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HOSPICE CARE
Rather than moving into a long-term care facility as they age, many older adults prefer to stay at home for as long as possible. This may be the right choice for you if you only need minor assistance with your daily activities and enjoy a close network of nearby family and friends. These guidelines explore the range of home care services available to help you maintain your independence within the comfort of your own home.
It’s natural to want to stay at home as you grow older. However, taking a step back to look at the big picture can help you decide whether staying at home for the long term truly is the right step for you. Too often, decisions to leave home are suddenly made after a sudden loss or emergency, making adjustments all the more painful and difficult. Take a look at your options, your budget, and some of the alternatives. Your home situation is unique, and several factors will weigh in on the best choice for you. Here are some of the issues in evaluating your options:
- Location and accessibility. Where is your home located? Are you in a rural or suburban area that requires a lot of driving? If you’re in an area with more public transit, is it safe and easily accessible? How much time does it take you to get to services such as shopping or medical appointments?
- Home accessibility and maintenance. Is your home easily modified? Does it have a lot of steps or a steep hill to access? Do you have a large yard that needs to be maintained?
- Support available. Do you have family and friends nearby? How involved are they? Are they able to provide you the support you need? Many older adults prefer to rely on family to provide help, but as your needs increase, they might not be able to fill in all of the gaps. It’s important to consider proximity to community services and activities as well.
- Isolation. If it becomes difficult or impossible for you to leave home without help, isolation can rapidly set in. You may not be able to participate in hobbies you once loved, stay involved in community service that kept you motivated, or visit with friends and family. Losing these connections and support is a recipe for depression.
- Medical conditions. No one can predict the future. However, if you or a loved one has a chronic medical condition that is expected to worsen over time, it’s especially important to think about how you will handle health and mobility problems. What are common complications of your condition, and how will you handle them?
- Finances. Making a budget with anticipated expenses can help you weigh the pros and cons of your situation. Alternate arrangements like assisted living can be expensive, but extensive in-home help can rapidly become expensive as well, especially at higher levels of care and live-in or 24-hour coverage.
You may be used to handling everything yourself, dividing up duties with your spouse, or relying on family members for help. But as circumstances change, it’s good to be aware of all the home care services available that might be of help. What you may need depends on how much support you have, your general health, and your financial situation.
Household maintenance
Keeping a household running smoothly takes a lot of work. If you’re finding it hard to keep up, you can look into laundry, shopping, gardening, housekeeping, and handyman services. If you’re having trouble staying on top of bills and appointments, financial and healthcare management may also be helpful.
Transportation
Transportation is a key issue for older adults. Maybe you’re finding it hard to drive or don’t like to drive at night. Investigating transportation options can help you keep your independence and maintain your social network. You may want to look into local transportation such as buses, reduced fare taxis, and senior transportation options to appointments.
Personal care
Help with activities of daily living, such as dressing, bathing, feeding, or meal preparation, is called personal care or custodial care. You can hire help with personal care, ranging from a few hours a day to live-in care. People who provide this level of care include personal care aides, home care aides, and home health aides. Home health aides might also provide limited assistance with things such as taking blood pressure or offering medication reminders.
Health care
Some health care services can be provided at home by trained professionals, such as occupational therapists, social workers, or home health nurses. Check with your insurance or health service to see what kind of coverage is available, although you may have to cover some cost out of pocket. Hospice care can also be provided at home.
Agency or independent provider?
As you search for home care services, especially personal care and health care, you will probably start getting referrals from full-service agencies, registries, and independent providers. Which is the best option? Here are some issues to consider when considering an agency, registry, or independent provider.
- Full-service agencies usually come at a higher cost, which can be substantial. However, agencies also provide prescreened applicants who have already had background checks. Since the caregiver works for the agency, tax issues and billing can be simpler. You can also check the licensing history of agencies and find out if they are bonded for issues such as theft. If a caregiver quits or is not working out, a replacement can be rapidly provided, and coverage may also be provided if a caregiver calls in sick.
- Registries and independent providers come at a lower cost, but require careful legwork on your part. You need to be aware of any tax and Social Security requirements since in most cases you will be hiring a home care helper as an employee. It’s also good to consider careful background checks and identity verification, since there is no independent verification. You are responsible for backup coverage in case of illness or sudden termination. Even if you are considering these options due to a word of mouth referral, it’s good to be aware of these issues.
Tips for hiring home care providers
How you go about hiring home care providers will partially depend on what kind of help you are looking for, as well as your country of residence. For example, hiring someone to handle shopping or yard maintenance is different from someone to provide hands-on or live-in care. However, there are some basic tips to keep in mind. Remember that the more time and homework you spend in the initial hiring process, the better the chances of success.
- Interview several candidates, in person, before hiring. You could do an initial interview at a public place if you wanted to meet the person first before bringing them to your home. Even if you are working with an agency, it’s important to meet the person who has been matched to make sure it is the right fit.
- Be specific about the tasks that you need, and be sure that the person you are considering is comfortable with those tasks. Ask open-ended questions to assess the person’s experience and competence with these tasks. If you’re hiring an independent provider, it’s a good idea to make a contract outlining the tasks, payment procedures, and termination procedures.
- If you are working with an agency, make sure you understand what is covered. What exactly is covered in a contract? Are there additional fees that apply to specific services or add-ons? If needed, what are the procedures for termination or requesting another provider?
- Check references carefully. Always check references carefully from more than one source. Listen carefully to the person’s tone and information. Are they enthusiastic about the candidate, or are the answers vague and short? Also, look for unexplained gaps in references.
- Do background checks on top candidates. If you’re working through an agency, background checks are often provided, but you’ll want to check exactly what is covered and how the check is done. If you’re considering an independent provider, you can check on the Internet, your local police department, legal aid service, or an attorney for referrals to individuals or companies that do this.
- Don’t be afraid to move on if it’s not the right fit. It’s especially important that you feel comfortable with your provider, since this person is providing services in the privacy of your own home. If you don’t, try talking to the provider to see if that helps. Sometimes miscommunication can be ironed out. If not, don’t be afraid to find another provider and give your current provider notice.
