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If you are tired of being called a Baby
Boomer, take heart, you may now fall into the Sandwich
Generation. The Family Caregiver Alliance (FCA) estimates that
between 20% and 40% of caregivers have children under age 18 to
care for in addition to an aging relative. If you are female,
you are 72% more likely than a male to be the one responsible.
The predicament that many primary caregivers find themselves in
is they don’t have the luxury of being able to stay at home.
The FCA fact sheet reveals that nearly two-thirds of family
caregivers are employed outside the home. Therefore, it is a
real necessity for families to rely upon hired caregivers to
assist them.
The one arena of the health care field that
continues to grow is home health care and yet, it continues to
be the least understood. Home health care can be divided into
three major categories: intermittent home health visits, private
duty nursing, and home hospice care.
Virtually any service that can be provided
to a patient in a hospital can be provided in the home utilizing
Intermittent Home Health Visits. This evolution of intermittent
home health visits has kept pace with the shorter and shorter
hospital stays. In addition to skilled nursing visits and
rehabilitation therapies (physical, occupational, and speech), a
patient can have an I.V. at home, oxygen , and even an X-ray.
These services are ordered by a physician as dictated by the
diagnosis, typically following a minimum 3-day hospital stay. A
patient does not always need a new diagnosis or in-patient stay,
however, to qualify. An exacerbation of an existing illness,
such as diabetes or multiple sclerosis makes a person eligible
for home nursing or therapy. The only stipulation is that the
patient be home bound. Home health visits are covered by
Medicare, Medicaid, or private insurance.
The second type of care that can be
provided in the home is Home Hospice care. Hospice is a special
way of caring for terminally ill patients, providing
compassionate end of life care to patients and their families
through a team of hospice professionals. The care that hospice
provides is meant to help make the most of the last months of
life by giving comfort and relief from pain. The focus is on
care, not cure. Hospice benefits are covered through Medicare,
Medicaid and most private insurance companies.
The third type of care found in the home is
private duty nursing. The predicament that many primary
caregivers find themselves in is they don’t have the luxury of
being able to stay at home. The FCA fact sheet reveals that
nearly two-thirds of family caregivers are employed outside the
home. It can become a real necessity for families to rely upon
private duty nursing services.
There are two types of private duty care – licensed and
non-licensed. Licensed private duty care is provided by
licensed healthcare providers, such as a registered nurse or a
licensed vocational (practical) nurse. It is utilized in cases
such as ventilator dependent patients, spinal cord injury
patients, or medically fragile children. This type of care is
typically reimbursed by private insurance or Medicaid.
Non-licensed private duty care is known in insurance company
lingo as “custodial” care. Assisting the frail elderly with
activities of daily living is not considered a medical need,
therefore, it is not covered by Medicare, Medicaid, nor most
private insurance policies. Unfortunately, this is the most
common reason for needing private duty care. The only type of
insurance that covers this type of care is long term care
insurance. Different plans have different benefits, however.
The caregivers associated with custodial private duty care are
certified nurse assistants (CNA), personal care attendants or
homemaker/companions. CNAs go to school for their training,
pass a state exam, are fingerprinted and cleared through the
Department of Justice. They are also required to have CPR
training. Personal care attendants and homemaker/companions
have not taken a certifying state exam, but that does not mean
they aren’t well trained to care for frail elderly patients.
The deciding factor for determining what level of custodial care
is necessary is determined by the need for hands-on care.
Too often, we see members of our family obligated to move into
nursing homes or assisted living facilities because their
frailty or other medical condition would make it unsafe for them
to be at home alone. They are not necessarily sick, they just
have difficulty performing activities of daily living, such as
bathing, dressing, eating independently, toileting, etc. It may
not be possible for them to be completely independent because
they cannot do their own grocery shopping or meal preparation.
They may be forgetful about taking their medications, or be at
risk for falling down. Most seniors will want to remain in
their own home or not feel like a burden in their children’s
home. They resist the loss of independence that a supervised
living environment creates.
The next major consideration is how much time do you really need
someone? Not every person requires 24-hour assistance. As the
customer, you are entitled to tailor private duty care to suit
your needs. The usual minimum amount of time is a four hour
shift. You may decide that you don’t need someone every day, or
only Monday through Friday, or you need to arrange for care
because you are the primary caregiver for an ill relative and
you need some respite. A bath package purchased from a
healthcare agency, which provides a skilled bather a few times
per week may suit your needs. If you require 24-hour care, do
you want a live-in, or do you want a rotation of three,
eight-hour or two, twelve-hour shifts? The advantage of shift
care over live-in care is you always have someone awake watching
the patient. For the restless or wandering individual, this may
be a necessity. You may only need shift care at night if your
concern is the danger of falling when going to the bathroom,
especially if your family member is frail and/or has limited
vision.
When utilizing an agency to provide your caregiver, be sure to
review all of the expectations of care and work with the agency
to determine the appropriate level of care to meet your needs. Sherry Netherland is available for seminars for community and
professional groups, Corporate Wellness Programs, or as a
keynote speaker for your organization. |
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