• May 21, 2009 at 11:36 pm

    Why home is the best place for Alzheimer’s care
    In-home care for Alzheimer’s disease has been gaining popularity for a number of reasons.

    1. 89 percent of seniors would rather live at home than anywhere else. Senior citizens fear moving into a nursing home and losing their independence more than they fear death, according to a study reported in The Wall Street Journal. 82 percent of baby boomers fear their parents will be mistreated in a nursing home.
    2. Staying at home causes less disruption and agitation. Even under the best conditions, any move is stressful, even for healthy individuals. Simply moving in with a relative poses a huge threat to the delicate balance in the mind of a person with AD. Abandoning the familiarity ingrained over decades living in his or her home can be traumatic. In-home care provides stability, allowing people with AD to remain more grounded, even when the world and people around them seem to be changing.
    3. Home care is safer. Institutionalized residents are at higher risk for developing acute illnesses such as pneumonia, dehydration and even antibiotic-resistant infections. The one-on-one personal attention by an in-home caregiver greatly lowers the risk of such illnesses, especially cross-contamination. Falls—which are often fatal to elderly adults—are twice as common in facilities than in private homes, according to the Annals of Internal Medicine. The close, individualized care and familiar surroundings made possible by in-home care significantly reduce the risk of falling, accidents and wandering.
    4. Home care reduces stress and depression for the whole family. Twenty percent of family caregivers suffer from depression, twice the rate of the general population. The “role reversal” of family caregiving is equally stressful on the relative giving and the one receiving care. Even people with AD remain keenly aware of the increasing physical and mental losses they are suffering. Plus they may feel embarrassed to require a family member (especially their child) to help them with certain issues such as gong to the bathroom. Transitioning to an institution can be even more depressing. An in-home caregiver not only provides respite for the caregiving relative, it requires the minimum stress-inducing change for the loved one who needs the care.
    5. Home care prevents institutionalization. Alzheimer’s disease can quickly render people to care for themselves. Simple tasks like bathing, using the toilet, and preparing meals become difficult ordeals. An in-home caregiver helps AD sufferers accomplish these activities of daily living, right in the comfort and familiarity of their own homes.
    How to find a caregiver
    Once you’ve come to the decision that you’d like to hire an in-home caregiver, where do you look for one? Your parent’s doctor or discharge planner may be able to refer you to a list of caregivers, in-home care agencies, referral agencies or geriatric care managers. Friends, senior centers, benevolent or religious organizations and even long-term care insurance providers are also useful sources for caregiver suggestions.

    • Private hire caregivers can be found advertising in the classifieds section of your local newspapers or online, on such sites as http://www.craigslist.org. Many are found by word of mouth, through friends, senior centers or your place of worship.
    • Referral agencies can be found by searching “senior care referral agencies” online or in the yellow pages. Referral agencies provide suggestions for private hire caregivers and other senior living options. While such agencies handle selection, prescreening for criminal backgrounds and checking references, their responsibility over the caregivers ends there.
    • Professional Geriatric Care Managers can also act as excellent referral sources. You can locate those nearest you (or your parent) through the National Association of Professional Geriatric Care Managers home page at http://www.caremanager.org. In addition to referrals to private hire and full-service agency caregivers, geriatric care managers offer the added advantage of being trained specialists who can assess and oversee the care of your loved one. However, this service comes at an additional cost.
    • Full-service home care agencies are plentiful and can also be located and researched online using terms like “home care” or “senior care.” Many senior centers, hospital discharge planners and other professional organizations also maintain lists of home care agencies. However, such referral lists may not be as current or informative as what you can find yourself during an Internet search. The same shortcomings may be true for phone book yellow pages listings. If you have long-term care insurance, your provider can also help you by providing an excellent list of reputable home care agencies that accept coverage.

    Your best approach is to use more than one of the above listed sources to develop a pool of caregivers you can interview and find the ones who best match your needs and means.
    Comparing private or agency caregivers
    The caregiver recommendations you get will most likely fall into one of two categories: private hire or full-service agency. Each has its advantages and considerations that need to be weighed.
    Private-hired care: a good deal but you’re the boss
    Privately hired caregivers are naturally the more inexpensive option. They are especially advantageous if they come referred to you directly by a friend, coworker or other associate. Nothing beats the first-hand personal reference of someone you know. Many private caregivers come highly experienced, with backgrounds in nursing or social work, and choose to work independently to make higher wages. Such caregivers know the importance of word-of-mouth referrals, an added incentive to maintaining great attitude and conscientiousness.
    The primary trouble with hiring a private caregiver is that it forces you into the role of an employer rather than a client. The responsibilities fall upon you to conduct their background checks, ensure they are legal to work, pay their wages, report their taxes and cover them with your insurance. You also face the nightmare of having to find a last-minute replacement in case your caregiver calls in sick—or doesn’t call in at all. Also, firing a caregiver, should the need arise, is never a pleasant task.
    “We were very lucky we found a long-time family friend who was a nursing assistant. I can’t imagine hiring a stranger off the online classifieds to come into our home,” said Janine Meyers, daughter of a Lewy body disease patient. “I don’t know the first thing about doing a background check, and I wouldn’t want my Mom to become another tragic news story or a statistic!”

