Recognizing the Need for outside Help in Caregiving

Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term the caregiver can handle it. Long-term, help is needed. Outside help at this point is needed.

A typical pattern with an overloaded caregiver may unfold as follows:

· 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
· 20 to 36 months--the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
· 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

It is also important to use outside professional help in a caregiver setting. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long-term care issues. The care manager has been there many times the family is experiencing it for the first time.

An elder law attorney can help iron out legal problems. And an elder mediator can help solve disputes between family members. Having competent advice can often make the difference between allowing a loved one to remain in the home or being forced to seek out government welfare assistance.

Due to pride or sheer determination some caregivers allow the situation to go beyond their control. They have gotten to a point where depression and fatigue have clouded their judgment. At some point the caregiver will have to admit that he or she can't handle it alone and a better solution must be found.

Dan Fisher RN, BSN

Connecticut Care Planning Council
A & D Home Health Solutions

Providing more options for seniors

POINT OF VIEW Project 2020
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BY JUDY LEITNER AND JIM KILLACKEY Comments 0
Published: October 24, 2009
Keeping Oklahoma’s senior citizens healthy and in their homes and their communities for as long as possible without needing nursing home care is a primary goal of Project 2020, proposed legislation that has the backing of U.S. Rep. John Sullivan, R-Tulsa, and numerous statewide eldercare organizations.
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Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Funds could be used to open more adult day care centers, establish additional senior center programs, provide meals and transportation to their doctors for seniors without vehicles, start more elder abuse-prevention programs, and offer more legal assistance to the growing number of Americans age 65 and older.
Medical equipment covered by Project 2020 could be used in the home to aid in a better quality of life. That could include items such as oxygen tents, nebulizers, sleep machines, catheters, diapers, hospital beds, wheelchairs, blood-testing strips and blood-glucose monitors for diabetics.
Project 2020 also would prevent people from spending their life’s savings to qualify for Medicaid nursing-home eligibility. It might be used, supporters say, to promote fall-prevention strategies, physical fitness activities, better nutrition and chronic-disease management for seniors.
"I believe it’s important for us to re-think the way we deliver care to the elderly. This bill provides a community-based strategy to ensure we meet long-term-care challenges ... and avoid more costly institutional care,” said Sullivan, co-sponsor of the Project 2020 initiative, which got its name because by the year 2020, one in six Americans will be 65 and older.
According to the National Association of State Units on Aging, initial estimates indicate that Project 2020 has the potential to reach more than 40 million Americans.
The bill also would help make sure the health care work force will be ready to care for an aging population; that could be done by expanding training for geriatric physicians.
No price tag has yet been attached to Project 2020.
A recent AARP report said Medicaid dollars spent on home- and community-based services can support nearly three people for every one person in a nursing home, according to Sean Voskuhl, AARP associate state director.
Another survey, Voskuhl said, showed that 89 percent of Americans age 50 or older prefer to live in their homes for as long as possible. Oklahoma has 317 nursing homes with about 18,000 residents.
In addition, Voskuhl said, Project 2020 should improve assistance for family caregivers who help seniors with daily living responsibilities.
Nearly eight in 10 Americans say they would be more likely to support a health care reform proposal if that initiative included home- and community-based long-term care coverage for seniors. Sullivan is the lead Republican sponsor of HR 2853, also known as Project 2020 and the Empowered at Home Act of 2009.
Leitner and Killackey are members of the Oklahoma the Oklahoma State Council on Aging, the advisory board to the Aging Services Division of the Department of Human Services.
Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Read more: http://newsok.com/providing-more-options-for-seniors/article/3411425#ixzz0V8OhNA2C

Dan Fisher RN, BSN
President
A & D Home Health Solutions, Inc
Phone: 860-667-2275
Fax: 860-667-2276

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Understanding Long Term Care Planning

Mary is trying to prepare her son to avoid the mistakes she made with her husband Bill. Five years ago, Bill lost his ability to communicate due to Alzheimer's. He also suffered from heart disease and diabetes. As his caregiver, Mary was never quite sure she was making the right choices about his long term care and medical treatment. Eventually Bill needed life support and Mary agonized over how Bill really would have wanted his life to end since they had never discussed it.

