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Home Care vs. Alternative Options

One of the "BIG" dilemmas for families involves facing decisions for care of our loved one. It can be very overwhelming, discouraging, stressful, and down right difficult. Over the years it has been expressed:


"My folks refuse emergency buttons in case of a fall."


"I have been the soul caretaker for my dad, but I'm getting worn out."


"The doctor said we need to look at options because it isn't safe for mom to be at home alone."


"It would break their heart if I told my parents they had to leave the farm & move into a facility."


The list goes on! Ultimately, the children of elderly parents are typically the "bad guys" in making the final call and decision. That is truly not an easy task despite looking out for their best interests.


There is hope & help out there! Unfortunately, if you are new to making this decision for your loved one, there is not a manual to assist a person through this. I'm sharing my own personal information over what I have seen and experienced over the years. None of the following information is to single out any company or facility. It is purely general information that can be used as a starting block so families can gather additional information when making life changing decisions for their loved ones.



Long Term Care/Nursing Home:


Sometime a long term care (LTC) facility is the best option for our family members. Many facilities also offer rehab services for those who need help recovering after a surgery. Usually rehab is a short-term stay and typically Medicare will pay some or all of the rehab services & stay. However, LTC facilities will usually have residents that are there for long term and will not be recovering enough to go home. The facility becomes a new home to your loved one. LTC facilities will typically accept Medicare, Medicaid, and other insurances. However, be sure you do your research on what happens if Medicaid is the only insurance used. The state may get compensated by accessing a patient's property. Do your research!


Facility living is just that. Typically a resident has either their own room or a shared room. The rooms typically consist of a hospital bed, a small dresser, bedside table, access to a bathroom that has a toilet & sink (sometimes the bathroom is shared with a neighboring room), a call light/call button, and a closet area. The hallways are typically long and the risk of other residents coming into wrong rooms is typical. Some facilities have ways to help deter this behavior.


Some benefits to LTC is the peace of mind that it is staffed 24/7, they have activities for the residents, communal dining, medication aides to disperse medication, Certified Nursing Assistance (CNA) to assist with dressing, undressing, toileting, bathing, and other functions that might be compromised for a resident. Some facilities have on-site beauticians, too. If a resident has a form of dementia, there are facilities that have a dementia "ward" that is designed specifically to this progressive disease.


Some downfalls to LTC might include if the facility has been "dinged" by the state. You can go online to https://dia.iowa.gov/health-facilities to research facilities to see if they are compliant with the codes, cares, and regulations before placing a loved one in a facility. We all want the best of the best for our loved ones and it is heartbreaking to know that some facilities are run very poorly. Some facilities are VERY short staffed right now. It is extremely important to ask questions and to have the facility show you anything and everything they can because they want the business, but you don't want a loved one to have a fall or has sat on the toilet for a lengthy amount of time because staff hasn't attended to them in a timely fashion. Typically if a resident pushes their call light, there is a window of 15 to 20 minutes that staff have to go answer that call light. That doesn't always happen.



Assisted Living:


Assisted Living facilities are designed to have individual apartments for the tenants. These facilities offer staff 24/7 that are CNA's, Med Aides, Nurses, as well as other staff. If someone were to move into an Assisted Living Facility, they need to be able to physically function fairly well. An apartment can be one or more bedrooms, one or more bathrooms, a kitchenette, living room area, sometimes a balcony, fireplace, or other features to make the apartment feel homey. It is designed to be someone's personal space and home while in the facility.


Some benefits to Assisted Living include privacy. Apartments typically have doors that lock so nobody can enter the apartment that isn't invited in. However, staff have keys so if there is an emergency, help can get to a tenant. Many facilities have emergency call lights or tenants have a call button that they wear so if there is an emergency, staff can be notified. There are activities available for tenants to take part in which allows socialization and building relationships/friendships. Communal dining is also typical, but tenants can typically have meals delivered to their apartment from the kitchen. Housekeeping and laundry services are sometimes an extra fee or included in the rent. Some facilities also offer shower aides for those that need assistance with bathing. If a tenant has some dementia, it is an option for staff to manage medication for that individual instead of the individual managing their medication. For tenants that still own and drive their vehicles, some facilities have a garage for tenants to store their vehicle. The freedom to come and go from the facility is fairly relaxed.


