Struggling to care for seniors at home

Deer In Headlines

By Gery L. Deer

A recent article in The Atlantic discussed the question of the difficulty of finding adequate care for America’s senior citizens as more of them are choosing to remain in their own homes as they age. In the article, published April 27, 2015 by Alana Samuels, the author relates the story of her grandmother’s plight to find adequate, affordable home care near the college town of Amherst, Massachusetts.

A shortage of qualified Certified Nursing Assistants (CNAs) coupled with outrageous hourly fees made the task of caring for her Parkinson’s ridden spouse that much more difficult. The author’s grandmother eventually gave up on agencies and a friend helped out until her husband’s death a couple of years later. It’s a story becoming all too common today.

By the year 2030, more than one quarter of all Americans will be over the age of 65. More than ever, those people are choosing to remain in their homes as long as possible, relying on home health care and the assistance of family for everything from grocery shopping to bathing.

Over the last few years, a host of “non-medical” in-home care agencies have sprung up all around the country, spread by franchise. Most offer no skilled health care services and little more than baby-sitting. They can help with things like shopping, cleaning and some companionship for homebound seniors.

But, these home care workers are not permitted to help in medical matters, not even to distribute medications, as would a CNA or other state-registered, skilled health care worker. One published estimate by Genworth puts the cost of non-medical home at a range of $10 to $36 per hour. The extreme discrepancy is attributed to variations in region and the type of care required.

One question families should be asking is exactly what could an unskilled worker possibly do that’s worth $36 per hour? Still, most have few options available; it’s either a nursing facility or home care.

Plus, the home itself can be more hazardous than the disabilities suffered by the senior. It may be necessary to modify the home to accommodate “aging in place,” with zero-clearance shower stalls, raised toilets, grab bars, and much more. This also carries added expense and attention to which families might be unaware.

The fact is that it’s much better, psychologically, and far cheaper for seniors to remain in their own home. But most people caring for an elderly family member cannot be with them all hours – people have to work and care for their own homes and families – and still need outside support.

The first place to start is with the local agencies on aging. Most counties or regions have a non-profit organization such as this to help put families and seniors in touch with needed services such as meals on wheels, in-home healthcare, and more.

Be aware, however, that most services referred by these agencies are self-pay and are not covered by Medicare or insurance. The advantage, however, is that they can generally offer a discounted rate on certain services based on the income of the senior. Contact the local agency for details.

For support on in-home modifications, consult the local builders association for referrals to certified aging in place specialists. Most can provide design and construction information for everything from a simple grab bar installation to more complex additions such as elevators.

Additionally, financial and insurance companies out there might be missing the boat on a potentially golden profit center – “in-home care insurance.” Separate from long-term care or other types of health insurance, this could be a specific product that addresses the far less-expensive options of keeping a senior at home rather than in a skilled care facility. Give it a slightly lower premium and the ability to purchase later in life, and it would likely be less difficult to sell.

Before hiring anyone, caregivers should do their homework. Get at least three references from previous clients and do a thorough Google search on the agency you choose.

Whatever the overall solutions to the home health care problem, it’s clear something has to be done in a hurry. With incidents of elder abuse on the rise in nursing facilities, it’s imperative that families have alternate care options.

Gery L. Deer is an independent columnist and business writer. Deer In Headlines is distributed by GLD Enterprises Communications. More at gerydeer.com.

More family advocacy needed for elder care

Caring for an aging parent is, in my opinion, one of the most difficult and often painful experiences life throws our way. Providing a safe, healthy environment for an elderly family member is just as taxing as doing the same for a child.

What makes this process even harder is when the parent is resistant to help or simply won’t accept that they are no longer in a position to take care of themselves. Poor decisions, an inability to recognize when driving has become hazardous and, worst of all, when they will listen to anyone’s advice but that of their children, complicates the care process and causes serious damage to the parent/child relationship.

It’s hard to watch parents age and knowing you’re headed the same direction only solidifies the reality of it all. It’s harder still when they resist every attempt to maintain their health and sometimes doctors undermine your efforts by telling them they don’t have to do anything they don’t want to.

I understand that people need to make their own choices, but some shrink in a hospital cannot possibly know an individual’s mental status by talking to them once for three minutes and asking a half dozen pointless questions. “Do you know where you are? Do you know what day it is? Can you draw this box? Write your name.” “Draw this box,” are they kidding?

How about we ask them what their checking account number is, or the name of their insurance company? How about asking when they last paid their phone bill? These are vital questions to someone who is supposedly “competent” and yet this is not what is included in a psychiatric evaluation for a senior’s ability to make his or her own decisions.

Then there are those who are intent on taking advantage of the elderly person’s desire to feel “needed” and useful. These individuals worm their way into the lives of the elderly, showering them with compliments and creating a rift between the senior and his or her family. These unscrupulous people are trying to get money and property away from the senior and alienate children and others who are trying to protect their interests.

Deer In Headlines author Gery Deer is helping his brother Gary Jr and sister Cathy to take care of their father, Gary Sr. and it’s rarely easy work.

