Articles Posted in Non-Medical Home Care

Published on:

During the past several months, several of my clients considered taking their loved one home rather than placing him/her in a long-term care community. After reviewing the costs of stair lifts ($2,500 to $16,000) and refurbished bathrooms, all of them opted to place the loved one in a community. That is because the loved ones would have required a 24-hour caregiver at a cost of at least $250 per day.

In contrast to these scenarios, my father-in-law had a stroke at age 85. After a stint in a nursing home, first with rehabilitation, then a short period as a nursing home resident, the family decided to renovate their father’s house for Disability access. I am going to share my sister-in-law’s thoughts as she recalls the situation:

As we saw in the months and year-or-more after Dad’s stroke, senior care giving is a continual learning process. My brother and I still sort of laugh (although it’s not really a laugh) about how Donovans put 50K into renovating the house for Disability access, but no one thought of certain details until those details hit us in the face.

Published on:

My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.

Continue reading

Published on:

A friend and I were having a casual conversation regarding the costs of hiring a 24 hour caregiver. Her sister was having difficulty caring for a spouse with dementia. I told her that in the western suburbs of Chicago Illinois, the figure I was quoted was somewhere in the area of $230-$240 per day. Someone overheard me and said, “Oh no, you can get a live in for much cheaper than that. When I hired a caregiver for my parents, they only paid $120 per day.” My response was, “The arrangement you made for them was not through a licensed agency. Trust me, you probably talked to a staffing agency who found you the person that fit your needs. There is a big difference.”

If you are considering home health care for a loved one, the agency should be a member of the Home Care Association of America (formerly the National Private Duty Association). Without going into a lot of detail, the agencies who are members of the association In Illinois hold a license. They adhere to a code of ethics. A licensed agency, in opposition to an independent contractor or staffing agency (as the person I referenced was talking about), is responsible for the screening, training, and back round checks of the staff among other things. Some choose to test test for drug and alcohol use. If you choose to hire an unlicensed caregiver you will be assuming all the responsibilities of an employer, and may have no recourse if something goes wrong. What may appear as savings in the short- term may have long term repercussions as exemplified in the following Real Life Story.

Real Life Story
The client was a woman in her late 60’s. She had a diagnosis of a debilitating disease that left her bound to a wheelchair, and needed assistance with all of her activities of daily living (ADL). That is, eating, bathing, dressing, toileting, transferring, and walking. She needed total assistance from a sit to stand position, a feat that was well-accomplished by one caregiver. She lived in her own home with two full-time caregivers. One caregiver assisted her from the late afternoon into the evening, and supposedly held a nursing degree at one point in time. Yet, she was no longer licensed. The other was an unlicensed caregiver who assisted her from mid-morning until late afternoon. Thus, there was a gap in care from the late evening to the next morning. The caregiver who had the nursing credentials was being paid three times the amount of the unlicensed caregiver. Both caregivers were employed by her for over ten years.

Continue reading

Published on:

Happy Holidays to you and your loved ones!

While the holidays can be a time of joy, they are also a time when extended family gatherings may provide us with occasion to notice that an older loved one’s health is deteriorating. As families reunite, celebrate the season, and take stock of the year gone by, they sometimes reflect on the passage of time – and begin to recognize how it might be affecting a senior member.

A sense of fear or worry — exacerbated, perhaps, by the darker winter weather – can then lead families to make rushed and hasty decisions about senior care or senior living options. Later, they hire me when they realize they have made an error.

Published on:

I know the above question addresses a topic that is not too popular. When my Father passed away due to a stroke and Alzheimer’s disease, my Mother was in her seventies and independent. She will be ninety-two on Tuesday, and she is still pretty independent. However, I am in an enviable position because one of my brothers lives close enough to her so that he can stop and take care of her errands every day. The other brother commutes to Chicago for his job and lives with her at night. Therefore, her needs are pretty well covered. However, the situation can become much more serious when each parent needs a different level of care. Could one survive on his/her own if one passed away? Please read on and be advised what could happen if you do not give this topic some thought.

REAL LIFE STORY

My client is a cherished friend from my childhood. I have known his parents since I was 6 years old, a fact that made my job a bit difficult from a personal standpoint. My friend (who lives out of state) contacted me because we had re-connected on Facebook. He was aware that I am a Certified Care Manager and asked me to assist with planning for his parents. His Father would be celebrating an 80th birthday in the near future. His Mother was in her late 70’s. When this story began, I was informed that his Father had suffered a fall at home. He was receiving treatment at a hospital that was located in an extremely busy area. My friend’s Mother was having some issues with her memory, and was driving to the hospital to visit her husband on a daily basis.

