location? If left alone for any period of | | | | they must pay out of pocket (or private pay) for |
| time are they at risk for physical abuse or financial | | | | any services. Typically a private home care agency |
| exploitation? Do they have the skills and resources to | | | | will offer services at a minimum of four hours per |
| meet their daily hygiene and nutritional needs? The | | | | day. Typical eight hour shifts are 7am-3pm, 3pm-11pm |
| answer is “NO” for many American | | | | and 11pm – 7am. Many elders complain that an |
| elders who live home alone. | | | | agency sends them a different caregiver each day. In |
| Independence vs. Isolation | | | | order to avoid having the same aide, that as much as |
| Many of my elderly clients who were trying so hard | | | | possible, order care every day for at least eight |
| to maintain their independence by living alone at | | | | hours. This will allow the agency to schedule the |
| home actually maintained nothing more than an | | | | same person for all your shifts. Because labor laws do |
| isolated existence punctuated by the occasionally call | | | | apply and the agency would have to pay overtime |
| or visit from friends and family. This type of isolation | | | | for time which exceeds 40 hours per week, you will |
| was also coupled with medication errors or abuse, | | | | most likely have at least two to three caregivers on |
| self neglect and unsanitary housekeeping. A person | | | | a full time case. The average hourly rate is $14.00 per |
| living in this situation will often “bloom like a | | | | hour. A live-in will cost about $150.00 per day. A live-in |
| flower” in the right retirement facility | | | | lives in your home and drives your car (or theirs for a |
| environment. It is amazing what three hot meals a | | | | mileage fee) and you are expected to feed them as |
| days, social interaction, clean sheets and regular | | | | well, even if you go out to dinner. By law, a live- in is |
| administration of medications can do for a | | | | entitled to two hours per day of free time. They can |
| person’s mind, body and spirit. A person who | | | | do what ever they like, including leaving the house |
| lives alone is more likely to fall and lay alone on the | | | | during their break. If this arrangement will not work |
| floor for days without being found. A person, who | | | | for your situation, consider hiring an aide around the |
| lives alone may make poor choices such as keeping, | | | | clock. Around the clock care is typically delivered in |
| (or worse,) spoiled food in the refrigerator. If a | | | | two twelve hour shifts which are done by two |
| person lives alone, there are many signs of illness | | | | different caregivers. |
| that no one will notice during sporadic short visits. | | | | One aide comes to the home from 8am until 8pm |
| Medical appointments may be missed and | | | | and is relieved by the second caregiver at 8pm until |
| prescriptions left unfilled. Many people feel that they | | | | 8am. Around the clock care can be delivered in many |
| are honoring their aging loved one by letting them live | | | | schedule formats. A live- in is expected to have their |
| alone, even though all the tell tale signs of self | | | | own private bedroom and bathroom although many |
| neglect are apparent. There is no honor or dignity in | | | | agencies are flexible on this issue. The live- in is |
| being found on the floor after one has laid in their | | | | expected to be awake all day and have at least 7 |
| own excrement for three days. Unfortunately, many | | | | hours of sleep at night. If the elder does not sleep at |
| families will wait for this type of incident before | | | | night, a live- in arrangement will not work. One option |
| insisting on either home health care or facility | | | | is to have the live in ($150/day) plus hire a caregiver |
| placement. If an elder is physically or verbally abusive | | | | to come to the house and stay up all night with the |
| to family and care givers, they are much more likely | | | | elder ($14.00. hour for eight nighttime hours). This |
| to be left alone to make their own decisions, | | | | costs $112 + $150= $262.00 per day. The only other |
| regardless of how dysfunctional their situation may | | | | alternative is to have around- the- clock care which |
| be. Elders with difficult personalities are many times | | | | will cost $14.00/hr X 24 hr=$336/day. Adding the |
| more likely to be abused by caregivers. They need | | | | eight hour night shift to the live in, saves about |
| more supervision, not less. | | | | $3,000 per month. The Veterans Aid and Attendance |
| American Family Dynamics and the Pressures of | | | | Pension is available to qualified veterans who need a |
| Today’s World | | | | caregiver in their home on a regular basis. |
| I hear people say “Americans don’t | | | | Types of Adult Housing and Facilities: |
| take care of their elders like other countries | | | | Independent Living Facilities usually offer small |
| do”. Well that is not my experience. The adult | | | | apartments with some meals included in the price. A |
| children who consult with Geriatric Care Manager or | | | | person who lives in an Independent Living Facility is |