Some downfalls to Assisted Living is downsizing from living in a house to now living in an apartment. This type of facility is monitored by the state, too, and will typically be checked once a year. You can check to see if there are any "dings" against the facility at https://dia.iowa.gov/health-facilities. Some facilities have rules that if a tenant falls three or more times in six months, they may be asked to move to another facility like LTC for their safety. Some facilities are VERY expensive to live in. Cash for rent is typically required because Medicare won't cover the cost. However, some facilities allow Medicaid after a tenant's money has run out. Always find out how many staff are available, if there are shortages, and if there are shortages if some staff are pulling extra long shifts, double or triple shifts. Like with anything right now in 2022, shortages in facilities is not uncommon and it is very difficult.



Home Care Aides:


Some elderly have Home Aides that are through a program that provides limited services such as bathing, laundry, housekeeping, and other vital services. Some of these programs are offered through Public Health. However, some counties have eliminated this program because other agencies in the area provide similar services. Home Aides are typically CNA's and have a set agenda to be with a patient for a short amount of time because they need to get to several patients in a day.


Some benefits to Home Aides is that they are managed under the supervision of a nurse. These Aides are the eyes and ears to the patients and report to the nurse with any concerns. Since Home Aides are also CNA's, a nurse can instruct them on how to perform certain cares such as ostomy care, wound care, and other cares that a patient may need. The nurse will typically make house calls once a week or so to assess the progression of healing. For patients that are on Medicaid, costs are minimal to completely paid for, typically. A patient must qualify and the agency must have the required paperwork. These services are very helpful because it provides less stress on the patient because tasks are getting done and families of those patients are able to enjoy their loved one and not feel like they have to do some of the chores and tasks when they visit.


Just like with anything, there are some downfalls. Most of these Home Aides are only available Monday-Friday from 8A-5P. They are tying to fit in as many people as possible in that time. It is hard to build a good relationship with the CNA and patient because of the rushed time. If care is needed after business hours, nobody is available and the patient must rely on family, going to urgent care, the ER, or hiring in additional help from another company/agency.



Independent Caregivers:


There are several ways to find Independent Caregivers. Sometimes it is through word of mouth, going to an online website, and advertising. Hiring an Independent Caregiver allows a loved one to stay in their home. In turn this allows for less stress on those receiving care.


Some benefits with having an Independent Caregiver is that hours of care can be set between the Client and the Caregiver. The Client can stay in their home longer and because of this form of care Clients often live a longer and happier life. Typical tasks that are performed as an Independent Caregiver might include laundry, transportation, cooking, cleaning, medication reminders, assistance with other tasks based off of the need of the Client.


Some downfalls with Independent Caregivers that need to be considered might include if the Caregiver is insured. Also, it is very important for the family to run a background check on the Caregiver they wish to hire. Often times neither one of these things are done. It is important to do for the safety and well-being of the Client. Also, if the Caregiver is performing nursing duties but is not a nurse, this can put the Client at high risk of developing an infection or taking wrong medications, or other problems. Independent Caregivers should put together an invoice and be paid by check. Any Caregiver who wants cash only is avoiding paying taxes and is not being honest. There should always be a paper trail.



Agency Owned Caregivers:


There are several company's that have developed that provide non-medical in-home care. (Home Sweet Home Cares & Services, LLC is one of those!) These company's offer Caregiver's who are assigned to Clients and assist with activities for daily living. It allows a Client to stay in their home for as long as possible and be as stress-free as possible!


