Home Healthcare—Helping Older Adults Live at Home Longer

Posted June 22, 2008 5:41 PM
Posted in Medical Care Article
by Mary Calvagna, MS

As people age, activities that were once simple to do—laundry, grocery shopping, yard work—can become more difficult to complete. Difficulty with certain tasks, however, does not mean that an older person is ready to move into an assisted living facility or a nursing home. An alternative that is growing in popularity is home healthcare.

Home healthcare describes a variety of health and social services provided in the home by trained professionals. The services can range from skilled care that is provided under the direction of your doctor and may include such services as dialysis or physical therapy to home support services like housecleaning or running errands. Home healthcare allows older adults to continue to live independently in their homes and get help with the tasks they cannot do on their own. One example of a home healthcare organization that many are familiar with is Meals on Wheels, a program that delivers hot meals to a person’s home.

Almost two million people over the age of 65 are using home healthcare services—and with good reason. Studies have found that home health care costs less than institutional care, provides more satisfaction to those who receive it, and often results in fewer and shorter hospital stays.

Home Healthcare Services Available
Many different services can be provided in the home, from light housekeeping to meal delivery. The following table lists examples of services available in the home.

Home Health Care Service Available Category
Bathing, Hair washing, Dressing Personal care
Housecleaning, Yard work, Shopping, Laundry Homemaking
Grocery shopping, Meal preparation, Meal delivery Meals
Bill paying/check writing, Account management Money Management
Medication management, Administration of intravenous drugs (e.g. antibiotics or pain medications), Dialysis, Physical therapy, Hospice care Healthcare
To shop for food, clothes, necessities; To and from medical appointments, social engagements, church activities Transportation
Daily/weekly visits, Phone calls Companionship


Paying for Home Healthcare Services
The cost of services will vary depending on where you live and the type of services you need. Some home healthcare agencies have sliding fee scales, so make sure to ask. Home healthcare services can be paid for privately, but there are also a number of public and private funding sources. Funding sources include the following:

Medicare
Medicaid
The Older Americans Act
The Veterans’ Administration
Private insurance

Deciding What Services You Need
The first step in finding appropriate home care service is talking to your doctor to determine what type of services you will need. You may only need help with preparing meals or you may require sophisticated medical care at home. Determining level of help required and type of services will help you find an appropriate agency.

It can be a daunting task. By contracting with an agency, you are allowing someone to come into your home or the home of someone you care about. To help ensure you are working with a reputable organization and that they provide quality care at a cost you can afford, research the organization extensively and prepare a list with important questions. In addition, your nurse, physician, hospital social worker, or discharge planner may recommend a reputable agency in your area.

If it is possible, anticipate what your possible needs may be and do some research in advance. Planning ahead is difficult because you cannot be sure about what types of services you will need, but it will help when it comes time to make a decision. To help inform your decisions, educate yourself on the concerns and issues that may affect older adults, taking into consideration your own financial and health issues, including any chronic health conditions.

Questions to Ask
The United States Department of Health and Human Services Administration on Aging provides the following 20 questions to help guide your search for a home health service provider:

How long has the agency been serving this community?
Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.
Is the agency an approved Medicare provider?
Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations?
Does the agency have a current license to practice (if required in the state where you live)?
Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?
Does the agency write a plan of care for the patient (with input from the patient, his or her doctor, and family), and update the plan as necessary?
Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?
How closely do supervisors oversee care to ensure quality?
Will agency caregivers keep family members informed about the kind of care their loved one is getting?
Are agency staff members available around the clock, seven days a week, if necessary?
Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?
How does the agency ensure patient confidentiality?
How are agency caregivers hired and trained?
What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?
How does the agency handle billing?
Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?
Will the agency provide a list of references for its caregivers?
Who does the agency call if the home healthcare worker cannot come when scheduled?
What type of employee screening is done?

RESOURCES:

Administration on Aging

http://www.aoa.gov

American Academy of Home Care Physicians

http://www.aahcp.org

Meals on Wheels Association of America

http://www.mowaa.org

National Association for Home Care and Hospice

http://www.nahc.org

National Institute on Aging

http://www.nia.nih.gov

References:

Age page: There’s no place like home. National Institute on Aging website. Available at: http://www.niapublications.org/engagepages/home.asp . Accessed December 8, 2005.

Caregiving statistics. National Family Caregivers Association website. Available at: http://www.nfcacares.org/who/stats.cfm . Accessed November 27, 2005.

