In-Home Care | In Care of Dad

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Essential Hospital Discharge Planning

Posted on February 21st, 2013 by kim

by Kim Keller

“Nearly one-fifth of Medicare beneficiaries — roughly 2 million beneficiaries per year — discharged from a hospital return within 30 days,” according to the Medicare Payment Advisory commission.

That’s a frightening, and preventable, statistic. One major factor is poor discharge planning. The process is often rushed and slapdash, and fails to protect patients from relapsing and winding up back in the hospital.

That’s why Karen and I felt pretty fortunate that our mom’s recent stay at Shands Cancer Hospital at the University of Florida in Gainesville was professional from top to bottom, with a well-considered discharge process.

It’s critical to get this step right. So, whether your own local hospital does this well or not, it’s a good idea to have a discharge checklist ready when you find yourself in this position. Here’s the one we rely on:

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Aging In Place

Posted on February 12th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Hurricane Sandy gave me something to think about regarding my frail elderly clients, some of whom were stranded without power or heat for a week or more. My clients universally want to “age in place,” as most elderly people do. They want to stay in their beloved homes, surrounded by their treasured belongings, living in their familiar communities until their lives are over. However, aging in place requires adaptation and change to make it a viable option for a safe and comfortable quality of life. But not everyone is ready to adapt, and few are ready to change.

Indeed, I am struck by the stark differences among my clients regarding their willingness, or lack thereof, to make the necessary adaptations to their circumstances.

For example, after the hurricane, one elderly couple I know, who could well afford a top-of-the-line generator, refused to get one. They did not want to spend the money, nor would they leave their home for a shelter of any sort. They said they would be fine by just adding another blanket or sweater and could survive an extended power outage, even though they knew that long periods without heat can be dangerous, even life-threatening, to older adults.

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When Home Alone Is No Longer Safe

Posted on January 31st, 2013 by karen

by Ed Moran, LCSW

I don’t think I can pinpoint the exact moment I first noticed my mother was getting older. Sure, I know on an intellectual level that Mom, like everyone else, gains a year with each birthday, but I’m talking about the physical changes that accompany aging. They were so subtle at first that I hardly took note. Though Mom is still very active at 75 and sharp as a tack, I’ve begun to wonder what life will be like for her in five or ten years. Can she stay in Florida, or should I try to bring her to Connecticut to live with family? Should she sell the house? Will she need home care? Will she need assisted living? Will she want any of these things? And what if she doesn’t want them? What will I do then? You may have noticed already how my anxiety over Mom’s advancing age is beginning to color my thought process, which is not necessarily a bad thing, if kept in moderation. Understanding our own feelings about our aging parents — anxiety and all — is crucial for making the best decisions about their care.

My mother has been very good about communicating her wants and needs, as well as discussing pertinent “what ifs.” If additional care were ever needed, I think my siblings and I would have a great chance of being on the same page with each other, as well as with Mom. But what about the situations where an aging parent is resistant? Naturally we all worry about our parents, especially if they’re alone. We see signs that living independently is becoming increasingly difficult, yet the parent denies the need for help. The situation becomes even more complicated when one parent accepts the need for change while the other parent resists.

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In-Home Care: Licensed Agencies vs. The Gray Market

Posted on October 23rd, 2012 by karen

by Kim Keller

There are two ways to secure in-home care — through a licensed agency or through the “gray market,” a term which simply refers to in-home care without using an agency. The gray market has become popular because it’s less expensive.

But cost is obviously not the only factor to consider. Marki Flannery of Partners in Care, part of the Visiting Nurse Service of New York, gives this list of things to consider when hiring in-home care:

Will the home health aide be caring for someone with a diagnosed medical condition?
If my mom hates the person I hire, can I quickly find a replacement — or even a replacement for the replacement?
If this person calls in sick or plans a vacation, am I able to work from home to provide care?
Can I trust this person to do the food shopping for my dad and only buy what he needs and not extras?
I’m worried that my mom might fall and break her hip — again — and then need to be hospitalized; do I have an aide who is trained to prevent falls?

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Whitman Family Art Class: A Daughter’s Journal

Posted on October 9th, 2012 by karen

by Beth Whitman

Dad had been attending an art class for almost ten years at the Methodist church in the town where he and my mom lived. So when they moved in with me, I set out to find someone who could teach an art class out at our home, as it was getting harder and harder for Mom and Dad to get around.

I found an extraordinary teacher and artist named Barbara McCarthy through the happenstance of casual conversation at coffee hour after church. Barbara began to come to our house every Tuesday at 1pm. At times there have been others in the community who joined our class, but mostly it’s just been family.

When we began, Dad was identified as the artist in the family, but all three of us participated in the class, and I was delighted to discover that Mom and I both had a talent for drawing that I had never known about. But Mom, who suffers from Alzheimer’s disease, never consciously “attended” art class — she just enjoyed being around activity. So I always made sure there was a seat for her at the table. After I set Dad up with his easel and oil paints, I would set out a drawing pad and colored pencils for Mom, and arrange a couple of things that might catch her interest as subjects. Then I would look around for a subject of my own. Generally, I had no idea what to expect — from the class, from Mom, or from myself.

