Home Health Care

Most elderly want to stay at home

but are confused about

how Home Health Care can help.

Peter and Mary have lived in their home for over 40 years.  They have loved and cared for the house, the garden and the 4 children they raised there.  Now as they are aging and the children have grown and gone, they find it increasingly difficult to keep up the place.  Basic yard work and housekeeping isn’t being done and daily household chores like cooking and laundry are becoming a bit overwhelming.  Yet despite Peter’s troubles with walking and managing showers and Mary’s failing eyesight, they want to stay at home rather than move into an assisted living facility. They decided to get a Home Health Caregiver who will come and help them out a couple time a week.    

Most elderly and disabled prefer to stay at home and are choosing to use Home Health Care services to make that possible. Home Health Care is a practical and efficient way for individuals with health care or age related issues to get the services they need right in the convenience of their own home. 

There are two types of Home Health Care options, which can be confusing when someone is just starting to look into Home Health as a possible solution to their care needs.

Skilled (Medical) Home Health Care

Skilled or Medical Home Health Care is generally used to help someone get healthy at home. Skilled Home Health is usually recommended after a doctor’s visit or a hospital stay and the care is provided by medical professionals, such as a visiting RN or LPN.  Because the level of care being provided is skilled, the costs can be high.  Skilled Home Health Care is usually limited to just a few hours a week and assists with very specific needs.

With Skilled Home Health Care you can expect:

•   Skilled nursing
•  At-home physical therapy
•  Pain Management
• Caring for wounds
• Prescription management

Non-Medical Home Health Care

Non-Medical Home Health Care is about sustaining and maintaining a quality of life at home.  It is about preserving safety and independence at home for someone who might not be able to remain safe and independent on their own.  Many times the Caregivers who provide these services are Certified Nursing Assistants (CNA).  These services are a lot less expensive than the Skilled Home Health and can be used on a wider scale.  Often those who use Skilled Home Health Care will also have Non-Medical Home Health Care come to help with various tasks to keep the home running smoothly.

With Non-Medical Home Health Care you can expect:

•  Personal grooming services like bathing or assistance getting dressed
•  Ambulation services like assistance getting in and out of the bed/shower
• Medication reminders
• Alzheimer's or Dementia care
• Errands like grocery shopping, picking up prescriptions or transportation to appointments
• Housekeeping, laundry and cooking
• Companionship

Home Health Care Costs

Because both Medical and Non-Medical Home Health can get expensive, people wonder what payment options are available to help with the costs.  The cost of services will vary depending on where you live and the type of services needed.  It is a good idea to shop around and learn what services are provided.  Some Home Health Care agencies have sliding fee scales, and others charge on a per task basis and others provide a Caregiver who can assist with all cares needed at set hourly rate. Non-Medical Home Health Care services are usually paid for privately, but there are also some public and private funding sources.  Funding sources include the following:

•  Medicare
• Medicaid
• The Older Americans Act
• The Veterans’ Administration
• Private insurance

Home Health Care (Skilled or Non-Medical) is a great way to get the assistance needed without having to give up the family home and move into a facility.  As more and more people understand the options available with Home Health Care, it is bound to become a favorite option for families everywhere.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Aging & Staying Positive

A positive attitude about aging plays 

an active role in health.

Life expectancy is increasing in the USA and other wealthy countries, yet as the population ages they are faced with very real prejudice.  Ageism against the elderly population manifests itself throughout the American culture.  From fighting against the “old geezer” stereotype, to the assumption of cognitive or physical impairment, to being the butt of the old timer jokes, today’s elderly constantly battle against Ageism.  In fact nearly 80% of the elderly population report experiencing Ageism. Despite the fact ageism is now recognized a problem in society, it is not decreasing at a fast enough rate.  American culture focuses and idolized youth. Negative stereotypes about the elderly often develop from of fear of the unknown and are established at a young age in a person’s mindset.  This fear of the aging process creates Ageism and is often expressed by the assumption that:

• Elders are slow when they move about.
• Elders are in ill health.
• Elders cannot learn new things.
• Elders are depressed and complain all the time about change.

