Frequently Asked Questions (FAQs) about Elder Care
"How do I know my parents need assistance?"
Some signs that indicate your parent(s) may need assitance are:
* Social activity has decreased, changed relationship patterns
* Participation in previously important activities (i.e. clubs, dining with friends or religious services) has stopped
* The home is no longer clean
* Mom/Dad's appearance is not clean (i.e. clothes are dirty, hair not combed, men not shaving)
* Bills are not being paid and not current; mishandling of finances (i.e. purchasing more than one subscription of magazine or newspaper, purchasing from TV)
* Driving is scary
* Alcohol usage has increased
* No management of pain medications
* Eating habits have changed resulting in weight loss, no appetite or is missing meals
* Behavior has become inappropriate (i.e. being unusually loud or quiet, paranoid or agitated)
* Phone calls are made at inappropriate times or repeat phone calls about the same issues; same conversations
* Participation in holiday and family celebrations or events has ceased
"Who will provide the care?"
Initially, a Professional Geriatric Care Manager can navigate the path for you. You can begin the process by talking to your parents about their life as they age. A good place to start is to bring up their end of life wishes, funeral arrangements. Be open to their ideas and needs and wants. This is not the time to be judgmental. Just listen. The goal is to get the loved one to open up.
"What is a Professional Geriatric Care Manager?"
A Professional Geriatric Care Manager is an experienced guide and resource for families with chronic needs. These professional, advanced degreed health and human service professionals can provide expertise and services. Families develop trust relationships with the Professional Geriatric Care Manager who has the knowledge and skills to assess the older person's physical, emotional and social needs and coordinate services to address the needs.
"How do I know the Professional Geriatric Care Manager is qualified?"
Generally, the professional has a degree in Nursing or Social Work and has experience working in the geriatric community. They are familiar with the community resources available and provide the information to the family.
"How do I access this type of service?"
Call Chapman & Associates at 303-400-0291 and ask for Geriatric Care Services.
"What is the first step?"
The first step we will recommend is an Assessment of the current living situation to determine your loved one's needs. A Care Plan will be developed from this information (with issues identified, intervention/action to be taken, goals, and referral options outlined). A time table for various tasks will be established with person responsible. This document is a very helpful tool to use in communicating between family members, care givers and providers.
"Who does the Assessment?"
The Nurse Case Manager can do the Assessment and provide estimated costs of the recommendations. The Professional Geriatric Care Manager can also make recommendations for a contractor and assistive technology that may be appropriate and helpful. The goal is to keep the loved one in the present situation for as long as possible.
"What is Assistive Technology?"
Assistive Technology refers to tools that help the elderly or disabled perform activities they have always done but now must do differently because of disability and/or limitations. There are many devices and services available to help. A needs assessment can help in defining the most effective devices at the lowest cost. Some examples are:
- Safety alert systems, communication equipment, telephone amplifiers, adaptive switches, wheel chair ramps, walkers, stair elevators, wheelchair lifts, elevated toilet seats
- Orthotic and prosthetic equipment
- Transportation assistance
"Who pays for Assistive Technology?"
Right now, no single insurance plan will pay for all services and/or devices. Medicare, Part B can cover up to 80% if the items meet the "durable medical equipment" description and serve a medical purpose. State-run Medicaid may pay for some Assistive Technology. This varies state to state. VA benefits may also cover some Assistive Technology. You will want to check to see what benefits are available through www.1va.gov/health/index.asp. Another useful site designed to serve as a "one-stop" link with valuable information is http://www.disability.gov.
"What is Home Health and Home Care Services?"
Home Health helps seniors live independently for as long as possible given the limitations of their medical status. Used properly, this service can delay the need for long-term care. Home Health services can include physical and occupational therapy, speech therapy and even some skilled nursing.
There is a difference between Home Health and Home Care Services. Home Health is medically oriented while Home Care Services generally refers to services such as assistance with chores and house cleaning services to assist seniors who may be recovering from an illness or injury. Chapman & Associates can assist with this process in that we have experience with the community and have actual working experience with many of the agencies.