Bill died last year. So many things were left undone regarding his care.

Mary has decided to plan for long term care and medical treatment before it happens. She has designated her son as her personal care coordinator. She has given him written instructions regarding different care scenarios and how to prepare for care giving. He also has copies of her will and trusts as well as other legal care documents. She has provided him an extensive source of long term care information as well as a list of her personal financial resources. Mary has implemented the financial solutions to pay for her care. And finally, she has provided her son with a detailed list of government and private long term care service providers.

By planning in advance for long term care, Mary has removed the guilt that loved ones feel in making care choices for her. She has researched and given direction on the types of care she desires, she has given direction and guidance to would-be caregivers and lastly she has planned for the means to pay for that care.

An article on the AARP website titled, "Talking about Independent Living" states, "Research has shown that, as people age, they prefer to continue living independently, preferably in their own homes. While adult children often worry about their parent's situation, it can be difficult to know if parents really need, or want, help from their children."

Children and parents should talk about all these things, except the parents should be the instigators and set the plan for the children to follow. What do you want your children, or friends to do in your behalf? When it comes time for them to help, you may not be physically or mentally able to execute your wishes. This is where your long term care plan comes into effect.

The time to start planning is now. Don’t wait until the choice is no longer yours!

Dan Fisher RN, BSN
President
www.adhomehealthsolutions.com

Connecticut Care Planning Council
Advisory Board

Caring for a Loved One at Home Can Be Challenging

Informal caregivers are family, friends or volunteers who provide care for a loved one. Informal caregivers are rarely paid directly for their services. They may receive indirect payment through sharing a loved one's income or assets. Although informal caregivers may provide services in a facility, in most cases they are providers of care in the home.

Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. The financial impact is another challenge. The financial burden depends on who the informal caregiver is. For a spouse there is typically no financial cost since income and assets will be the same with or without a need for care. However, if a spouse offering informal care is employed and has to quit his or her job to provide care there is a significant impact on that family's finances.

Despite the fact that there may be no significant financial impact on a spouse caring for the other spouse at home, there can be significant impact on the emotional and physical health of the caregiving spouse. Because of the strain and burnout often associated with caregiving, the healthy spouse may experience deteriorating health and eventually require long term care services as well. In some cases healthy spouses have succumbed drastically to the pressures of caregiving and died prematurely, well before their care recipients have died.

Another caregiver challenge may be the need of constant surveillance on a spouse with advanced dementia. Still another caregiving challenge could be a son living 500 miles from his disabled parents and constantly traveling to and from his home, trying to manage a job and his own family as well as taking care of the parents. Other challenges to home care may be caregivers who simply don't have the time to watch over loved ones and those loved ones are sometimes neglected.

The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:

· Inadequate care provided to a loved one
· Lack of training for caregivers
· Lack of social stimulation for care recipients
· Informal caregivers unable to handle the challenge
· Depression and physical ailments caused by caregiver burnout

In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must understand the problems outlined above, deal with them and correct them. This often involves bringing in so-called formal caregivers such as care managers, home care companies or other long term care advisors. The responsibility for recognizing home care challenges and solving them is shouldered by the team of specialists and advisors that have been invited in to offer their help.

Dan Fisher RN, BSN

http://www.adhomehealthsolutions.com/
www.careconnecticut.org

Care Management Services for Your Loved One

Also known as Geriatric Care, Elder Care or Aging Care Managers, a Geriatric Care Management Specialist represents a growing trend to help full-time, employed family caregivers provide care for loved ones living close by or needing long-distance care. Care managers are also particularly useful in helping caregivers at home find the right services and cope with their burden.

As with hiring any paid long term care provider to come into the home, hiring a care manager is the same principle. For those who desire to remain in the home, the care manager can help make that a reality and keep the care recipient away from a premature admittance into a care facility.