The stereotype assumes that the elderly are needy, feeble, idle and demanding rather than deserving, yet in reality the majority of elderly today are self-sufficient, middle-class consumers with resources, talent and time to contribute to society. Unfortunately Ageism not only affects how society treats the elderly but also how the elderly perceive themselves.

Reliable research on today’s aging population shows an increased quality of life while aging. This research supports the idea that stereotypes held by people have a direct link to their health and well-being.  For example, Yale University found that older people who hold negative stereotypes about themselves getting older are more likely to display negative response to stress, self-efficacy, cognitive function, and are more likely to have a negative view of their own peers. Not only was it found that negative stereotypes affect performance and attitudes, it was also found that these beliefs contributed to the elderly’s will to live with healthy development.

These stereotypes may hold some value to the people who are suffering with later stages of an incurable diagnosis. Those with health issues who are active and hold a positive outlook on reaching developmental milestones throughout their entire life are not affected by negative stereotypes and do better physically and emotionally. The good news is that holding positive views of ageing has a real beneficial impact on people.  Keeping a positive attitude compared to a negative attitude on aging has been associated with a 44% greater likelihood of recovery from severe disability.

Holding a negative thought about aging is self discriminating.

“If you are a man you are prejudiced against women you will never know how a woman feels. If you are white and you are prejudiced against blacks, you will never know how a black person feels. But if you are young and you are prejudiced against the old, you are indeed prejudiced against yourself, because you, too, will have the honor of being old someday” (Lewis, C 1989)

Changing negative stereotypes is difficult because people hold predetermined social images reinforcing these stereotypes, and thus are resistant to change. Environmental and social impact of being comfortable with aging allows for a positive impact on healthy life choices for all generations.  

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Sources:

Journal of the American Medical Association

 Levy BR, et al "Association between positive age stereotypes and recovery from disability in older persons" JAMA 2012; 308: 1972-1973.

Lewis, C. 1989. How the myths of aging impact rehabilitive care for the older person. Occupational Therapy Forum

Susan Sherriff, CNA and Marketing student, is a contributing writer to Elder Topics as part of a Marketing Internship.  As a member of the HomeAid Health Care team, Susan uses over 10 years of Caregiver experience to assist our elderly and disabled Clients who wish to remain safe and independent at home.  HomeAid is a sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two companies provide comprehensive care that meets the needs of the elderly and disabled in the Fox Valley of Wisconsin.

Sibling Troubles Revived

Caring for aging parents can revive

relationship troubles between siblings.

You grew up together.  You learned, played and fought together as children and were the best of friends and the worst of enemies all at the same time. You know your brothers and sisters well but now that your aging parents need their children to actively help them, you may find working with your siblings to be far more difficult than you ever imagined.

Martha‘s mother recently passed away.  When looking back at the whole experience, Martha could say she was now at peace with it but deeply regretted the relationship damage that took place with her brother and sisters during the months leading up to her mother’s death.  Conflicts over large and small issues drove a deep wedge between the siblings.  There was bickering over medications and doctor appointments.  There was squabbling over spending time with mom.  There was quarreling over who was to help with specific tasks.  There were out and out fights over expenses. It was like all the adults in the family reverted back to childhood battle lines and no one was fighting fair.

United in crisis

Ideally, siblings will unite and work together to care for their parents when they are ill or become too frail to care for themselves.  Yet in real life it is often a crisis that suddenly forces siblings to unite to provide care for an aging loved one.   These crisis situations trigger a lot of family friction.   Conflicts are made worse by brother and sister’s fine-tuned ability to push each other buttons and relive childhood rivalries.  Arguments over care sap the strength out of the family at the time when their parents need them to work together.  It is also very upsetting to the aging parents who depend on their children for help. 

