Elder Care Guidance 

Ensuring Your Loved One To Remain Safely In Their Home

Community resources can be quite helpful and are very necessary
when trying to care for an older relative. These resources may vary
from city to city, state to state. Key players in identifying community
resources are social workers, therapist, case managers. Social
Workers/Case Managers can be found at Hospitals, Home Health
Agencies, Hospice Services and Senior Centers. Many times you
can learn about the community resources in the newspaper, phone
book, senior center and by calling your local Area Agency on Aging.

Home Health Care: This service is usually introduced and medically
ordered by the doctor or discharge planner when someone has been
hospitalized and the patient is being discharged home but the patient
is still in need of skilled care. Home health care is usually a nurse,
RN or a physical therapist, PT who have been ordered by the doctor
to follow up with the patients condition on a temporary basis. Usually
a few visits are paid by Medicare. Additional services offered by
home health care are, a certified nurses aid, CNA who can assist
with bathing and personal care. A social worker can assist the
patient and family with emotional support as well as accessing
community resources that would be beneficial for the family. An
occupational therapist, OT who can assist the elder in adjusting to
their environment. A speech-language pathologist, SLP assists the
elder in rehabilitating their speech, that was impaired by an illness
through conducting speech exercises.

Medical equipment: Many times an elder will need to utilize some
medical equipment to help them adjust and assist with their mobility.
Many times Medicare will pay for some devices that are ordered by a
doctor. When medical equipment is ordered a company will deliver it
to the elders home. It is very important to have someone with the
elder if the elder is not able to understand instruction on how to use
the equipment safely. For instance oxygen can be very difficult for an
elder to understand how to operate therefore it is important to have
someone else there to learn the instruction.

If your older relative is in the hospital and is going to be
discharged soon, ask the doctor or discharge planner if home health
care can be ordered to assist with the patients recovery at home.
Find out how many visits would be authorized and what level of care
would approved by Medicare. For instance would an RN be the only
level of care appropriate or would the PT also be ordered to help the
elder adjust to walking again after a fall. Medicare may also
authorize a home health aid and an RN to come to the home if the
family needs instruction on how to bath a loved one who has a
wound. Many times these services are not cut and dry within
Medicare but based upon the individuals illness and disability.

Homemaker/Companion or Chore Services: This service is not
covered by Medicare and usually is an out of pocket expense for the
patient and family. This service provides an aid, companion or house
cleaner to assist with companionship or chores around the house.
Many agencies require a minimum of hours a week, and can also
provide 24 hour care. You can also find individuals who are personal
care attendants through local colleges and senior centers. These
individuals would need to be interviewed and you would hire them as
individuals opposed to hiring an agency care giver. In Home
Supportive Services is a program based on qualifications which will
provide this service at a reduced rate. This is a program that varies
from area to area so it is important to find out what programs are
available that may help with home care.

National Association For Home Care www.nahc.org
American Health Care Association www.ahca.org

Nutritional Services:
Grocery stores many grocery stores will deliver your groceries right to
your door. Many times the grocery has a minimum requirement for
the delivery of the groceries. This is convenient and is helpful for the
elder if they can still safely prepare food yet cannot drive.
Restaurants/Internet Gourmet Delivery If the elder has the financial
means and access to a computer a wonderful gourmet meal can be
delivered to the home and charged to their credit card.

Meals on Wheels many communities provide a meals on wheels
program. This service is usually offered for a reduced fee and the
elder will receive up to two meals a day, one warm meal and the other
a cold meal to be warmed up later. This can be another way to ensure
your loved ones safety and maintain a degree of socialization. If for
some reason the elder does not answer the door when the food is
being delivered usually there is so form of follow up from the
organization to report a concern.

Congregate meals most of the senior centers provide a reduced cost
meal on site for lunch or other times. Also hospitals are great places
to go for discounted senior meals which also offer a congregate
setting.

Emergency Response Systems: This service usually charges a
monthly fee and this is an out of pocket expense for the elder or
family. The service uses a device to monitor safety for your relative
through the use of a necklace or bracelet and intercom. Many of
these services offer levels of care which can include the service
calling the relative at certain times of the day to check on them. In
case of an emergency the elder would touch the button on the
necklace or on the bracelet

Transportation Service: This service can consist of a variation of
organizations. Many times a taxi service has a special program for
seniors. Many cities have a dial a ride service. Other communities
have a disabled transportation service that requires an application
prior to approval.