| other eldercare professionals are very concerned | | | | expected to manage their daily care needs on their |
| about their parents. They love them and they want | | | | own, but the staff would readily recognize if needs |
| the best care their money can buy. That’s the | | | | increased and assist the resident in obtaining the |
| clincher: what their money can buy. In America, | | | | needed help. Some facilities have extra care services |
| caregivers, maids, etc,, are expensive. Perhaps in | | | | available for additional charge to help the resident |
| another country where slave labor is commonplace, | | | | “age in place.” Others may ask a |
| people can afford plenty of care. But in this country | | | | resident to move out if their needs exceed the |
| it costs $12.00 per hour (or more) for a home health | | | | scope of that particular facility. Limited transportation |
| aide. At eight hours per day, that is $96.00 per day. | | | | is usually provided although many residents are still |
| That is $2,880 per month or $34,560 per year | | | | driving when they enter an Independent Living |
| – more than the average working American | | | | Facility. These facilities may cost anywhere from less |
| earns per year. The average woman gets a social | | | | than $1,000 per month to over $5,000 per month |
| security check of less than $500.00 per month. Do | | | | depending upon the luxury amenities and location. |
| the math and you will soon see that unless you are | | | | Assisted Living Facilities usually offer hotel size rooms |
| wealthy, many people cannot afford to keep their | | | | with the option to share a room or pay extra for a |
| elders in their own home with a part time caregiver | | | | private room. Three meals and snacks are usually |
| or even in their children’s home with a | | | | provided as part of the price. Residents are expected |
| caregiver. | | | | to need some assistance with their daily care needs. |
| Now couple this financial problem with another very | | | | Medication administration is strictly supervised. The |
| real problem. Most middle income women in their | | | | State laws dictate who can live in an Assisted Living. |
| fifties, who are caring for their elderly parents, are | | | | The State does not want Assisted Living facilities to |
| also trying to hold down a job, help their young-adult | | | | house nursing home candidates or Nursing Homes to |
| children and maintain a marriage. If a middle income | | | | admit people who could function just as well in an |
| woman stops working to care for her parents, she | | | | Assisted Living Facility. Assisted Living residents must |
| and her husband either cannot pay their bills or they | | | | be able to walk and transfer ( from bed to chair or |
| must significantly reduce their standard of living. I | | | | chair to standing) with the assistance of only one |
| know a few husbands who are fifty-something and | | | | other person. An Assisted Living resident can be left |
| feel they have worked too hard and too long to | | | | alone in their room for two hours or more. Nurses |
| have their dreams of retirement evaporate because | | | | aides are on duty around the clock. Registered nurses |
| someone else’s needs are suddenly more | | | | or Licensed Practical Nurses are on duty at least |
| important than their own. Now that Americans have | | | | during the daytime. Many medical services may make |
| come to grips with the concept that it takes two | | | | rounds and visit residents at least monthly. It is not |
| incomes to live well in this country, they are more | | | | uncommon for an Assisted Living resident to never |
| determined than ever to have a retirement. Paying | | | | have to leave the building for a medical or beauty |
| $35,000 per year for a caregiver can take a huge | | | | appointment. Prices may range from under $1200 |
| chunk out of the retirement savings. Frankly, most | | | | month to over $8,000/ month, once again depending |
| people couldn’t afford to do it even if they | | | | upon the amenities. Medicaid has a program called the |
| wanted to. Because most Americans’ net | | | | Medicaid Waiver which can pay part of the cost of |
| worth is in the equity of their home, selling the family | | | | the Assisted Living. However, funds have been |
| home is the most common way to finance elder care | | | | historically limited and waiting lists can be long. The |
| services. If the family home sells for $100,000.00 and | | | | Veteran Aide and Attendance Pension is designed to |
| the average cost of an Assisted Living Residence is | | | | financially assist qualified veterans who need the |
| $36,000.00 per year, an elder can afford to live in | | | | services of an Assisted Living facility |
| that Assisted Living for 2.7 years. Coincidently, the | | | | Dementia Specific Facilities are designed especially for |
| average amount of time a person lives in an Assisted | | | | the memory impaired resident. The building, floorplan, |
| Living before moving on to a nursing home is 2.5 | | | | furnishings, décor, activity program and even |
| years. | | | | the lighting have been scientifically engineered to |
| Many adult children, who do have the desire and | | | | enhance the lifestyle of residents with dementia. |