Characteristics of elderly home healthcare users: data from the 1996 National Home and Hospice Care Survey. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/ad/301-310/ad309.htm . Accessed December 6, 2005.

Getting the most out of home healthcare. Yale-New Haven Hospital website. Available at: http://www.ynhh.org/choice/home_health.html . Accessed December 6, 2005.

Home healthcare: a guide for families. United States Department of Health and Human Services Administration on Aging website. Available at: http://www.aoa.gov/press/fact/pdf/fs_hhealth_care.pdf . Accessed November 27, 2005.

JAMA patient page: Home healthcare. The Journal of the American Medical Association website. Available at: http://jama.ama-assn.org/cgi/reprint/287/16/2168.pdf . Accessed November 27, 2005.

Last reviewed December 2005 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Caring for aging parents

We live in a very mobile society where family members don’t always live in the same town or even the same state. In fact, according to the National Institute on Aging, approximately seven million Americans are long-distance caregivers, mostly caring for aging parents who live more than an hour away.

“It’s only natural that adult children of seniors will have some concerns about how their aging parents are doing, especially if they are apart during the holiday season,” said a member of the Right at Home office. “Identifying strategies for long-distance caregiving will make the challenges of caring for aging parents or loved ones more manageable.”

Below are tips from Right at Home for long-distance caregiving:

1) Establish Support Contacts in Your Aging Parents’ Community – Make a list of family, friends and neighbors’ phone numbers and addresses. Ask if you can check in with them to find out how your loved one is doing. They may also be willing to stop by your loved one's home for regular visits.

2) Stay in Touch With Your Parents – Keep in regular touch with your loved one by phone, letters, and e-mail. Record any changes you sense in his or her personality or ability to function day by day.

3) Make Observations During Visits – When you are able to visit your parents, pay attention to any changes in grooming, eating, or social activities. Look for changes in the way he or she manages money, cleans, shops, and gets around.

4) Keep Track of Important Information – Find out where your parents keep important documents such as his or her insurance policies, bank account numbers, investments, living will and power of attorney (for legal, financial, and health care purposes). It’s also beneficial to have a list of physicians that your relative is seeing, and any hospitals or clinics that are involved in his or her medical care, and any medications he or she is taking.

5) Look into Professional Help Options – There are several options for aging parents who need additional assistance. In home caregiving agencies, such as Right at Home, provide services such as companionship, meal preparation, and light housekeeping to help seniors continue to live independently with the help of a caregiver.

6) Identify Community Resources – Research local area agencies on aging, senior centers, churches, synagogues, or other volunteer organizations about available resources for seniors. To locate the area agency on aging, individuals can call Eldercare Locator, public service of the U.S. Administration on Aging, toll-free at (800) 677-1116 or visit www.eldercare.gov.

7) Involve Your Parent – Allow your parents to retain as much decision-making ability as possible. Remember that your primary objective is to help your loved one to fulfill his/her needs, not to take over your relative’s life. In some situations, when your loved one is unable to make decisions, you may need to do so on his/her behalf.

8) Take Time for Yourself – Caregiving can have an emotional and physical toll on caregivers, especially when done long-distance. Make sure you are eating right, getting enough rest, exercising regularly and keeping up with your own medical needs.

Remember, the holiday season is a time for family, togetherness and making memories. By taking the time to address these long-distance caregiving issues, your family will have the much-needed sense of security, comfort and hopefully the ability to create new memories with your aging loved ones for many years to come!

Public radio’s “Marketplace’’ recently offered an interesting segment lamenting the short supply of geriatricians.

At a time when the 85-and-over set is the fastest growing cohort in the American population and the nation’s 77 million baby boomers, like it or not, are heading into old age, this is unfortunate.

Geriatricians — essentially family doctors for the elderly — earn about $150,000 a year. That’s less than half the $400,000 of, say, radiologists, in a health care system that rewards specialists who do the most procedures and often spend the least time with patients.

Few experts in the field of geriatrics see any likelihood this will change, absent an overhaul of the reimbursement system. Instead, their focus is on teaching the core principles of their specialty to everyone in the medical arena who comes in contact with the elderly, from surgeons to discharge planners.