    Are the risks worth the savings?
    While cost is a consideration for some families, the hourly savings of hiring an independent caregiver come at a price. “I tell people that when you hire privately, you are not being a wise consumer, says Kathy Johnson, PhD, a geriatric care manager in Palo Alto, CA. “You cannot protect your loved one against caregiver theft or misuse of personal property, until it’s too late.”
    There are plenty of horror stories in geriatric care industry about families who have hired unqualified, untrustworthy or even inhumane caregivers. Excessive
    long-distance phone bills, missing cash or jewelry, extra miles on the family car, are just a few of the scenarios that are all too common when a private caregiver is on a job. “I’ve seen it myself,” says Dr. Johnson. “I know it is something most people who are considering a private hire don’t think about.”
    Even worse, you can’t protect loved ones against abuse from private caregivers, which is often subtle. “I’ve seen so-called caregivers leave diapers on until soaking, bring their relatives into the house to take over while they do errands, or spend hours on their cell phones while the client sits in front of a TV,” she notes.
    Unless you intend to visit your loved one every day, you have no guarantee that the private caregiver is doing the right things. A good agency, on the other hand, will conduct surprise visits, ongoing supervision, preparation and review of a Plan of Care. Thorough follow-through and follow-up on the Plan of Care by agency personnel is your guarantee your loved one is receiving superior, consistent care.
    When families seek a nanny or baby sitter for their children, they always want the very best they can afford. However, when it comes to care for their aging parents, some people consider price-shopping as an acceptable behavior. Is the bargain worth the cost of your peace of mind?
    Agency-provided care: getting more for what you pay for
    While less than the cost of most institutionalized care, full-service home care agencies may charge double the cost of an independent caregiver. However, agencies handle the major aspects of hiring a caregiver for you and eliminate the headaches of management and scheduling.
    Agencies know their business reputation depends on assuring their caregivers are experienced, competent, professional and safe. Therefore their services normally include:
    • Conducting thorough checks of employees’ criminal backgrounds, DMV records and legal work authorizations
    • Checking multiple references and work experience
    • Providing worker’s compensation insurance
    • Bonding or maintaining liability insurance
    • Handling collection or reporting of all payroll taxes
    “To protect our clients, we go the additional step of checking multi-state criminal records, including reports of elder abuse,” Chris Ensmann, president of Home Care Assistance of Dallas/Fort Worth. “We also require all of our caregivers to pass a unique psychological exam, written and assessed by PhD psychologists at our corporate headquarters, to verify honesty and conscientiousness.”
    One of the greatest advantages of working with an agency is that they handle the challenge of supervising caregivers, replacing a caregiver who isn’t a good fit and supplying a substitute caregiver when a hired one will be absent. “We chose Home Care Assistance because we know we can call them for anything, 24/7, “ says Ken Bailey, of Houston. “They’ve even managed an emergency scheduling request we made within a hour!”
    With a privately-hired caregiver, you’re on your own. Hiring a caregiver from an agency also reduces the risk of contagious disease infection by making it possible for a caregiver who is ill to call in sick, knowing his or her shift can be quickly covered with the help of the agency’s staffing coordinator.
    What to look for in a caregiver or home care provider
    Finding the caregiver who is right for your loved one requires some research. Following is a checklist of questions to ask potential caregivers or providers, to help you determine which is best for you.
    1. How experienced is the caregiver, and/or how long has this provider been in operation?
    2. What references come on behalf of the caregiver or this provider?
    3. What is the caregiver’s criminal background, driving and work legality, or how does this agency screen caregivers?
    4. What are the services offered and their associated fees? Is there a minimum charge or long-term contact required? Does the caregiver or this provider furnish written statements explaining all of the costs and payment options associated with home care? Do they accept long-term care insurance? Do they take credit cards?
    5. What special training does the caregiver have? Does this provider train its employees?
    6. Is the caregiver insured ad bonded? Does this agency cover employees with liability insurance against client injury or loss of property?
    7. Would the caregiver be comfortable with surprise visits, or does this agency conduct unannounced visits periodically to evaluate the client’s quality of care and re-evaluate home care needs?
    8. How does the agency follow up on and resolve problems? Do case managers consult the client’s family members, geriatric care managers and other care professionals related to the case?
    9. Is the client’s course of care documented, detailing the specific tasks to be carried out by the caregiver? Does this provider take time to educate family members on the care being administered to the client?
    10. What procedures do the caregiver or this provider have in place to handle emergencies? Are caregivers available 24 hours a day, seven days a week? Will the agency guarantee the caregiver will show up, or at least work to immediate replace a caregiver who is unable to arrive for an assigned shift do to illness or other issue?
    11. Will the home care provider to supply you with a list of references, such as GCMs, discharge planners, clients or their family members, and community leaders who are familiar with the provider’s quality of service? Is the home care provider accredited by the Better Business Bureau?
    12. Does this provider offer to let you meet with a number of potential caregivers, to see which seem most compatible with our loved one and you?
    The ideal home care agency for you should be able to answer all the above questions with a “Yes.”

    The caregiver interview
    When selecting a home care agency or a caregiver, you should ask open-ended questions that will prompt more than a simple “yes or no” response. Ask for previous, real-life examples of problem-solving with other clients similar to your parent. Look for a caregiver who communicates well. Caregivers should be good listeners and should be able to repeat instructions back to you. Make sure the caregiver is compatible with you or your parent, so time together can be enjoyable. Discuss with the caregiver some appropriate actions to common situations that may arise with your loved one.
    Remember that a home care provider and caregivers strive to ensure your loved one not only survives, but also thrives with the highest possible quality of life. Their purpose is to enable your elder relative—and you—continue to live the healthy and independent life you both deserve.

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