On the other hand, sometimes the family is attempting to keep a loved one at home when that is not the best choice. For many and various reasons care in the home may be impossible. For example consider the family where all family members are employed full time and both mom and dad need intensive care at home. There is also not enough money to pay for caregivers to come into the home.

In an attempt to cover the situation, the family trades off taking care of mom and dad in the morning and in the evening and on weekends. But they simply can't attend properly to the needs. A care manager may have a better perspective of the situation. In this case an assisted living facility or other facility setting could be a much better choice. If there is not enough money then a Medicaid facility may be the only choice.

Another example might be an individual who has Alzheimer's and has become difficult to manage. It just may not be possible for a caregiver in the home to watch out for this individual. Yet because of stubbornness or lack of proper judgment the caregiver is trying to cope. Again, a care manager can help in this situation and recommend a different care environment.

The value of a care manager is the value of a person who understands thoroughly the issues of caregiving and has seen many of the scenarios over and over again. This experience combined with the perspective of an outsider, who is not so close to the situation so as to impair judgment, is extremely valuable to families coping with the challenges of long term care.

Care managers can charge anywhere from $50.00 an hour to $ $200.00 an hour. Or they may charge a flat fee for a care assessment and plan. It is important to check out the background of the care manager for the situation you are trying to solve. For example if it is a family dispute, a care manager with a background of mediation would be best. If it is a matter of proper medical treatment, a care manager with a background in geriatric nursing would be valuable.

The family shoulders the cost of a care manager. Long-term care insurance may also cover the cost of a care assessment. Many policies will pay $250.00 to $300.00 for a care assessment. Policy language usually refers to this as care coordination.

Dan Fisher RN, BSN

A & D Home Health Solutions
Connecticut Care Planning Council

Understanding the Roles of Formal and Informal Caregivers

Formal caregivers are typically paid providers but they may also be volunteers from a government or nonprofit organization. Where care is being provided in the home there is often a mix of formal and informal care provided. And the trend is towards using more formal care since, unlike the past, more informal caregivers are employed. They choose to remain employed but must juggle limited time between caregiving and maintaining a household and a job.These added responsibilities often make it necessary to hire non-medical home care aides to provide supervision and help when the primary caregiver cannot be present. Or as adult day services become more common, caregivers may pay for this form of formal caregiving to get rest or to allow for maintaining some employment.When care is no longer possible in the home, then formal caregivers come into play on a full-time basis. This may be in the form of a congregate living arrangement, assisted living, a continuing care retirement community or a nursing home. It is at this point that long term care can have a significant impact on the finances of the care recipient and a healthy spouse living at home. Care facilities are quite expensive and the cost for maintaining a spouse in such a living arrangement may rob a healthy spouse at home of an adequate standard of living. It's quite possible the healthy spouse may end up with food stamps and subsidized housing where, before the need for a care facility, this may not have been the case.Or it is more often the case that the couple recognizes this dilemma of splitting living arrangements in two locations and an attempt will be made to keep the spouse needing care at home as long as possible. This may help with the finances but often results in destroying the physical and emotional health of the caregiver by creating a situation where the caregiver has difficulty coping with the responsibilities and physical demands.Another reality of providing informal care services in the home is the increasing need for physical and emotional support that often goes unrecognized until too late. As care needs increase, both in the number of hours required and in the number or intensity of activities requiring help, there is a greater need for the services of formal caregivers.Unfortunately, many informal caregivers become so focused on their task they don't realize they are getting in over their heads and they have reached the point where some or complete formal caregiving is necessary. Or the informal caregiver may recognize the need for paid, professional help but does not know where to get the money to pay for it.Other members of the family should be aware of this burden and be prepared to step in and help their loved one who is providing care recognize the possibility of becoming overloaded. It is also the job of a care manager or a financial adviser or an attorney to recognize this need with the client caregiver and provide the necessary counsel to protect the caregiver from overload. The advisor can also likely find a source for paying for formal care that the caregiver may not be aware of.An overloaded caregiver is likely to develop depression and/or physical ailments and could end up needing long term care as well. The consequences of not being able to cope with the burden of caregiving might even result in an early death for the caregiver.