“If we got to the point where everybody in the health care system was an expert in caring for older people, we wouldn’t need geriatricians,” Dr. Leo M. Cooney of Yale University School of Medicine told me a few years back. “Or we wouldn’t need them as frontline providers. We’d be like consultants, making sure everyone else was as skilled as possible.’’

Tell us about your experiences with your geriatrician — or your frustrations in trying to find one.

-What is Elder Law?

-How do I find Elder Law Attorneys to network with?

Rather than being defined by technical legal distinctions, elder
law is defined by the client to be served. In other words, the
lawyer who practices elder law may handle a range of issues but has
a specific type of clients--seniors.

Elder law attorneys focus on the legal needs of the elderly, and
work with a variety of legal tools and techniques to meet the goals
and objectives of the older client.

Under this holistic approach, the elder law practitioner handles
general estate planning issues and counsels clients about planning
for incapacity with alternative decision making documents. The
attorney would also assist the client in planning for possible
long-term care needs, including nursing home care. Locating the
appropriate type of care, coordinating private and public resources
to finance the cost of care, and working to ensure the client's
right to quality care are all part of the elder law practice.

Find an elder law attorney(s) in your area by visiting:
http://www.naela.org

Home Town for Seniors

am an avid reader of Globe North to follow local area issues. Reading your article in this Sunday's (8/3/08)
Globe North (slow motion" about the shift in population i can see how this applies to all parts of the Commonwealth. We all realize that the state has a major problem with funding from the Federal Government
if this trend continues.
In the article you point out the movement of population from Lynn to neighboring Peabody (Brooksby Villiage)
which is an assisted living for Seniors mostly affluent long time residents of Lynn looking for a safe and affordable upscale community. I assume Most would rather have rremained in their home and take the next available alternative remaining in the neighboring town in Essex County. We all want to improve our lifestyle.
A followup to your piece on the growing Senior population and their contribution to stability of a city and towns
and what the programs that could be put in place keeping long term residents it their neghborhood and particularly in home environments.
Example Mass Senior Action an advocate group for Seniors have supported with success protecting the rights and needs of elders in Senior and Disabled in subsidized housing. I would like to see them expand to help long time residents not only remain in familiar localities but in the home environment of a familiar neighbor hood.
IN MALDEN:
The Mayor Richard C. Howard, the Malden City Council, The Malden Revelopment Authority, Council on aging after urging from senior groups have plans to opening a new Malden Senior Community Center (Dec 8 2008)
in the downtown Area to improve the economic climate and revitalize Malden Center.
I would suggest their would be much interest to have Globe North do an in depth article of what is happening in Malden to retain our population is a safe and enjoyable city.
I have talked to the Mayor and he is for an outreach program to have a promotion and participation of all non profits in the New Senior Community Center. The concept is to have services to "keep independent living in the neighborhood"
How we can help home caregivers. We need the cooperation of all the non profits who are charged with servicing the Seniors our City Council who represent the citizens throughout the city all the citizens with a Vision For Malden
I would call it a declaration of Independence.
Right now I am trying to get a Focus group to gether for Ideas Interest and comments.
We have a model of several village concepts as guides of what can be done.
As an example:
Beacon Hill Village an all encompassing concierge service created by residents who want to grow old in the homes they have lived in for years.
This could be done on a regional basis or City wide even in a neighborhood.
This is what needs to be determined.
In the service by an organization they can deal with almost any contingency
large of small
without relying on relatives of friends. To preserve their Independence, they
can turn to the village as the non profit association is known
At Beacon Hill they have 320 members find virtually any service, large of small
from 24 hour nursing care to help with a home meal. all at a discounted fee or
from an "entitlement program"
Dan O'Leary Executive director(Mystic Valley Elders ) is on board and has already
had a focus group in Melrose to a standing room only crowd Keven Duffy of Healthy Malden has expressed interest. And Phil Gerioux of Tri Cap is considering his roll. All the city councilors and been briefed. Jim Nestor has all the information and was to contact Chris Depietro Dirtector of Elder Affairs Malden for her input. It would be a help if you and your members would find out from Jim his progress (Jim Nestor) and get a status report
REMEMBER NEW SENIOR COMMUNITY CENTER IS IN WARD 4 VITAL to economic development
of the downtown area.

Any neighbohood resident is asked to participate with membership between 50 and older.
Anyone with a parent needing sercie should be involved.
MaldenSenior
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Howard McGowan
MaldenSenior
349 Pleasant Street
Malden, Ma 02148
781 324 8076

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