"People are always asking me when I'm going to retire. Why should I? I've got it two ways - I'm still making movies, and I'm a senior citizen, so I can see myself at half price." - George F. Burns
It isn't always necessary, or even appropriate, to place an elder in assisted living or a care facility. In fact, the goal really is to maintain independence and keep one's loved ones at home as long as possible.
There are different types of home health care, and there are variations on those, too. Sheila Smith, owner/ administrator for Alternative Home Health, says that plans are decided on a case-by-case basis, depending on what a senior wants or needs.
Medical equipment like a walker can help seniors stay in the home and stay mobile with that extra support. Caregivers should make sure that he or she can operate the equipment properly and is comfortable using it.
A few small, inexpensive items can make independence easier and safer for seniors. A neck cord for eyeglasses keeps them close so they aren’t misplaced; night lights are an inexpensive way to light dark hallways or rooms after dark; a pillbox keeps track of medicines and can be filled once a week by a caregiver or by the senior to stay on schedule.
Wearing sensible shoes is one way to stay safe inside and outside the home. Another is making sure throw rugs are intact with non-skid pads underneath.
"I would say that 80 percent of our patients would rather be at home than in a hospital or nursing facility," Smith noted. "No one really says they don't want to go home. Each patient is unique, though. The challenge lies in identifying any barriers to their treatments. Do they need equipment? What services are necessary? How much interaction will be needed with the physician? How many of our resources will we need to put into their case?"
There are basically two kinds of home health care, skilled and non-skilled. Skilled care involves medical care and is ordered by a physician, the majority of the time after an illness, accident or hospital stay. Caregivers can include nurses, physical therapists, speech therapists, social workers and health aides and are required to be Medicare certified.
They are able to take vital signs like blood pressure and heart rate, as well as administer medications, blood tests and IVs. They dress wounds and help the patient regain physical movement. All results are reported to the doctor for any adjustments in "maintaining or elevating the patient's status." Smith adds that some patients elect to spend their final days at home, and, in those cases, skilled staff monitor and manage their deterioration.
Some seniors are reasonably healthy and just need or want some assistance with daily tasks. Non-skilled caregivers, or paraprofessionals, are available for this type of care without a doctor's order. They provide homemaking services like light cleaning, doing dishes, grocery shopping and laundry and personal care services such as bathing, dressing and monitoring medications. This type of care helps keep the client out of assisted living or a nursing facility if he or she has a manageable health issue such as diabetes, arthritis or cardiovascular disease.
Ankota, a company that develops health care management systems, says that 70 percent of home health care clients are over 65 years old. Their research indicates that more people will be using home services because hospitals are releasing patients sooner, the general population is aging and more illnesses and more complex treatments will be managed at home.
In its 10th annual "Cost of Care Survey," Genworth Financial found that home care is a viable and even preferable option for long term care. In the United States, the average cost of a private room in a nursing facility rose 4.5 percent annually over the past five years, amounting to $83,950 in 2013. Rates for a semi-private room rose an average of 4.2 percent to $75,555 per year in 2013.
However, their survey found that the median hourly rate for health aide services was $19 per hour last year, an annual increase of 1 percent per year during the past five years. "Health aides," for this survey, help with personal care tasks like bathing and dressing, but no medical care. For homemaker services, the median hourly rate was $18 per hour, up only .84 percent annually for the last five years. Both of these categories are considered non-skilled.
What are some of the considerations when deciding whether a senior could remain at home? The spouse, family members and caregivers should evaluate the situation objectively. The priority is the senior's safety.
Issues to look for inside the home include secure stairs and hand rails if the house is on more than one floor; making sure traffic paths are clear of clutter and other items that could cause a fall; fixing carpets or rugs that are sticking up; possibly installing a safer bathtub or shower; making sure smoke alarms are functional; installing "big button" phones that are easier to see; placing night lights in at least the bedroom, hallway and bathroom; turning the hot water heater thermostat to 120 degrees or below to prevent burning the skin. For stairs, inside and outside, place strips of bright tape on the edges.
If the senior is mobile, make sure that outside walkways are clear and, if there are concrete or paved sidewalks, in good repair. The path to the garage, if it is detached, should be well-lit, and a garage door opener should be installed.
Medications should be clearly marked. Adult children or caregivers should monitor the prescriptions, if possible, to make sure they are being taken according to doctors' orders. One way to do this is setting them up in a pill box for daily use. Even if an elderly spouse is administering them to the other senior, it's no guarantee that it is being done properly. This writer's father insisted on setting out her mother's meds, but, because of his increasing dementia, he would randomly change her dosages. Her mother, who had Alzheimer's, would also hide pills in pockets, drawers or under a pillow if she didn't want to take them.
Caregivers or adult children should also check the expiration dates on the prescriptions. Sometimes doctors will change the dosage or course of medication, and the outdated pills are still in the same cabinet. If the senior is at all confused, this could cause serious complications. Contact a hospital or police department for information on how to dispose of medications, both prescription and over the counter.
Those evaluating the home should consider the possibilities of the senior needing medical equipment. Is the living space on one floor? Is there room to safely maneuver a wheelchair or walker around furniture and through doors? Can a bedroom, living room or dining room accommodate a hospital bed?
Socialization and services are important, too. Does the senior know and have a good relationship with neighbors? Local Senior Centers provide a social outlet with dinners, games, outings and support. In Belmont County, Senior Services also provides meals on wheels. Is transportation available to doctor appointments and grocery shopping if the senior is unable to drive? What about yard maintenance and shoveling snow?
Ankota's statistics say that 80 percent of people over 60 years old prefer to maintain their independence and live at home. Other statistics say that only 10 percent of those in nursing homes live for five years after moving in, and, in fact, an average of 65 percent pass away within one year. Family members should consider trying to keep their elderly relatives at home for as long as they are able. The seniors may be happier and healthier, and thankful for the support.