Choose the Right Home Caregiver
In-home care is often required for an elder to stay at home. To secure quality home care, you must become an informed consumer of services.
Most long-term, in-home services are for such maintenance care as bathing and meals. Typically, families pay the costs out of pocket. Long-term care insurance may cover in-home care. To ensure optimum coverage, review the insurance eligibility requirements carefully.
A caregiver may be acquired through a home care agency, an employment agency or your own means. A home care agency screens applicants and monitors employees. It also pays the employment taxes and carries insurance in case of accident or injury. Many home care agencies are certified to receive Medicare funding and meet minimum government standards.
The hiring of an unaffiliated caregiver through an employment agency or through your own means is less costly than using a home care agency. With an unaffiliated caregiver, there is no ongoing agency involvement. Many such caregivers are excellent, although there is no quality control. Be sure to carefully check references and acquire worker’s compensation insurance.
An unaffiliated caregiver is defined as either an employee or independent contractor. "Anyone who performs services for you is your employee if you can control what will be done and how it will be done," according to the U.S. Treasury Department. If the caregiver is your employee, you must deduct and pay the required employment taxes. An independent contractor defines the work to be done, how it will be done, and must make the tax payments.
To help establish a mutually satisfying relationship with a caregiver:
- Write out a specific plan and job expectations, including personal care
(e.g., bathing, toileting and exercise) and household duties (e.g., meals, shopping and housekeeping), or ask the caregiver for a plan; - Be honest about your elder's temperament, i.e., easygoing or demanding
(remember, someone's behavior may be different with family members than
with others); and - Identify one point person with whom the caregiver can discuss care and employment issues.
In-home care is a highly desirable option for many families, providing you find the right caregiver to match your family's needs and resources, and if you establish a mutually satisfying relationship. With the right caregiver, you can ensure that "there's no place like home" remains a positive refrain for the elder and the entire family.
Questions to ask a home care agency
- What specific services are provided?
- What is the charge for each service your elder may need?
- Is the agency certified to receive Medicare or Medicaid funding?
- Will services be paid by health insurance or Medicare?
- What qualifications are required by the home care agency?
- What specialized training or skills does the caregiver have?
- Who supervises the caregiver?
- Are services available 24 hours a day and on weekends and holidays?
- Will your
elder have a consistent caregiver?
- If a caregiver does not arrive, will someone else be sent?
- What are the agency's safeguards to ensure caregivers are respectful?
- Is a written
care plan provided? How often is it reviewed?
Is it reviewed with the family and the elder's physician? - How are complaints resolved??
Questions to ask an individual caregiver
- What experience
have you had working with individuals who require
care similar to my parent/elder relative?? - What training and skills do you bring to this position??
- What do you enjoy most about working with the elderly??
- How would you handle a situation when an elder refuses medication or care??
- what possible emergencies can you foresee and how would you handle them??
- Whom will you call for help if you have difficulty handling a situation alone??
- Can you provide several references?
Credit: ElderCare Solutions newsletter
Prescription medications improve an elderly person's quality of life. But with medications, as with so many things in life, very often less is more.
Individuals over 65 years old receive a full one-third of all prescription medications and purchase about 70% of all over-the-counter medications. Because of physiological changes, the elderly are at higher risk for adverse drug reactions. Taking numerous medications for one or more chronic conditions increases the risk even further. While adverse drug reactions are estimated to occur in 2-10% of younger adults, that number soars to 20-25% in the elderly.
Among the most common side effects of medications are: cognitive changes, such as confusion, memory loss and sedation; changes in blood pressure; and incontinence or other changes in bladder and bowel functions. Taking more than three different medications increases the risk of a fall. Some of the changes that may be dismissed as part of aging are in fact the result of the adverse effects of medication.
Inherent risks exist in every medication. To help your elders receive the greatest benefit from medications with the fewest side effects, ElderCare Solutions suggests the following:
- Inform all physicians your elder sees of all medications that have been prescribed. An increasing problem in medication management has resulted from multiple medications being prescribed by different specialists for concurrent problems.
- Find out what each drug is intended to do and if there are non-medicinal ways to treat a problem, such as a change in diet or exercise.
- Ask about side effects. Are there foods, medications or activities that should be avoided when taking a medication, and conversely, can foods or activities enhance a medication's effectiveness? How long will the elder need to take a medication? How will you know if it's working?
- Use one pharmacy and establish a relationship with the pharmacist, who is often an untapped wealth of information. Make sure pharmacy records are up to date regarding allergies and drug reactions. Ask your pharmacist about prescription drug interactions with over-the-counter medications.
- Review medications with physicians and pharmacists each time a new medication is prescribed to ensure that the new medication does not adversely interact with others. Periodically review all medications with the physician. Medications are frequently added, but not often eliminated.
- Don't stop taking a medication without consulting your physician. Some medications need to be reduced gradually to prevent detrimental side effects.
Many older adults ask very few questions of their doctor for fear the doctor will think they're "questioning" his or her judgment. Let your elder know you want to be involved to ensure their well-being and your peace of mind.
Responses to medications vary from individual to individual. Family and elder involvement in medication management creates a healthy relationship with your health care provider and in turn can be an important safeguard against health-threatening drug reactions.
Credit: ElderCare Solutions newsletter