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In 2005, according to Family Caregiver Alliance (FCA) statistics, the majority of caregivers in the United States (83%) are family members. The typical caregiver is a 46 year old female with some college experience who provides more than 20 hours of care each week to a loved one. In addition, she may be also working full-time and/or taking care of young children. Another large population of caregivers is spouses. Half (53%) of all caregivers reported that their health had gotten worse due to caregiving and said that the decline in their health affected their ability to provide care (National Alliance for Caregiving, 2004). Additionally the National Alliance for Caregiving (NAC) reported caregivers do not go to the doctor because they put their family’s needs first (67%), or they put the care recipient’s needs over their own (57%). More than half (51%) said they do not have time to take care of themselves and almost half (49%) said they are too tired to do so (2004).
In light of the above statistics, it is easy to see how caregiver burn out occurs and more important – to realize the need for respite for caregivers of any age. What resources are available to help “take care of the caregiver?” There are several that provide reliable options: In-home Home Care, Adult Day Centers (ADC), and facility-based respite stays.
In-home Home Care provides for caregivers to come into the home (private residence, Independent Living, Assisted Living) on a scheduled or as-needed basis. Some Home Care Agencies or Personal Service Agencies that offer these services have background checked, drug tested, insured, trained employees (Certified Nursing Assistants, Home Health Aides or the like) who come into the home to provide assistance with Activities of Daily Living (ADLs) such as bathing, dressing, transferring, toileting, meal prep, medication reminders, as well as companionship and light housekeeping. They are also able to take the individual to the doctor and on errands or outings. This gives the caregiver an opportunity to leave the home or to continue to work outside the home without worrying about their loved one. The cost of these services usually ranges from approximately $20-25/hour. Mileage may be additional if the caregiver uses his or her car to transport the client. The cost of these services may be covered by long-term care insurance (LTC) and the VA Aide and Attendance benefit. This coverage will vary from policy to policy under LTC and will be based on financial qualification for the VA benefit.
Adult Day Centers are another viable option if the cared for individual is easily transported. These centers are community-based group programs designed to meet the needs of seniors and other adults who require supervised care. They help the participants to continue live in the community, relieve stress on caregivers, and reduce the cost of care by preventing or delaying nursing home placement. ADC usually have half- or full-day enrollment options and open early and close late to allow caregivers who work the opportunity to drop off before and pick-up after work. Some centers have transportation for an additional charge. Adult day services provide a variety of health, social, recreational and therapeutic activities. While the services offered by ADC vary from location to location, they may include AM/PM snacks, lunch, activities, outings, current events, exercises, medication administration and some even offer bathing (usually at an additional charge). Depending upon the program, the cost of ADC can range from $45 – $65/day along with a one-time enrollment fee ($50-$75). This cost is approximately one-fourth the cost of nursing home care.
Respite Stays are utilized by caregivers who need an extended length of time away from their loved one for whatever reason (vacation, illness, work, etc.). These stays are offered by senior living communities and provide the senior room and board, medication reminders/administration, involvement in facility activities, transportation, assistance with ADLs, and whatever else may be needed. The cost varies widely from facility to facility and is not covered by Medicare. There are some senior communities who require a minimum stay of two weeks, while others have reduced the length of stay to only one week or perhaps just a weekend. Not all senior living communities offer this service, so it is recommended to check with each one individually. It is always advisable to visit a facility before making a decision for your loved one. Due to the increasing popularity of respite stays, advance planning will allow for a better selection.
Regardless of which option a caregiver selects, the need for respite from caregiving cannot be overstated. What would happen to your loved one if suddenly you, the caregiver, were taken ill and could no longer provide care? What would your loved one do or where would your loved one go? The answer is unpleasant and most likely not an option you would have chosen with the luxury of time on your side.
By Nancy Hanley, RN
Geriatric Care Manager
There may a come a time when adult children feel the need to have their parents nearer to them. This is typically prompted by a change in health or cognition of the senior, or the logistics of trying to care for parents long-distance. Whatever the trigger, there are numerous aspects to consider when orchestrating the move. If the move is out of state, the details become more involved and require thorough pre-planning.