To avoid conflicts siblings need to face the fact early on that they will someday be called on to care for their aging parents.  Preventing disputes over how best to provide that care is ideally done long before any care is needed.  Sitting down with parents before any care issues arise and discussing the realities of aging is the first step to keeping the family intact and working together through the care years later on.

Talk it out ahead of time

Long before the need exists, when the adult children are in their 40’s and the aging parents are roughly in their early 70’s, have a serious talk about the future.  Gather the family and openly discuss the possible scenarios of the parent’s future care needs.  It may feel premature and a bit morbid to discuss your loved one’s mortality, but it is foolish to pretend they will not age or face health issues someday.  Most people avoid this uncomfortable discussion and wait until a crisis forces the issue and then they must make quick decisions which often lead to mistakes, conflicts and frustration.  It is wise to talk about the parent’s wishes and how they could be honored so the entire family has a framework for the future.  Having a general care plan in place will go a long way if a crisis hits and also will serve to lay the ground work for future long term care. 

Figure out who will do what

Recognizing off the bat that the division of labor will never be perfectly fair, discuss among the siblings who could do which tasks and how much money each would be willing to pitch in to pay for care if necessary.  Try to roughly divide up the responsibilities according to ability.  Sketch out a game plan that all members of the family can theoretically agree to. Don’t assume that since you were all raised in the same family that you naturally agree on what is best for mom and dad.  There will be some emotionally intense moments when you will not agree at all and these will test your bond as siblings, so try to define roles and rules ahead of time to ward off extra conflict.

Gather all the important documents

The sibling(s) with strong organizational and finance skills should be appointed the Power of Attorney for finances by the parents.  Everyone in the family should have a clear understanding of under what situations that power would be activated and what tasks the Power of Attorney will take care of.  This sibling should know where all the money and accounts are kept as well as all the insurance and investment paperwork. Once activated, the POA of finance should gather the titles to the house and cars, safety deposit boxes, keys and passwords for all accounts. They should review any long term care insurance and all other insurance policies your parents have set up and understand the fine print about what is covered and how it will be covered.  The sibling in charge of finances will take care of organizing all the important paperwork, arrange the payments for all bills and should keep the rest of the family informed.  The POA of finances will become knowledgeable about their parent’s financial details and be able to manage the available money to cover care and end of life costs.  They will be responsible for exploring public assistance options if the funds run short. 

Health Care Decisions

As parents age, their health care becomes an increasing concern.  From managing their medications and doctor appointments, to helping with mild cognitive issues to working out end of life care, the amount of decisions can be overwhelming.  The sibling who has been appointed POA of health care will have their hands full once their power has been activated.  If the aging parents were clear about their health care directives and where they wish to be when full time care is needed, then the many decisions will not be such a major source of stress.  Yet even with clear guidelines in place there will be many health care issues where conflicting opinions between siblings cause stain.  One family set a rule that the sibling present at the moment gets to make the decision and, once made, it cannot be second guessed.  Even though all agreed to this rule in the beginning, the siblings found it quite difficult to abide by.  Again, it is having a clear understanding of the roles and rules between siblings that make the care years easier to manage. 

With long term family ties, a little grace will go a long way, especially when stressful situations demand a unified working cooperation.  Know ahead of time that all decisions regarding the aging loved ones will not be unanimously accepted but agree to disagree nicely for the sake of the parents and future family relationships. 

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

What you need to know when you are the family Caregiver

Knowing what to expect can make it easier.

Providing care for an elderly loved one feels like the right thing to do.  Often family members grow into the role of Caregiver as their aging parents need more and more help.  A bit of yard work in the fall, help with spring cleaning, driving to doctor appointments and weekly trips to the supermarket are easy to accommodate and most families are happy to have the opportunity to help.   It is when the need for help becomes daily or reaches a point when your elderly loved one isn’t safe living on their own any longer, that families need to make some hard decisions.  Families will often slide into becoming their loved one’s full time Caregiver and then they find themselves providing care for their own young family and their aging parents. 