"How do I know that my loved one is getting quality care?"
Talking with friends, neighbors and local agencies on aging gives one the best information for referrals for Home Health and Home Care Services. Here are some questions to consider:
1. Is the agency locally owned or is it nationally owned? How long have they been established in the community?
2. Is the quality of care certified by agencies such as the Joint Commission for Accreditation or Healthcare Organizations?
3. If required, does the agency have a current license to practice?
4. Is the agency an approved Medicare provider?
5. Does the agency provide a list of charges for services and a brochure outlining their service promises?
6. What is the hiring criteria for caregivers? Are references checked? What training to the caregivers receive? How is employee screening handled?
7. Do the caregivers speak the same language as my loved one?
8. How closely are caregivers supervised? What are the quality of care standards that are established? How is patient confidentiality handled?
9. What is the protocol for handling complaints and problems? Who is called and what are the standards for resolving problems? What is the time frame? How is the family member notified of the problem and by whom?
10. Is there available agency staff around the clock, seven days a week, 24 hours a day? When is the Nursing Supervisor called?
"When is Home Health Care appropriate?" (Jones family case study)
It is not always easy to determine when a senior needs Home Health Care or a nursing home. A recent case involved a couple who we will refer to as Mr. and Mrs. Jones. Mr. Jones was ___ years old and was diagnosed with ___. His wife was diagnosed with Alzheimer's and was placed in an Alzheimer's Unit. Over the course of the summer months, Mr. Jones became more and more feeble and unable to take care of his own needs. A caregiver had been hired to come in and assist with his meals, bathing and day-to-day living. Mr. Jones continued to drive and then we learned that he was driving impaired. Chapman & Associates arranged to have him seen by a physician who wrote a prescription to have a driver evaluation. The driver evaluation determined that Mr. Jones should not drive. Working with the physician we were able to have Mr. Jones stop driving. Mr. Jones, after visits to his wife at the Alzheimer's Unit, wanted to bring her home to live with him. There was no way as he was not physically able to care for her needs. His health condition failed daily, he was hospitalized and moved to Hospice. He died soon after placement. His wife's daughter came to town and moved her mother to Georgia. Chapman & Associates worked with the Fiduciary and family members to get the placements and moves made.
"Who pays for Home Health Care?"
Coverage for Home Health Care varies across states and within states. The cost will also fluctuate depending on the type of healthcare professional that is required. Home Care Services can be paid for by the patient or by the family or through private and public sources. Funding for services may be available through Medicare, Medicaid, the Older Americans Act, the Veteran's Administration or private insurance. Medicare pays for the largest amount of services provided their conditions are met. Some conditions are that the patient must be under doctor's care, must need skilled nursing care, occupational, physical or speech therapy or at least intermittently. The services must be provided in accordance with a home health care plan specifically written for the patient and the services must be medically reasonable and necessary and providedby a Medicare-approved agency.
"Just what is hospice care?"
Hospice care programs are available to help terminally ill individuals live their remaining days with dignity. These programs assist the family or caregiver in making the patient as comfortable as possible around the clock, seven days a week.
Hospice is a type of care, not a place of care. It is usually provided in the patient's home or can be provided in a special residence for this purpose. Hospice care addresses not only the physical needs of the patient, but also the psychosocial needs which may include pain control, symptom management and emotional and spiritual support. The team may be made up of the patient, attending physician, nurses, home care aides, clergy, social workers, volunteers and therapist if needed.
Making end of life choices is a very personal process. It depends on one's philosophy of living and spirituality as it does on his/her physical condition and concerns of the family. It is important that patients have reviewed the FIVE WISHES form or provided end of life instructions for those who will be handling this for the patient.
"Who pays for hospice care?"
Medicare, private health insurance and Medicaid cover hospice care for patients who meet eligibility. Private insurance and veteran's benefits may cover hospice care under certain conditions. Many programs offer health services on a sliding fee schedule for patients with limited resources.
Family caregivers and patients facing end of life decisions may have to deal with very difficult issues of grief and loss both before before and after the loved one dies.