Where to Live
First to consider is where a senior will live once relocated. Will the senior reside with the adult child? If so, and the adult child works, is the senior able to remain alone at home during the day? If not, where is the most appropriate setting for the senior to live? This will be dependent upon the health status and functionality of the senior. Exploring options for senior living communities is highly recommended once it is determined how much support the senior requires. Continuing Care Retirement Communities offer one good option as they allow older adults to “age in place” through a continuum of care, beginning with Independent Living, progressing to Assisted Living, and then if the need arises moving to either Memory Care or Long-term Care (Nursing Home).
How to Move
A second aspect to consider is how to physically move a senior. Obviously the shorter the distance; the easier the move. However, relocating a loved one from say Florida to Indiana will require some advanced planning. Is a family member able to drive/fly down to Florida, close down the senior’s home, and transport the senior back to Indiana? If not, perhaps it would be wise to consider the use of a Senior Move Manager who can facilitate the entire move from packing, to donation of unwanted goods, to ordering a moving van. A reliable source for Senior Move Managers can be found at: www.nasmm.com.
If a senior is on traditional Medicare, there should be no insurance changes required. However if the senior is on a HMO/PPO (Advantage Program), it’s necessary to apply for new coverage in the new state of residence. There are certain requirements/restrictions for making this change, so consulting an insurance benefits specialist is recommended.
Along with the physical act of relocating are the “administrative” aspects associated with uprooting a senior. Things to consider are: insurance coverage; transferring medical records and insuring all legal documents remain valid if the move is out-of-state. It is prudent to review all legal documents/designations every 2-3 years to make sure that they are as up-to-date as possible. Individuals who are designees may no longer be capable/in a position to serve in their roles, so changes are required.
For example, if a spouse is the Power of Attorney (POA) and has been recently been diagnosed with cognitive impairment, it would be wise to name another person to fill this role. While some legal documents will be honored from state to state, it is always best to have them reviewed by an attorney in the new state of residence.
Transferring medical records from one provider to another is always a challenge so it is recommend that seniors request their records well in advance of their move and hand-deliver them to their new providers. This assures that records will not be lost or misplaced in the paper maze of the new provider’s practice inbox.
Locating New Providers
It is recommended to choose new medical providers as soon as possible, before the need arises. There are several avenues by which to do this – professional referrals from one’s old provider, personal referrals from family and friends, or using a system such as Healthgrades. Healthgrades is a website (www.healthgrades.com) that provides comprehensive information on all types of providers, including specialists. It also “grades” each on a 5-star system with 5 being the best. Healthgrades can also reveal whether or not a provider has/had any sanctions, such as malpractice suits. One important question to consider when locating a new provider is whether or not the new provider accepts Medicare, as some are limiting the number of Medicare patients they accept or even rejecting all Medicare patients.
Geriatric Care Managers (GCM) are good resources to consult prior to relocating senior loved ones. They can offer invaluable advice and helpful tips to make the transition process less stressful for the caregiver(s) as well as the senior. Should the caregiver not have the time or desire to initiate the moving process, a GCM is able to oversee the entire process from start to finish.
By Nancy Hanley, RN
Geriatric Care Manager
In an attempt to help seniors remain independent and in their own homes longer, many families opt to hire private caregivers for their loved ones. The rationale for this decision is usually driven by cost. Typically, “cutting out the middle-man” is a savings but the pitfalls of making this decision are numerous. There are many aspects to consider if you are the “boss” of a caregiver and families need to be aware of the ramifications.
To start, many families think that the neighbor across the street would be a perfect caregiver for their loved one. While this may be true, what back-up plan is in place if the neighbor becomes ill, gets into an automobile accident, or goes out of town to visit family? Or better yet, using a relative as a caregiver is a win-win situation for both the senior and the relative. The relative gets paid to take care of one of her own / his own loved ones. Again, when an emergent situation arises, who will step in? This does not happen when a home care agency is in place, as they have a pool of caregivers ready to send when needed.
Perhaps the most important aspects to consider when hiring a private caregiver are the tax obligations, legal issues and required insurance coverage. Whether the household help is a part-time or full-time employee, as an employer one is obligated to withhold and pay Social Security and Medicare taxes. The amount withheld would be based on the current IRS tax code. Employers of caregivers in Indiana are required to withhold State income taxes on any compensation paid and are required to pay Federal and State unemployment taxes for caregivers earning $1000 per quarter.