The Sandwich Generation

A term coined by Carol Abaya in the early 1990’s, the Sandwich Generation describes those in their 50s or 60s who are sandwiched providing care for their aging parents and their adult children and grandchildren. It is a challenging time period for these people as they have demands on their energy and resources from everyone in their family.  Many start out enthusiastic and excited about being able to give back to the one who had raised them, only to become burned out and bitterly disappointed at how their relationships, quality of life and energy levels have been destroyed.

For those who decide to take on the many responsibilities and demands of becoming the Caregiver for their aging loved ones, there are some basic tips which might make providing care easier

Know that you will have to make hard choices

Many don’t realize when they start out as family Caregivers that they are now have taken on the responsibility to make another person’s decisions.  Many times this makes the Caregiver the least favorite person in the family.  Having to decide on an endless list of health care issues, finances and quality of life decisions can be exhausting, but it is often compounded by your loved one not agreeing with what you think is best.  Siblings often add their 2 cents, making basic decisions a multi-leveled negotiation. Many elderly will resist getting input into major decisions believing their independence is being infringed on.  Often they are slow to consider the options and will put making any type of choice permanently on hold.  It is frustrating for those who provide care to be patient and respectful especially when deadlines are looming.

It is wise to have major decisions already determined before they become an issue.  Sit down with your aging loved one and discuss how they want their affairs handled long before they can no longer manage themselves.  Your loved ones can set up directives early which will take the pressure off of you to decide for them later in life.  Life is much easier when medical directives are in place, the will has been made, Power of Attorney for finances and health are set up and end-of-life choices have been decided.

Know that caring for an elderly parent is not like caring for a child

Remember that your aging loved one has lived an entire life before you even came into existence, so treating them as if they were another child is disrespectful and demeaning.  Expect there will be times when their behavior is as stubborn as a toddler’s, but do not respond as you would to a child.  Instead try to find out what is going on and give them the time to discuss their concerns and fears.  Do not expect your loved one to easily adapt to your schedule and ways of doing things.  They are probably pretty set in their ways and have every right to be so.  Also remember that they crave adult interaction and need to be included in your family’s normal life and activities, even if doing so requires a lot of extra effort on your part.  The last thing you want is to have them feel as if their presence is a burden and that they are isolated and lonely and just taking up space in your home.

Know that providing care can be uncomfortably embarrassing

Understand that as your loved ones continue to age, their need for assistance with personal care will increase.  This can cause embarrassment for both generations.  Helping with showering, dressing and toileting can be weird for the adult children of aging parents, but after a few times it will feel less awkward.  Trouble with incontinence and loss of body functions can make everyone cringe and for some it is just easier on relationships to have a professional Caregiver come in a couple times a week to help with personal cares.

Know that providing care will affect your other relationships

Being a Caregiver is a very demanding job.  It requires a servant’s heart at all times and usually without any recognition or thanks.  Most often it is the women in the family who take on this role in addition to all their other duties and responsibilities.  Being stretched to the limit, the family Caregiver will find relationships on all sides bearing the brunt of frustrations, exhaustion and weariness. Interaction between the aging parents and adult children can become strained, as well relationships with everyone else in the family.  People often imagine having multiple generations under the same roof will be wonderful, especially for the younger children.  They fail to realize that the aging have limited tolerance for noise and commotion and would prefer some space from the younger members of the family. 

Know that doctors are interested in prolonging life, not the quality of life

Doctors will be a primary source of information and help as your loved one’s health needs increase.  They are kind, caring and committed to your loved one’s well being, but their main concern is dealing with the physical concerns that prolong life.   This most likely will result in more and more prescriptions for medications, endless office visits and lots of tests.  As the family Caregiver, your job will be to facilitate the doctor orders, to manage the medications and interface between physicians.   It will fall on you to become your loved one’s advocate for health care concerns.  Yet your primary concern should be about making the final years and months comfortable and enjoyable.  Most elderly are far more concerned about quality of life over longevity and if often falls on the family Caregiver to ensure the quality of life through social interaction, conversation, easy projects and just being there to listen. 