Laws addressing the rights of seniors, as well as those regarding patient rights, seem to take no account to dementia and speak only to protecting them from family members bent on securing money or locking them away in a nursing home. What about those of us who are trying to protect our parents and provide a safe, secure life for them in their own home as long as possible? Where is our protection and support? There is none.

Preserving a person’s dignity is difficult enough without being able to handle even the most basic decisions absent a mile of legal documents in place only to provide more money for lawyers. Power of attorney documents are meaningless unless the person is thoroughly incapacitated and no one will help without signing over deeds and financial statements.

Believe it or not, sometimes money has nothing to do with it! There are actually situations when families are trying to preserve an aging parent’s lifestyle, dignity and financial security. Someone should be out there advocating for us, not making it harder. Unless you’re loaded with money, there is just no support for people dealing with this kind of problem.

So what is to be done? Good question. I am all for protecting the rights of the elderly and maintaining their ability to make decisions, but there are many degrees of incompetence between fully cognizant and Alzheimer’s dementia and that should be taken into account.

My mother lost all of her reasoning ability as Alzheimer’s set in and it nearly bankrupted my family to get her under a guardianship so we could keep her safe and well-cared for. But when a senior has some competence but not all, that needs to be addressed and the family should be able to have some advocacy for protecting the interest of that individual without so many roadblocks.

Legislation should be put into place for the varying degrees of dementia and stop relying on the ‘one size fits all’ psychiatric evaluations that prove nothing more than the person can read a calendar.

 

Gery L. Deer is the editor and publisher of The Jamestown Comet.com an independent columnist and business writer based in Jamestown, Ohio. More at http://www.gerydeer.com.

 

Aging in place: Helping seniors remain home longer

Current statistics show approximately 1.3 million American seniors now reside in nursing homes at an annual cost of more than $83,000 per room. As more of the population comes to retirement age in the next decade, those numbers are expected to triple. Some seniors, however, are choosing to invest money to modify their current homes to meet specific accessibility needs so they can remain there as long as possible.

The professional building trade refers to it as, “aging in place,” adapting an existing home to serve as a long-term residence including the retrofit of service equipment such as grab bars, ramps, side-entry bathtubs and so on. Other alterations include the widening of hallways, lowering of cabinets and sinks, or the addition of an elevator.

Some builders now offer certified contracting services for the express purpose of refitting a home for longer occupancy, regardless of disability. For the last several years, the National Association of Home Builders (NAHB) has provided a specialized certification called, “Certified Aging in Place Specialist, or CAPS. The program is designed to educate contractors on the latest methods and products for creating a safe, supportive environment in a senior’s existing residence.

The number of seniors living in retirement communities and nursing facilities is expected to triple in the next decade.

Keep in mind that when you hire a Certified Aging in Place Specialist you are buying a service rather than a product. Each CAPS professional draws from a different knowledge base and will approach your project from a unique perspective, focusing on your needs.

Marty Walling, owner of Marty Walling Construction, LLC, in Riverside, Ohio, has been an NAHB Certified Aging in Place Specialist for more than two years. According to Walling, the process should be all about the individual experience and meeting the needs of the resident.

“A CAPS professional is trained to identify and recommend attractive design solutions that create a safe and comfortable environment for individuals who want to age in place,” Walling said. “Aging in place is more than the simple addition of grab bars and bathtub seating. These modifications offer seniors the ability to live in their own home and community safely, independently, and comfortably regardless of age, income, or ability level.”

But not every contractor is right for these kinds of jobs and consumers should do their homework before hiring. The first step is to contact the NAHB to find a CAPS designated builder in your area. This is a niche market and few remodelers have the proper certifications.

Next, have a meeting with the builder in the home to be remodeled and discuss the needs and expectations of the project. Attendees should include the caregiver and, if possible, the individual who will most benefit from the alterations. He or she can demonstrate any accessibility problems in their existing environment so the builder can properly adapt solutions to the need.

Expense and time are also of importance and should be discussed as soon as needs are assessed and products are selected. Walling noted, “Project costs will vary with need but the average bathroom upgrade, for example, takes about two weeks to complete and the resident can remain in the home while the work is done.”

Décor should also be considered when making changes to existing furnishings. “Savvy CAPS builders will work with designers to incorporate color and style to match the home’s décor and do their best to avoid the sterile, hospital look,” Walling said. “There are safety products available that blend right in with the current design of the space which can sometimes make the modifications less obvious.”

It’s also important to stress that this kind of remodel is helpful to all types of people, not just the elderly or disabled. Alterations can be made for any need and it is all about making the homeowner more comfortable and providing them with a feeling of safety, security and ease of access.

If you or a loved one are considering nursing care because of accessibility and you own your home, an Aging in Place upgrade might be the right solution. A CAPS specialist can help you determine what works for you or whether the changes are practical, mechanically and financially. In either case, the safety and security of the resident should be the primary concern.

 

Gery L. Deer is an independent business contributor to WDTN-TV2’s LIVING DAYTON program. More at http://www.gerydeer.com.