Employers of private duty caregivers are also responsible for verifying that their employee is legally entitled to work in the United States. A thorough employer should perform drug testing and background checks, both local and national. In addition, checking references is a good source for first-hand information about the proposed caregiver.
One aspect that many “bosses” fail to consider is Workers’ Compensation Insurance. Injuries while on the job pose one of the greatest financial risks. If there is no Workers’ Compensation Insurance and a caregiver is hurt while caring for the families’ loved one, the family who hires a private caregiver is responsible for medical expenses and disability. One should not assume that Homeowner’s Insurance alone will cover this, as many policies exclude help in the home. Another risk arises if a discrimination or harassment suit would be filed. Purchasing an umbrella policy with a discrimination rider can be expensive but will provide added protection should the need arise.
One would think that the solution to the problem would be to hire caregivers through a home care agency. While many times this is the case, there are unfortunately some agencies who hire private contractors thus skirting the responsibility of being the “employer”. These types of agencies generally find the caregiver and place them in a home setting, leaving the family vulnerable to all of the aspects discussed above. This situation can be avoided by hiring caregivers who are employed by an agency and pay the agency directly. Home care agencies who are members of the National Private Duty Association (NPDA) www.privatedutyhomecare.org/ fall into this category.
If a family is willing and prepared to take on the role of “boss” then a private caregiver may be a good fit for them, providing they have a contingency plan in place in the event of an emergency. Proactive planning is the hallmark in dealing with many of the issues that seniors and their loved ones face. Today more and more baby boomers are seeking help for their aging parents. It is a wise decision to consult with an attorney or accountant before becoming the employer of household help to insure that all aspects of legal and tax responsibilities are realized.
By Nancy Hanley, RN
Geriatric Care Manager
As we all know, people are living longer. This fact is attributable in part to the advances in medications that help control disease progression and improve quality of life. However, as people age they often end up taking a variety of different medications, both prescription and over-the-counter (supplements, herbals, vitamins), which may result in dangerous side effects and serious drug interactions. In addition, the medications that once were therapeutic at a younger age may have lost their efficacy or are not metabolized adequately by the liver so are more harmful than helpful.
Polypharmacy (defined as “many drugs”) is common in seniors and even more common in those seniors who have more than one provider. Before the advent of specialists (cardiologist, pulmonologists, orthopedists, endocrinologists, etc.) the primary care physician (PCP) oversaw all of the medications for his patients. This is no longer the case. In addition, there are now hospitalists who see patients only while they are in the hospital, adding one more to the list of providers who may be prescribing medications for seniors. Today more than 40% of people over the age of 65 are taking five or more medications. In addition, about one-third of those seniors experience an adverse drug effect—a fall, precipitous drop in blood pressure, confusion or even heart failure.
Medication mismanagement, either taking the incorrect dosage, forgetting to take a medication, or stopping certain medications precipitously, is one of the most common causes of emergency room visits for seniors. A 2008 study found that about half of the 2.1 million visits Americans made to emergency rooms for adverse reactions to medications, or about 1.1 million visits, were made by people age 50 and older. Of that group of visits, about 61% were made by individuals 65 and older, of whom 60.9% were women.
To help address the medication issues faced by seniors and their caregivers, The Beers Criteria [PDF] was developed by the American Geriatrics Society (AGS). These guidelines caution against the use of certain medications in older adults and alerts seniors to risky medications that are potentially harmful for them. While some of the guidelines may seem surprising; cautioning seniors not to take regular Aspirin over the age of 80 or the fact that some antidepressants can cause dangerous drops in sodium levels in the blood, they are important in preventing unnecessary trips to the emergency room as well as possible subsequent hospitalization. There are 53 different medications on this list which was recently updated on March 1, 2012.
In addition, seniors and/or their caregivers should keep an up-to-date comprehensive list of ALL medications they are taking, not just prescription medications, so that each provider is aware what another physician has prescribed. Good communication with the ordering physician is necessary to report any side effects, allergies, or previous health issues which may impact the prescribed medication, positively or negatively.
The use of a weekly medication reminder box will help considerably in medication compliance. It should be set up by a person who is knowledgeable about the medications, their dosages, their administration times, and the reason for taking the medication along with possible side effects. If the senior is not capable of preparing his or her weekly medications then a family member or nurse hired from a skilled home health care company can perform this task for them. Another alternative is to locate a pharmacy which dispenses daily medication doses in pre-packaged envelopes.