| financial means to bring their elders to live with them, | | | | Many Assisted Living Facilities and Nursing Homes |
| still cannot. They cannot because the medical or | | | | offer a dementia program or dementia unit, but there |
| psychological needs of the elder are beyond their | | | | are entire facilities which specialize in this unique |
| capacity to manage. For example, if Grandma is | | | | population. Dementia Specific Facilities can be either |
| sweet and docile by day, but | | | | Assisted Living Facilities or Nursing Homes. They are |
| “sundowns” or grows agitated as | | | | secure in order to prevent residents from wandering |
| evening falls, this poses a difficult problem for the | | | | off the property and getting hurt or lost. The price |
| caring family. When some people experience | | | | for this extra level of care is usually about $1,000 to |
| dementia or other medical issues, they may stay | | | | $2,000 more per month than a non-specialty building. |
| awake all night. They sometimes wander out of | | | | Nursing Homes are State regulated and are inspected |
| doors or rummage through drawers and closets. This | | | | at least annually. A person who needs a nursing home |
| behavior will keep the whole family awake at night. If | | | | generally cannot live safely in an Assisted Living |
| a working family cannot sleep at night, this situation | | | | environment. A typical resident is either wheelchair |
| will become intolerable very quickly. Some adult | | | | bound or bed bound. Those who can walk around |
| children have been raised by violent, aggressive | | | | freely may need the nursing home environment |
| parents who are now violent aggressive elders. | | | | because they need constant medical supervision. The |
| Children who have been raised under these conditions | | | | medical component of this environment is similar to a |
| need not feel obligated to bring their parents to live | | | | hospital or hospice setting. The emphasis is on |
| with them, despite the pressure they may get from | | | | rehabilitation or custodial care rather than socialization |
| outsiders who do not know the real story. | | | | and activities. The ICP Medicaid Program (institutional |
| Elders and their families who are trying to make | | | | care program) will pay for the room, board and |
| difficult choices about elder care benefit from a | | | | medical costs of those residents who meet the |
| professional assessment from a geriatric specialist. | | | | financial and medical criteria. It is possible to plan in |
| Professional care managers can offer an objective | | | | advance to help an elder meet these strict criterion. |
| opinion based on a clinical evaluation of the physical | | | | Financial Realities |
| and cognitive status of the elder. Physicians, hospital | | | | Keeping an elder at home with a caregiver can be |
| case managers, facility admissions coordinators and | | | | the most expensive option of all. Many families feel |
| social workers can also offer advice about | | | | keeping their loved one in the comfort of their own |
| appropriate placement of an elder or even suggest | | | | home is priceless. If a paid caregiver cost $14.00 |
| how to set up services in the home to best meet | | | | hour, eight hours per day is equal to $2,880.00 per |
| the elder’s needs. | | | | month. Around the clock care exceeds $10,000 per |
| Home Health Care – Stay Home without Being | | | | month. Independent Living Facilities cost an average |
| Alone | | | | of $2,300.00/ month and provide no personal |
| At the very least, any elder living alone should have a | | | | assistance. Assisted Living Facilities range from about |
| medical alert system. This is a necklace or wrist band | | | | $2,500/month to $5,000/month and provide limited |
| with a panic button that can be pushed in case of | | | | care. A Nursing Home (without ICP Medicaid |
| emergency. If the button is pushed a dispatch center | | | | assistance) can cost from 5,000.00 to $7,000.00 per |
| receives the signal and makes and attempt to | | | | month and will provide total care. |
| communicate with the elder through a speaker placed | | | | Anyone considering hiring home health or moving an |
| in the home. If the elder needs help or does not | | | | elder into a care facility of any type should have their |
| respond to attempts to communicate, emergency | | | | elder’s current needs assessed by a qualified |
| services will be dispatched to the home. Many | | | | professional who can ascertain the elder’s |
| services will also contact friends and family to notify | | | | current medical/psychological and financial needs and |
| them that assistance is needed. A good candidate for | | | | anticipate future needs/solutions. With careful, realistic |
| this device is one WHO DOES NOT have memory | | | | planning, caring for an elder does not have to be a |
| loss as memory loss makes it difficult to learn to | | | | financial or emotional nightmare. Making the right |
| operate new appliances. | | | | choices for you and the elder you care about is |
| There are two basic types of home health care | | | | easier when you enlist the help of people who know |
| services: Medicare and Private Duty: | | | | the eldercare community and all that it has to offer. |