Dan Fisher RN, BSN

A & D Home Health Solutions
Connecticut Care Planning Council

Why Work Through an Agency to Hire Private Duty Caregivers?

One of the greatest long-term needs of older adults and those with chronic illnesses is for in-home, custodial care services. These workers are often referred to as home health aides and certified nursing assistants. These in-home workers make it possible for people with functional limitations to remain at home in a comfortable, familiar environment. Home health aides (as we will refer to this class of workers) provide a wide range of assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, assisting with ambulation or transferring, toileting, feeding and providing medication reminders. In addition, home health aides help with what professionals call, instrumental activities of daily living (IADLs), such as shopping, meal preparation, making medical appointments, transportation, laundry and companionship.Due to the cost and the increasing shortage of home health aides, many families seeking to hire in-home staff turn to private individuals rather than working through an agency. While at first glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.Tax IssuesAs a private employer, the individual or family is required to pay Social Security, unemployment and payroll taxes. Many home health aides will represent themselves as independent contractors, ostensibly relieving the hiring individual of these tax obligations. However, it is the responsibility of the hiring individual to be sure that the aide truly is an independent contractor and is therefore paying their own taxes. In many instances, the aide will not meet the legal criteria as an independent contractor. If the aide has not met his or her tax obligations, this responsibility falls to the employer. This can be a serious obligation because it may involve interest on back taxes, civil fines and the possibility of criminal penalties. Potential private employers should seek the advice of a labor lawyer to assure appropriate hiring practices with respect to federal tax laws.Workers' Compensation and Liability IssuesAs the employer, the individual or family paying for the private home health aide would be held liable for any work-related injury that occurs on the job. This can include the cost of all medical expenses and any disability payments that might become applicable.Since the home-care industry is noted for work-related injuries, this can be a huge risk, especially if the caregiving tasks include lifting, transferring or bathing. There are also risks related to communicable diseases if the aide does not abide by universal precautions that are required by all licensed agency personnel.Furthermore, the employer retains any liability that arises out of an injury to the person being cared for or any other person on the premises. If the home health aide were to cause an accident, for example, in which other family members suffered any harm or losses, the employer would bear the full responsibility for all costs and compensation.Abuse and ExploitationUnfortunately, there is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual. While most individuals who become home health aides do so out of a desire to help others and to contribute to the community, there will always be those who see this type of work as an opportunity to take advantage of someone. This becomes especially easy when the aide and the recipient of care are isolated in a private home setting with little or no supervision.Families don't fail to provide supervision out of malicious neglect. Supervision is often difficult because of geographic distance, lack of expertise, or the close emotional bonds that often get established between the aide and the person receiving the care. Furthermore, families often do not have the time or the resources to do criminal background checks, or to contact references, if they even think to ask for references. Sometimes families are so grateful for the care provided by an aide that they are also vulnerable to manipulation and exploitation.Agency SupervisionA licensed home care agency has a responsibility to provide ongoing supervision for their employees. This includes helping the aides to understand the changing needs of clients, assuring the proper limits of care according to the practice acts of the various levels of professionals, and mediating difficult relationship issues.Providing supervision is often as important for the aide as it is for the family. Home health aides often work with very challenging situations in the isolation of the private home situation. There are often issues of different cultural and faith traditions, different expectations about personal schedules, eating preferences and expectations. An agency supervisor can help to clarify the roles of the home health aide, and the expectations of both worker and care recipient. Furthermore, the agency can support the aide in setting appropriate limits on the types of care that can be provided. For example, an older adult might expect an aide to help with dressing changes or high tech care that is legally the responsibility of a licensed nurse.In situations in which there are personality issues because of cognitive changes or a history of challenging relationships, the agency supervisor is available to provide guidance and support to both staff and care recipient. This can be very fragile, especially if there is a lack of trust or behaviors that are strange to the home health aide. The support of a supervisor can help the aide understand that this is part of the disease process and cope with behaviors so that the aide and the client can have a successful relationship. Often, supportive supervision is the key to making a challenging situation work.Please take a moment to visit us at:

http://www.adhomehealthsolutions.com/

Connecticut Care Planning Council

Misconceptions about the Need for Long Term Care and Who Provides It

A large majority of the American public still believes that the government will provide long term care when needed. It is this misconception that most likely prevents people from planning care for themselves. In fact, a recent study revealed that many people believe they can give away assets prior to the need for long term care and qualify for Medicaid. The study supports the premise that this knowledge prevents people from considering buying long term care insurance as a way to fund the cost of future care.

Indeed it may be possible to use the system and allow Medicaid to cover care but at what cost? Why would anyone want to plan to spend his remaining years in a nursing home--which is the preferred living arrangement of Medicaid? Why go through the expense and effort of trying to manipulate the system to get welfare care, when a little preplanning at an earlier age would be a better option?

In our practice we hear frequent objection to long term care planning from people who think Medicare or the Veterans Administration will take care of them. These people simply don't understand the limitations of government systems. Below are quotes taken from individuals who, over the years, have voiced these misconceptions.

"Uncle Jim got along just fine with the government paying his care"

"I can give away my assets and have the government pay for it"

"We have a trust and all of our assets will go to our family so the government will pay for our care"

"I'm not interested in home care or assisted living, just stick me in a nursing home and Medicaid will pay the bill"

"Long term care insurance is too expensive"

Government could be more involved in providing care but our antiquated system of delivery prevents this from happening. The National Aging Network, a government-sponsored program, is in the best position to help people receive long-term care in their homes. And studies have shown that the cost of providing this kind of care is significantly less than the cost of providing nursing home care through government programs.

Unfortunately, for every dollar that supports a person through the aging network the government spends about $270 supporting a person in a nursing home. Because it has inadequate funding, the aging network must confine its valuable services to people who have little income or for social reasons are disadvantaged. Moderate and middle income Americans can receive some services from the network but are mostly excluded or must pay their fair share of the cost.

We believe the public's misunderstanding of Government long term care programs is an impediment to proper long term care planning. When people understand the limitations of relying on government programs they are most likely to be more motivated to plan for the future by making provisions in advance and providing advance funding to pay for care. Prior planning also allows people to have a choice in their care setting and in the type of services they receive.

Dan Fisher RN, BSN
President
www.adhomehealthsolutions.com

Connecticut Care Planning Council

Home Safety for Seniors

Many seniors live in homes that are more than 20 years old or more. It may have been safe when they were 55 but is it still safe for them today?



According to the U.S Consumer Products Safety Commission, more than 600,000 older Americans are treated each year in hospital emergency rooms for injuries at home. Many of these injuries result from hazards that are easy to overlook, but easy to fix. By taking simple corrective action many of these injuries can be prevented.

We all wish to remain independent at home. However, aging and chronic illness can make staying at home difficult, if not impossible. Home modifications may become necessary for a person to remain safe and independent within their own home. Home modifications can range from something as simple as installing grab bars in the bathroom to construction that widens doorways and installation of a wheel chair ramp.

Before making any home modifications you should assess the home room by room carefully considering any present or future needs of the individual. Would the person benefit from a handheld shower head, grab bars or wheel chair ramps? In all areas of the home check for clear pathways, runners and throw rugs, electrical and phone cords, worn and ripped carpeting, worn or broken stairs, smoke detectors, proper lighting, burned out light bulbs, space heaters and stoves. Any visible sign of a safety risk should be repaired immediately. One last thought, could the individual benefit from a personal emergency response system?

D Fisher RN, BSN

A & D Home Health Solutions

Connecticut Care Planning Council