It is important to remember that while medications are of benefit, there are inherent risks in even the most innocuous drugs such as Ibuprofen. It is up to the seniors and their families/caregivers to be proactive in order to prevent adverse drug reactions which can only lead to a health crisis.
By Nancy Hanley, RN
Geriatric Care Manager
When was the last time you rode with a senior family member? If it has been awhile, it might be a good idea to plan an outing and ask the older adult if they would mind driving. This is a perfect way to evaluate how safe your senior driver is to both themselves and other drivers. Do they follow too closely; not react quickly enough when braking or stopping; or simply are not as aware of their circumstances as they should be? If the answer is “yes” to any of these questions or you arrived at your destination white-knuckled and stressed out, it’s time to consult with your senior’s primary care physician (PCP) about recommending a driving evaluation. While this is a rather prickly subject that most family members eventually face, it doesn’t have to be a battle, nor does a family member have to be the “bad guy” in taking away the keys to the car.
As we age, we lose the ability to react quickly in sudden situations and / or to physically be able to respond in emergent situations. This may be caused by a cognitive deficit or a decline in physical acuity. For example, a senior with a cognitive issue may become directionally confused or may no longer recognize common road signs. A senior may not hear emergency sirens due to impaired hearing, or not recognize that the light has changed from red to green due to visual disturbances. Or because of neuropathy in their lower extremities, the older adult may not be able to effectively brake or accelerate at the appropriate time.
A driving evaluation is an excellent way to determine whether a senior is capable of driving, or if certain restrictions need to be imposed (e.g. no night driving, no driving on interstates, or with special adaptations for their car). The one-on-one evaluation is administered by an Occupational Therapist. In addition, the senior undergoes a behind-the wheel assessment and is monitored in all safety areas. Then based on the results, recommendations are made to the senior as well as the PCP and designated family members. There are two sites in theIndianapolis area that help evaluate older adults for driving safety. They are:
Easter Seal Crossroads Rehabilitation
4740 Kingsway Drive
Senior Driving and Mobility
4682 Northwest Plaza
West Drive, Suite 12
As mentioned earlier, the driving evaluation must be initiated by a referral from the senior’s primary care physician (PCP). This referral, along with medical information such as diagnoses and medications, is submitted to the evaluation site to aid in performing a comprehensive and accurate evaluation. The objectivity of this evaluation may take some seniors off the road, while extending the driving life of others who are safety compliant with new driving restrictions. In either case, the responsibility of this emotional decision is placed in the hands of a non-family professional.
What is Vial of Life?
Vial of Life or Vial of L.I.F.E. (Lifesaving Information For Emergencies) is a national program that allows individuals to provide key medical information to first responders in the event of an emergency. The vial, usually an empty bottle, plastic sandwich bag, or magnetic sleeve is labeled with a Vial of Life sticker and contains all pertinent medical information needed to treat them - diagnoses, medications, allergies, legal designations, medical providers, and insurance information. The forms to complete the Vial of Life are usually free and may be downloaded from an online source and produced by the individual.
What information should go into my Vial?
- Completed Vial of Life information form
- A picture of yourself (this is to help emergency personnel make sure the information in the Vial matches you if you are in need of help)
- Living Will (if you have one)
- Do Not Resuscitate (DNR) order (if you have one)
- Any other helpful documentation you feel is important for emergency personnel to know – EKG strip, blood type, etc.
Where should I keep my Vial at home?
Once all the necessary paperwork has been put into the Vial of Life with the appropriate sticker on it, place it on top or on the side of the refrigerator. Some individuals choose to keep it in the freezer. Stickers are also placed in the front window of the home so emergency personnel will know to look for the Vial. All first responders are trained to look for the Vial.
Where can I print the forms ?
You can print the Vial of Life form and also the stickers at the Vial of Life website at: www.vialoflife.com. Near the top of the webpage choose “Print a Vial of Life Kit” and from there you may print out the form and / or the stickers. Note: To print the stickers you will need to have adhesive backed paper in your home printer. This type of paper can be purchased at any office supply store.
To learn more about Vial of Life, please visit www.vialoflife.com.