Published on:

One of the facts that I stress to my clients is that skilled nursing is not one-to-one care. Other facts that a lot of my clients don’t take into account are how the costs of a 24 hour caregiver (which can start at $200 per day if they agency is licensed) are going to affect their loved ones’ long term financial picture. This usually occurs when the child is in a rush and s/he doesn’t have the time to research all of the options. Or, the child feels guilty about the stigma associated with placement in a long-term care community. Everyone’s circumstances are different. As a Certified Care Manager, I assist my clients with looking at all of the options, including staying at home. But, you have to keep the senior’s long term financial picture in mind. If a senior can afford to stay at home, that is the best place for him/her if their medical conditions don’t require the presence of a nurse and if the socialization with the caregiver is adequate. People hire me for my senior living advisor services once they have already hired the full-time caregiver and discover after a period of time that the loved one is running out of money.

Last November, a family hired me because their Mother had three, unlicensed caregivers who were taking care of her in shifts for the past ten years. The son told me she had easily spent over one million dollars on caregivers. When he and his siblings realized that she was going to run out of liquid cash in the next year, they hired me to find a nursing home for her.

When I arrived at her home, the place was spotless. My client was impeccably clean and every single hair on her head was in place. She was sitting in a cheerful kitchen where the caregiver had fed her breakfast. Although my client was a total assist with all activities of daily living including toileting, and had latter stage dementia, I saw her smile and try to respond to the caregiver’s kind tone of voice. It was obvious that my client had received excellent care. That observation was verified by her son, who informed me that he often stopped in on all three ladies unannounced.

Published on:

I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story

One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

Published on:

For the first time in the seven years that I have been a senior living advisor, I actually told a prospective client not to move their loved one out of the current long term care community. About 50% of my clients come from the children of elderly loved ones who “did it themselves” the first time around. The result is often placement at the wrong level of care, or at a community that “looked nice,” but delivers poor care. This time, I actually discouraged my prospect from making a change.

The elderly loved one had been placed at a county facility and was paying privately. If I had done the initial placement, I probably wouldn’t have selected it as one of my top three choices. However, the community has a respectable reputation. The senior had begun rehabilitation in the short term rehab. unit. After the senior hit a plateau under Medicare, the decision was made to keep the individual in the long term care area.The family expressed concern over the fact that the staff was much smaller in the long term care area versus the staffing in the short term rehab. unit. Staffing is always better in the short term unit in opposition to the custodial care that the residents receive in the long term areas, a fact that the family was unaware of.

They also told me that they were disappointed that the staff appeared disinterested and was not “engaging with” their loved one. My answer was that most of the communities are understaffed. Nursing home care is not one-to one care, a fact that many of my prospects don’t understand until I explain it to them. On the average, a loved one could be sharing a certified nurse assistant with nine other residents, another fact they were unaware of. I explained if the expectation was to “engage” their loved one, they should hire a companion from one of the licensed home care agencies.

Published on:

As a senior living advisor and Certified Care Manager, I always conduct a face to face assessment of my client. This gives me an opportunity to evaluate him/her from a cognitive and functional standpoint. I observe the environment s/he is living in, talk with the family about the individual’s personal history, finances, and support system. That way, I can make an assessment of how I can improve the senior’s quality of life by recommending services that allow them to remain at home (That is, via the most economical and efficient services). Or, I can help them ascertain whether placement in a community would be more appropriate. In either case, I always include the senior in the care plan if they are able to participate. Just as I do my “in person” due diligence, you should do the same when researching senior living options. Here is what you should expect if you rely on the internet as a credible source of information:

1. I recently used Google to research the words “Chicago nursing homes.” I received over 44,000,000 returns. When you look at the websites for long term care communities, they rarely give you in depth information, and the prices are almost never listed.

2. Some of the websites will show the viewer the most newly decorated or beautiful areas of the property. They neglect to show the overall big picture. I have arrived at many of these organizations to find that the pictures on the site were no reflection of what the community was really like. Conversely, some of my clients have looked at the sites for the communities I have recommended to them. One my my clients reportedly logged on, and told me she was disappointed with how dingy and oppressive they looked. In truth, the facilities were beautiful and the pictures that were posted didn’t do them justice.

Published on:

This is a question that is asked of me and often causes controversy among the families that I serve. My goal is to find the best answer, and every situation is different. In the seven years that I have owned my senior living business, no two cases have been exactly alike. However, when a senior is still capable of making his/her own decisions, s/he almost always wants to remain in the home as long as possible. The only exceptions to the rule are if a senior is lonely and wants the socialization of being in a community, ot if medical issues no longer allow the senior to remain at home, or s/he can no longer afford the luxury of in-home care. Placement in a community is often the second choice to remaining in the home and normally arises when the senior is exhausting their funds. However, caution needs to be taken with this strategy, as many nursing homes are requiring a year or even two years of private pay before a person is admitted. This insures against the immediate filing of a Medicaid application, which can take up to a year for a resident’s reimbursement.

If you have a senior loved one who may need some help with his or her activities of daily living, I share below the ballpark figures for non-medical home care and long-term care community costs in the Cook, Will, Dupage, Lake. and Kane Counties in Illinois.

Non-Medical