Some benefits with hiring an agency typically includes Caregiver coverage. Perhaps one Client might need 24/7 care in the home, that Client might have several Caregivers to cover the needed care at different times. Some Clients might only need four hours three times a week. This adds socialization and stimulation for the Client. It also guarantees care! An agency typically will do a home assessment and get to know the Client first so that the perfect Caregivers can be assigned to the Client. Non-medical assistance such as housekeeping, laundry, cooking, medication reminders, transportation, and more can be provided to assist with activities for daily living.


Some downfalls with hiring an agency might include the cost. Typically in 2022, the range for home care care is on the rise. It is not uncommon to have to pay upwards of $30-$35 an hour for services. Because agencies are non-medical, insurance like Medicare do not cover the care and it is paid for by the Client. Also, some agencies require a deposit for services. This typically will be returned at the end of services provided unless there are unpaid invoices. Some agencies do offer help through Medicaid programs such as being CDAC providers or work with the Veteran's groups to provide help with funding. Or, if a Client has taken out an insurance policy for long-term care for home care, that can be used for the non-medical services. The two biggest obstacles with having in-home care is the cost and that it is non-medical.



Palliative Care:


Many people are not familiar with palliative care or what it entails. A doctor will typically offer up this option for a patient if the patient is living with a serious illness. The idea is to receive medical care for their symptoms with the intentions to cure their illness. However, some illnesses are not curable but the patient can still healthy enough to get treatment but maybe doesn't qualify for hospice. Patients on palliative care can "graduate" out of the program if they have recovered!


Some benefits to palliative care include nursing care that checks in with the patient (typically in the patient's home) once a week or more frequently when needed. The nurse has a direct line of contact with the doctor to discuss any changes of the patient. Medicare typically covers this service. Palliative care services are usually out of the same office as a hospice group so that records are easily accessed and navigated. The less stress the better.


Some downfalls of Palliative Care might include that the stops a nurse makes are for a very short window of time. Additional services might need to be incorporated to assist with day to day cares. Also, since this service is typically associated with a hospice group, that can be difficult to accept. It is important to remember that palliative care is not necessarily end of life care.



Hospice Care:


Hospice Care has a very negative stigma. However, it is VERY important to research what hospice is all about. It is truly different from what it was many years ago. They offer comfort care services so that patients are as comfortable as possible as they approach the end of their life. Get familiar with hospice groups in your area and learn what you can. Remember that death is a natural event in our lives and picking a hospice group is just as important as other decisions we make in life.


Some benefits to Hospice Care is their focus on comfort care. Nobody should go through pain and suffering at the end of life. Perhaps a patient has been told they have 6-weeks to live, it is important to incorporate hospice so that they can get familiar with the patient and be available to treat pain and anxiety as it happens. Patients can choose to go into a facility, hospice house, or be at home while on hospice care. When a patient goes onto hospice care they have a Social Worker, Clergy, Nurse, Massage Therapy, and other services available if they wish to take advantage of those. Typically a nurse will make home visits once a week but more when there is a change. They also have a direct line of contact with the doctor to get medications to assist with any pain or anxiety. Medicare will typically cover the cost for services because it has been diagnosed medically necessary per a doctor.


There are very few downfalls with hospice care. Many groups are very skilled and knowledgeable with the care they provide. They are easy to talk to when you have questions and they take their time with each patient and the patient's loved ones. If the patient wants to stay in their home, it might be helpful to get some home care to come in and assist with cares for the patient. Many family members just want to be family and don't want to turn their loved one or perform pericares or baths to their loved one. It is also nice to have a caregiver with experience so that they can inform the family and be a support in what is happening throughout the steps of passing away.



Disclaimer: This blog is solely based on my personal experiences as a Caregiver over the years. There have been things I have been exposed to and have experienced. With that being said, none of my information above is for or against any company or entity. It is purely informational because knowledge is power! Despite my 19 years of experience, there are still things I am learning or things are changing.

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