Where’s the bumper sticker that reads: ‘Adult child on board.’ Something that alerts others that the driver is stressed out, lacks sleep from excessive worrying, and is trying to juggle the lives of those aged 25-75. She’s in her car leaving work for the second time in the past two months to head to the emergency room because Mom fell…again. Does this sound familiar? For many the ‘what do I do now’ is hire home care providers for support but there’s something you should know first – home care doesn’t go far enough.
The situation you are in right now is common among adult children who are faced with caring for their aging parents. The New England Journal of Medicine shows that 1 in 5 people age 65 and older are re-hospitalized within 30 days and 1 in 3 within 90 days after a health care episode. An important question for you as you explore options – how will the home care provider you choose break this health care roller coaster to create the work/life balance you need and the control/independence your parents desire. Here’s what you should know as you consider home care services:
1. Understand the coordination burden. At Homespire, we often hear from families who thought once they got the home care provider in place they’d be done – no more calls at work, no more running around, struggling to balance work and life. Here’s what they didn’t realize: every time the caregiver calls in sick, the burden usually falls back to the family. In addition, they still have to coordinate Mom’s medications, getting her to seven different doctor appointments and managing the different instructions from each of them. It’s one of the reasons we developed our Life Care Management model to provide that missing coordination and ongoing guidance. We also offer a 100% guarantee that no shift goes unfilled. If a caregiver calls in, we fill it, not you.
2. Be wary of a short-term solution for long-term needs. Your mom may be sent home with Medicare home health services and you think it will cover everything. However, Medicare home health services are typically focused on a ‘skilled need’ such as nursing or rehabilitation therapy to help your mom recuperate after an illness or injury. The services are short-term and ‘intermittent’ meaning they are not designed to provide all-day (or night) help. The issue with this is who will cover the overflow of care – driving her to upcoming doctor appointments while you are at work, grocery shopping with her or even playing cards? If you’re worried Mom is most vulnerable at night, home health won’t cover overnight or 24-hour care either. All of these tasks will be left to you or private-pay services to cover the gaps. Another important consideration – Medicare home health is time-limited, it will end and what will you do then to continue her care? Sometimes short-term is all your mom needs, but if she needs more, it is best to start planning as soon as she comes home from the hospital.
3. Evaluate the level of professional guidance. According to Anne Tumlinson, founder of Daughterhood, traditional private-pay home care services do little to change the risks of hospitalizations and adverse events for seniors. Tumlinson, who has spent the last two decades working to improve how America cares for our frailest seniors, cites research from the 2011 National Health and Aging Trends Study that shows that 60% of people who are living in the community with difficulty and receiving paid home care report an adverse consequence associated with unmet needs. She stresses that while in-home care and caregiving services are needed, they don’t go far enough to truly change the outcomes for people. Seniors and their families need more professional guidance; they need livable, connected communities of support. And that starts with a trusted advisor or Life Care Manager (LCM), who works with seniors long term.
With most private-pay home care services, you get a home health aide with some nursing oversight. The missing piece is the professional guidance, not nursing oversight, but someone who can set up a plan that looks at your Mom’s whole person and can coordinate the various services and support needed to reach her goals. The nursing role with many of these home care companies is narrowly focused on supervising the aide and not looking at the whole picture of your parent’s needs and wants.
That’s one of the reasons Homespire created the LCM role. They are registered nurses with extensive home and care management expertise providing personalized care and guidance to assist with everything from accompanying Mom to her doctor’s appointment and managing medications to advocacy, socialization, navigating resources, and dealing with changing needs. Each client gets a dedicated LCM who becomes her go-to person for all aspects of wellbeing.
4. Look for a proactive approach. One of the main reasons home care doesn’t go far enough is that it’s reactive, not proactive. Not only is the focus usually only on your mom’s physical needs and activities of daily living, but home care services are provided AFTER a health crisis has occurred. Most home care client plans do not put in place the professional guidance that helps to proactively catch little issues before they become major crises and land your mother back in the hospital.
5. Know the setting limitations. Most home care providers are unable to follow your Mom when her needs change and she’s hospitalized, goes to a nursing home, or decides to move to a different type of senior living option. The care from traditional home care can’t follow her and it interrupts her continuity of care. You may feel like you are back at the beginning each time she moves as her needs change, when what you really need is care that can move with her across all settings so gaps in care don’t occur.
6. Ask how they plan to reduce her need for care. The goal shouldn’t be to continue services for as long as possible. The goal should be about your mom’s individual needs and what will it take to help your mom so that she is living healthier and more independently. Most home care services aren’t designed to methodically work to reduce the amount of care your mom needs. You only get that when there is a higher level of professional guidance and a proactive approach working together to reduce the adverse events that 2011 National Health and Aging Trends Study found still occur for 60% of the people who have home care.
Check for proven outcomes that show how the provider prevents crises from happening and reduces hospitalizations and ER visits. When issues are caught early before they result in a fall or major health complication, your mom is able to stay as independent at home as possible and is more likely to be able to reduce her need for overall care. While this isn’t possible in every situation, it should be something that is discussed.
Informed decision-making is important when weighing your options for the right solution. We’ve heard many times from other adult children who wish they had known that home care just wasn’t enough to improve outcomes and independence for their aging parent. They assumed these things would be covered but didn’t know the right questions to ask until they were back again juggling and trying to maintain that work/life balance.
Got questions about how you can find that balance? Call 24/7 to learn all your options and overcome the gaps.