Geriatric Care Management: This service is provided by a
professional social worker or registered nurse. Most of these
professional either have a bachelors degree or a masters degree in
their profession. These professionals are experienced with the
elderly population and many of them have a certificate as a GCM.
The largest and well known organization that grants these certificates
is called The National Association of Geriatric Care Managers. A
GCM can complete a psychosocial assessment in the residence of
the older relative to screen for safety, assess level of coping, assess
the support systems, assess for the level of cognitive functioning and
many other areas of the aging process. The GCM can maintain an
ongoing relationship with the elder and the family as the need
permits. The fee for this service is usually a private pay/out of pocket
expense for the relative or family.

Senior Case Management: This service is many times offered
from the local senior center as a means of reaching out to those
seniors who are homebound or those who are restricted somehow
from resources. Usually this service is free and it provides a few
visits or phone calls to the older relative. They also can offer
assistance with getting connected to additional resources, low cost
services within the community.

Adult Protective Services: This service is free and it is provided
by the county to protect adults who may be physically abused,
emotionally abused, financially abused (fiduciary abuse) and
neglected care. Usually a social worker comes to visit the adult to
assess for any abuse and then assists the adult and family to stabilize
the situation.

Adult Day Care: This service is either a social day care or a health
day care which can assist with those individuals who have physical
disabilities. Both types of day care provide supervision, meals,
social interaction and activities that stimulate the mind. This service
usually accepts Medicaid/Medical or private pay. Medicare does not
cover adult day services. The adult day care services usually open
early in the morning Monday through Friday and end in the late
afternoon. Many of them do provide transportation but some may
not. This service can be a wonderful opportunity for a caregiver to
have a break, a respite.

Many caregiver organizations will assist financially with respite.
The caregiver organizations may vary in areas covered as well as
programs available.

National Family Caregivers Association
800-896-3650
www.nfcacares.org

National Alliance for Caregiving
www.caregiving.org

Children of Aging Parents
800-227-7294
www.caps4caregivers.org

Caregiving.com

www.caregiving.com

Senior Center: This service focuses on outreach to the elderly
population by providing a location for elderly people to meet for
meals, activities and social support. Many of the senior centers also
provide case managers that can assist with specific needs such as
providing meals to the homebound. Many senior centers have
volunteers who can telephone isolated seniors and offer a sense of
connection.

Area Agency on Aging: This service is a centralized location to
obtain information about community services for the elder population.
Many times this is the gate keeper in accessing services.

Veteran Programs: If your loved one is a Veteran it is important that you contact the Veterans Administration to inquire about current
benefits available.

Long Distance Caregiving

The first step to coping with this situation is to recognize the
anticipated stresses. In the United States most of our family is
spread throughout the states thus causing stress on the family when
an older relative is ill or needs additional assistance. Other stresses
are family dynamics. Family dynamics usually return to the previous
level of functioning. These dynamics most definitely affect the way we
handle the process of caring for our parents or older relative even
when we are far away. Being aware of these triggers can assist in
coping more effectively. Today there are many services that reduce
the pressure on the family regarding long distance caregiving issues.
Most of us want to allow our loved ones to remain as independent as
long as possible. Now with services such as emergency response
systems, meals on wheels, hiring help in the home and senior center
case management we can let our loved one remain in their own home
longer these days. There is a time when we need to recognize the
signs of when a loved one needs to be placed in a care facility. Care
facilities come in all shapes and sizes. Depending on the care
needed for the elder.

Housing Options: When It Is Time To Move

Subsidized Senior Housing: These are apartments that the
Federal and the State help with financially. This is a housing option
for those who can live independently safely and who qualify financially
for reduced rent. Many of these vary from state to state and may have
a waiting list.

Homesharing: This is a housing option for those who have a large
house and want to rent out a room in exchange for household chores.
The agreement is between the individuals and usually requires some
time involved to interview and run a background check.

