When You Need In-Home Care
The time to think about your need for in-home care is before the need arises. "Choosing With Care," a program recently hosted by North Shore Village, provided a useful overview of what individuals, families, spouses and partners need to take into account when considering in-home care. The program was led by NSV member Nancy Yalowitz, who is a licensed social worker with extensive experience in helping patients and families assess their home care needs. Nancy told the NSV group that planning for home care often falls into three main areas: Needs, Finances and Timing. A summary of her presentation follows. If a need for home care arises in your household, remember that the Village can assist with referrals to providers that we have vetted. And, we have volunteers like Nancy who can help in planning your care.
Things to Consider Before Engaging A Paid In-Home Caregiver
NEEDS - What are the needs of the recipient, family and caregiver? If the patient is coming home from the hospital or a rehab facility, you can get help from a discharge planner or social worker prior to release, as well as from your doctor. Important considerations:
• Living Situation: Does the recipient live alone or with family/friends? What is the capability of neighbors, extended family, and friends to provide car? Layout of the house: are there stairs, is the bathroom accessible? If round-the-clock care is needed, is there a place for the caregiver to sleep?
• Ability to perform Activities of Daily Living (ADL's): bathing, dressing, grooming, toileting, transferring, eating.
• What are the nights and days like? Does recipient sleep through the night, or get up several times during the night? What times during the day would caregiver assistance be needed? Answers to these questions can help determine whether you need hourly come and go or live-in assistance.
• Medical needs: Will you need any special equipment, such as a hospital bed, wheelchair, bath bench, oxygen? What medications will need to be administered, and who can do that? Is there wound care? Catheter? Feeding tube? Will the recipient need to do exercises learned in rehab?
• Transportation: Can the caregiver drive? Use recipient's car? This is an area where NSV volunteer drivers can be called upon.
• Physical issues: What conditions might be present, such as incontinence, obesity, or lack of mobility that will put extra demands on caregivers?
• Caregiver needs and characteristics: If the caregiver does not drive his/her own car, is public transportation accessible? Does the caregiver smoke or wear fragrance? Is the caregiver OK with pets in the house? Does the recipient have a preference as to male or female caregiver? What is the level of proficiency with the English language?
• If the caregiver is retained through an agency, these considerations come into play: In an emergency, must the caregiver call 911, or will a DNR (Do Not Resuscitate) order absolve the agency? Who supervises the caregiver? If the recipient lives alone, can the caregiver manage the household?
FINANCES - How will the recipient or his/her family pay for caregiving assistance? If you've ever saved for a rainy day, it is now raining!
• If you have long-term-care insurance: What "triggers" the policy? Is there an elimination period? Does the home care agency accept the insurance? Does the policy limit the kind of caregiver(s) it will pay for? For example, will the policy pay for a "custodial" caregiver - one who is not an RN, CNA or LPN? Does the company reimburse the recipient [policy-holder] or the agency?
• Private vs. agency-affiliated caregiver: Compare the costs of these two options. If you engage a private caregiver, what is the backup if the caregiver is unable to come on a given day? Who is the employer, you or the agency? How is the caregiver paid? Who pays the payroll taxes? How are background checks and reference checks handled? If a caregiver is unacceptable, who fires her/him?
TIMING -
• If you are having a planned medical procedure, such as hip or knee replacement, you can make actual or contingency plans for your home care. Seek advice from your health care team in advance of your hospitalization and discharge. Keep in mind, however, that if you are working with an agency, it is unlikely that you will know who is assigned to you until you are discharged. Assignments are made based on the best match for the recipient, and caregiver availability.
• When a crisis or sudden need occurs: Perhaps the recipient has fallen, and needs help getting in and out of bed. Or, the family caregiver is no longer able to transfer, toilet or bathe the recipient. In these cases, it is important to know the response time of the agency in placing a caregiver in your home.
• Will there be an opportunity to interview caregiver(s) before making a decision? Don't count on it, except in cases where you have advance knowledge of what you will need and when you will need it. In an emergency, or when discharge is imminent, it is hard to schedule appointments with caregivers. For older adults, the length of a stay in a hospital or rehab facility is largely determined by Medicare rules and regulations. The day and time of your discharge is not up to you, although it can be reassessed if not having a caregiver in place will jeopardize patient safety. That's why it's essential that you take control of planning your home care. And remember that North Shore Village stands ready to assist with caregiving issues, referrals and trouble-shooting.
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