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A Good Death At Home

Posted on October 2nd, 2012 by karen

by Joan Blumenfeld, MS, LPC

Eli wanted to die, and he wanted to die at home.

He had no children and no siblings. His wife of more than 60 years, who meant everything to him, had died a few years before. He had some distant cousins scattered around the world, but he had not been in contact with them for more than half a century.

Eli had congestive heart failure and refused his medication. He refused to eat or drink. He had a bed sore the size of a saucer and as deep as a cup. Eli, who had been a smart, cultured, feisty, interesting and handsome man, was now frail in the extreme and approaching the end of his life.

He had lost the will to live.

I was called in by his lawyer, a good friend who held Eli’s medical power of attorney. Eli was to be discharged from the hospital the very next day. He had been there for a week being treated for the bed sore and dehydration. Not surprisingly, the lawyer was at his wits’ end. He had no idea what kind of help Eli needed or where to find it. That’s why he called me — this specialized knowledge is the purview of a Geriatric Care Manager, not a lawyer.

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Let’s Talk About In-Home Care

Posted on July 2nd, 2012 by kim

by Kim Keller

Like many of our friends’ parents, our mom, who was our dad’s primary caregiver, was resistant to having in-home care. There were many reasons: she felt that Dad was her responsibility; she was concerned about the cost; and she didn’t want a stranger in the house. We’ve also heard other friends talk about their parents’ fear of relinquishing control of their surroundings, and losing their independence.

Here’s what we did. We started slow. We got our mom to agree to in-home help for just four hours a week, for just one month. If she didn’t find it helpful, then we promised to stop bugging her about it. But just one visit hooked her in, and she realized that she couldn’t live without the help. It wasn’t too long before we had full-time care. The added benefit for Mom was that she found comfort in having someone in the house she could talk to, off whom she could bounce ideas. It made decision-making — which often required tough calls — a little less lonely for her.

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Ten Tips From The Caregiver Trenches, No. 4

Posted on May 21st, 2012 by kim

Fourth in a Series Detailing Our 100 Most Beneficial and Indispensable Lessons

by Kim Keller

In the summer of 2006, our dad died after a long and devastating illness. As with most difficult journeys in life, this ordeal turned out to be a tremendous learning experience for Karen and me. We realized that what we had learned was valuable and that it should be shared to help empower other families just like ours, just like yours. In Care of Dad is dedicated to our father but it was created with you in mind.

In that spirit, here are ten more of the most important lessons we’ve learned:

• Refer to the Beers Criteria — The Criteria, named after geriatrician Mark H. Beers, M.D., identifies potentially inappropriate medications for people over 65. First published in 1991, the list was recently updated, naming 53 drugs that should be (a) avoided all together because of a high risk of adverse effects or limited effectiveness, (b) avoided with certain types of diseases or disorders because the drug could inflame the problem, and (c) used with caution. If your loved one is taking a drug that’s mentioned on the Beer’s List, then discuss it with the appropriate doctor. Keep in mind, the list is just a guide and should never preempt doctor’s orders.

• Interview In-Home Care Agencies — Before you commit to using an in-home care agency, be sure to meet and interview whoever will be coordinating your services. You’ll need to prepare a list of interview questions. Here’s our list to help you get started.

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When Pride Delays The Need For Help

Posted on March 1st, 2012 by karen

by Myra Marcus, Ph.D.

My mother turned 91 this past December. A strong, stubborn, and determined woman, she prides herself on her ability to drive, play bridge, manage her finances, and even have a boyfriend.

She has no qualms about summoning an ambulance at 2 a.m. when she experiences chest pains, and she knows if she’s convincing enough, she’ll be admitted to the hospital. This does not mean that she is crying wolf — it is just her way of getting the care and attention she feels she needs.

She is also quite canny and has figured out how the health care system in this country would leave her behind if she was not able to advocate for herself. She prides herself on her independence and resilience but she is tired — tired from the stress and strain of “keeping up” and never “letting go.”

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Calculating The Cost Of Care

Posted on November 14th, 2011 by kim

by Kim Keller

Here’s a fabulous resource: The Genworth Cost of Care Survey, which provides the costs for various home care providers, adult day health care centers, assisted-living facilities and nursing homes. The survey notes the lowest, highest and median costs of these services by state (including the District of Columbia), as well as the median annual costs of care by city.

Here are the national median costs for:

Homemaker (Personal Care Assistant or Companion): $18/hour

For someone who lives at home and needs additional household help, such as housecleaning, cooking, running errands, companionship
No personal or medical care provided
Price is based on a non-Medicare, licensed agency
Most agencies require a 4-hour minimum
Genworth notes that the lowest hourly rate is $9 and the highest is $34

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