Know that you will need help

Being a family Caregiver can be difficult and stressful, especially when providing care for an aging loved one is sandwiched in with all the other demands of life.  While in the midst of providing care, life can get so busy that it is difficult to see the toll that it takes on your energy, relationships and family.  Most families eventually realize that they need help.  Finding a professional Caregiver to come into the home a couple times a week makes an enormous difference.  Respite Care is another option that allows family Caregiver to get away and unwind. 

Families often naively believe that they can provide care for their aging loved ones with minimal stress or stain on their lives.  Since the end goal is enjoying a close and loving relationship with their aging loved ones, knowing what to expect can make it easier to avoid stressful problems for the entire family. 

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Talking about Home Health Care

Having the conversation can be

upsetting to both generations

The holidays are over and you have enjoyed spending quality time with your loved ones.  During your visit you noticed that your mother was often confused and needed a lot more help than she did the last you were together. Doubt and worry about her ability to live alone are your constant companions now as it is obvious that her safety has become an issue.

While debating the possible options you realize that home health care would solve the problem. She could remain at home and have a professional Caregiver come daily to check on her, remind her to take her medications, and help out with the household chores.  The Caregiver could drive her to appointments, supervise showers and generally be there when you can’t.  You want to talk to her about bringing a home health Caregiver into the home, but dread starting a disagreement.

How to talk to your loved ones about getting help:

What to understand:

Most elderly take great pride in their independence.  The idea of having a Caregiver come to the home is embarrassing to them.  It is a sign that they cannot manage alone any longer.  Although they logically understand they will need help someday, most don’t believe that day is now.  Often introducing the use of home health as getting just “a little extra help” around the house is a more acceptable approach.  Mentioning that a Caregiver will do the cleaning and help with the laundry makes the use of outside help a little less threatening.  Once your aging loved one is used to having someone come into the home and that Caregiver has becomes a familiar companion, accepting help from them in other areas is not such an issue.  Typically home health Caregivers provide a wide range of services including housekeeping, laundry, meal preparation, medication reminders, help with personal cares and transportation.  A good Caregiver never infringes on their Client’s independence but works in the background to help when needed.

How to start:

Start a general conversation and be very tactful.  Raise questions about the care of the house.  Just remarking that it must be difficult keeping up such a large place could guide the conversation along the right track.  Most elderly are well aware that the care of the home may be slipping.  Avoid statements that can cause your loved one to become defensive.  Instead, ask if there is anything you can do to help.  If there is a lot of resistance to just talking about it, you might want to wait a bit to mention the idea of home care.  Gently mention your concerns and ask what possible solutions might be considered.  Ask for her ideas of what they would like to do. 

Avoid Elder Speak:  

Your parents are not your children and will not respond well if you speak to them in a   controlling manner. You may be convinced you have found the solution, but announcing what you have decided is disrespectful and will hinder the entire process.  The last thing you want is your loved one to react negatively to your decision and that may taint relationships with you and any Caregiver who comes to the house.  Don’t dictate what needs to happen, but allow your loved one to see the logic of your suggestion.  It is much better to include them in the conversation and really listen to their desires. 

Listen:

Adult children of aging parents are busy and often think things need to happen on their schedule.  The elderly operate at a much slower pace.  Waiting quietly and patiently for an elderly parent to think things over can be difficult.  Listen to what is said and try to understand their anxiety and fear of change.  Let the idea of accepting help settle a bit and after some time re-approach the idea.  A hard sell or nagging about using home health rarely works and since the goal is providing safety and independence at home, most elderly will soon realize that it is the preferred option to moving to an institution.  

