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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 fro 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 everyday, 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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