Retirement Communities: This is a housing option for those who
want to be in an environment that offers social activities, meals as
well as maintain their independence. These facilities require a
monthly fee which the elder usually pays out of pocket.

Continuing Care Communities: This is a housing option for those
who may want to sell their existing home in order to purchase long
term care in advance for a large sum of money. These facilities
usually require that the person be functioning independently prior to
being accepted to the continuing care facility. Once accepted the
individual can stay at the same facility despite change in level of care.

www.ccaconline.org Continuing Care Accreditation Commission
(CCAC)

Assisted living Facilities: This is a housing option for those
who require some assistance and can afford paying a monthly rent
plus any additional fees for the required assistance. These facilities
usually vary in price and in size. The facility provides congregate
meals, laundry services, transportation to doctors appointments, and
medication monitoring as well as assistance with bathing if needed.
Some of the facilities provide a secured Alzheimers/Dementia
unit.

www.alfa.org Assisted Living Federation of America (ALFA)

Board and Care Facilities, Adult Foster Homes, Residential
Care Facilities: This is a housing option that usually is in a home
that has been approved by the state to be licensed as a board and
care residence. Usually the rooms are shared with a shared
bathroom. The staff can provide medication monitoring, shared
meals, laundry and some assistance with bathing. These facilities
charge a monthly fee that the elder is responsible for.

Skilled Nursing Facility, Convalescent Home, Rehabilitation
Facility: This facility is usually for those who need additional time to
recover from a medical condition. Medicare does pay for a limited
stay when additional recovery is deemed necessary by the doctor.
Many times when an elder has been in the hospital the doctor will
write an order for the patient to be transferred to a nursing home for
an additional few weeks to ensure recovery. The non-emergency
ambulance will transport the patient to the nursing home if medically
needed. The patient will be seen by a nursing home doctor or may
be seen by their own doctor if that doctor has privileges at that facility.
Those individuals who have Medicaid/MediCal also can be cared for
in this facility pending the facility has a Medicaid/MediCal bed
available. There are items that Medicaid does not reimburse the
nursing home such as diapers and so the family will be obligated to
provide these. Many time the Medicaid/Medical beds are 4-8 in a
room depending on the size of the room. Most facilities go through a
screening process in order to be certified as Medicare and
Medicaid/Medical approved facilities.

www.medicare.gov provides a listing of the nursing homes in
every state that have been reviewed. The facility reports can also be
accessed at this web site.

www.jcaho.org The Joint Commission on Accreditation for
Healthcare Organizations (JCAHO)

www.carf.org The Commission on Accreditation of Rehabilitation
Facilities (CARF)

www.ltcombudsman.org Understanding what an
Ombudsman is and their role while in a nursing home

Hospice Care: Hospice is home care that is paid for by Medicare,
Medicaid when a person is diagnosed with a terminal illness and has
been given the prognoses to have six months or less to live.
People who are on hospice usually will stay at their home or will be in
some type of care facility.

Hospitalization:
Getting through the medical maze: Keeping your health happiness, and surviving hospitalization

Even if you anticipate going to the hospital for a planned medical procedure it still stirs up those unexpected feelings of loss of control,
helplessness and loss of independence. When we enter a hospital we are called a patient. We have to wear a hospital gown that exposes our pride and we are given a buzzer to press if we need something.

We have to wait for someone to attend to our needs.

Each hospital has specific units depending on the level of acute care
required. Now a days if a patient is stabilized the patient is discharged home as soon as possible.

Many families feel completely taken by surprise when they are told that their loved one is being discharged that day.

This is for many reasons. Insurance does not reimburse thehospitals for extended length of care.

Many diseases exist in hospitals and it is actually healthier for astable person to recover at home opposed to staying in the hospital.

Many times patients recover better at home opposed to thehospital because we seem to sleep better in our own bed and a nurse wont be waking us up every two hours.

Being discharged can be alarming to the family. They are concerned about the stability and the additional care that may be required.

Families are usually overwhelmed due to the initial crisis thatled to the hospitalization and exhibit difficulty processing additional information.

The reality of the hospital experience may not be what we would expect.

Hospitalization requires families to come together not to argue but to join together to understand what happened and what will be needed to ensure the safe recovery.