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Hydration for Health, Water for Life

Drinking water is a key element in

 maintaining health for the elderly

Wise up on water

Water is often overlooked as one of the six basic nutrients (along with carbohydrates, fats, vitamins, proteins and minerals) needed for positive well-being and better quality of life for the elderly. Water can make a valuable contribution to health in old age. As we get older our body’s receptor for thirst decreases. To stay hydrated do not depend on feeling thirsty. Thirst may not be a reliable guide to tell you when you're becoming dehydrated, especially for older adults.

Evidence for drinking water

Medical evidence shows that good hydration can assist in the management of diabetes, urinary tract infections, incontinence, constipation, kidney stones, heart disease, low blood pressure, cognitive impairment, falls, poor oral health, skin conditions, help prevent pressure ulcers, and many other illnesses.

Proper hydration will increase blood circulation to all vital organs including skin which will prevent and help heal pressure ulcers.  Drinking water will stimulate urination and help the body flush out bacteria. Drinking extra water will help stimulate the bladder for healthy bladder function; experiencing fewer incontinent episodes is one effective way to prevent urinary tract infections.  

Dehydration lowers blood pressure which causes confusion and dizziness. Dehydration is the leading cause of falls.  Balanced hydration is essential for the safety and efficacy of some medications. One class of medications affected by hydration status is the non-steroidal anti-inflammatory drugs NSAIDs (Aspirin, Ibuprofen, Ketoprofen, and Naproxen) which has the potential to cause kidney damage in response to dehydration.

Tips for Water Consumption

• A glass of water five minutes before standing will help stabilize blood pressure and prevent fainting.
• Drink a glass of fresh water when you get up in the morning.
• Have a jug of water readily available with thinly sliced oranges,  limes, lemons, and ice cubes. 
• Drink small quantities throughout the day. Drink water at mealtimes and also between meals.
• Eat  foods high in water content, such as fruits and vegetables
• Substitute hot caffeinated beverages for hot water with pieces of  fruit in it.

Questions

Is tap water safe to drink?

Yes. The United States water supply is completely safe to drink and of high quality.

Do I need to filter or treat my tap water before I serve it to drink?

No. The tap water you receive is carefully monitored, tested and is supplied ready to drink straight from the tap. Sometimes filters will polish the taste slightly, but the same effect can normally be achieved by leaving the water to chill in the fridge this will help take away any chlorine taste.

If I drink more water, will I have increased bladder function?

Yes, for a while, and that’s a very positive change. People will use the toilet more often if they drink more, and while there are perceived problems in the extra effort of more frequent visits, people also need to be aware of the serious ill-effects of not drinking enough and not going to the toilet often enough. Evidence shows, however, that the restriction of overall fluid intake does not reduce urinary incontinence frequency or severity.           

Start drinking early with a fresh glass of water. Promote the fact that water ‘flushes through’ the system and helps to prevent kidney stones, UTIs and constipation. Increased bladder function may also help reduce the need for additional medication.

What are the immediate benefits of hydration? 

Water is an essential nutrient and dehydration is a common problem for the elderly population. There is evidence that improving water intake:

• Reduces constipation and subsequent medication
•  Reduces confusion (with reduced risks of falls and fractures)
• Reduces headaches
• Reduces urinary tract infections
• Improves skin integrity and reduces the risk of pressure sores
• Improves blood pressure
• Reduces consumption of unhealthy caffeine, alcohol, soft drinks and sparkling drinks
• Reduces the cost of providing other commercial beverages. 

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Susan Sherriff, CNA and an Occupational Therapy Assistant student, is a contributing writer to Elder Topics as part of a Marketing Internship.  As a member of the HomeAid Health Care team, Susan uses over 10 years of Caregiver experience to assist our elderly and disabled Clients who wish to remain safe and independent at home.  HomeAid is a sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two companies provide comprehensive care that meets the needs of the elderly and disabled in the Fox Valley of Wisconsin.

Sources:

http://my.clevelandclinic.org

http://www.mayoclinic.org/diseases-conditions/dehydration/basics/definition/con-20030056