Hope Hospice is publishing a five-part monthly series about common family caregiver mistakes. Following is Part 2, a continuation of the previous discussion on preparation. This series is written by Debbie Emerson, MS, Hope Hospice Community Health Educator.
Revisit Part 1: Not Planning in Advance
Revisit Part 1.5: Not having healthcare, financial, and legal affairs in order
One of the most debilitating aspects of being a care partner is the feeling that you’re in this alone, that no one else is helping you. Having a support team in place is essential for the care of your loved one and critical to your own well-being. However, physical distancing recommendations as a result of the COVID-19 pandemic have made it difficult to reach out to family and friends. As you try to keep your loved one and yourself as safe as possible, it has become necessary to minimize or even eliminate in-person contact with others. So of course, you’re feeling even more isolated and overwhelmed.
As our country begins opening up, we hear the term social bubble. This refers to choosing a very small group of family and friends who have been following infection-control measures with whom we can interact for short periods of time in an outdoor or well-ventilated environment.
However, while social bubbles may be acceptable for many, as your loved one’s care partner and advocate you need to carefully assess when and how you may begin to increase contact with others. Just because county health departments say you can begin to interact with others, doesn’t mean that you should. Carefully consider your own health and the health of your loved one, especially if one or both of you have underlying medical conditions. Your loved one’s physician would be the best person to advise you about what is safe for your circumstances.
When I was caring for my mother several years ago, it was necessary for me to supplement her care after a hospital discharge. My mom was not happy with this plan—I was the only one she trusted. She did not want any “strangers” coming into her home, and I must admit that I had the same concerns: What if they’re scammers or steal from us? What if they abuse my mom? How do I know I can count on them to be here when we need them? Are they competent in providing care?
Convincing my mom that it was necessary to bring in someone to help with her care was not easy. I finally relied on one of my tried-and-true tactics of persuasion: Doctor’s orders. She still was not happy, but she gave in. I had overcome the first, and possibly biggest, obstacle to hiring in-home care. But now I was faced with the equally daunting task of figuring out where to begin.
Although you may have been reluctant to do so in the past, now may be a good time to investigate the possibility of hiring in-home help. Agencies are now implementing stricter infection-control precautions for their employees; they are just as concerned about safety as you are.
There are two broad types of in-home care services:
1) Home Health Care. The key word here is health. Home health care is specialized medical care that is ordered by a physician and is administered by trained healthcare professionals such as nurses, physician assistants, physical therapists, occupational therapists, medical social workers, dietitians, etc. Home health care is covered by Medicare and most insurances. These services can continue as long as the patient is homebound and under the care of a physician who certifies that continued treatment is required to maintain the patient’s current condition and/or to prevent decline.
You can obtain lists of home health agencies in your area from a hospital social worker/discharge planner, or possibly your physician’s office. It is your right to choose the agency you prefer.
Medicare’s Home Health Compare is a very helpful online tool for evaluating home health agencies. I wouldn’t even consider hiring a home health agency unless I first checked their reviews on this site.
2) Home Care/Personal Care. This type of in-home assistance offers basic functional, non-medical help such as bathing, dressing, grooming, dining, medication reminders, shopping, light housekeeping, companionship, shopping, etc. This type of care is also referred to as custodial care. Patients must pay out of pocket for services (see below for some options for paying).
Your loved one’s safety and security is of utmost importance when bringing someone into the home to provide care. With the realistic fear of contracting COVID-19, the risks are even greater. So, it is especially important now that you do your due diligence and properly research agencies and/or private contractors prior to hiring.
These days, many of us use online resources such as Google and Yelp to find goods and services. While at first this may seem like an easy, efficient strategy, the problem is that there are thousands of home care options; sorting through them can be overwhelming. And, as with all service providers, there are some that are excellent and reputable, but there are some that are not. It’s easy to fall prey to slick marketing campaigns, especially when you’re in a crisis situation and frantically looking for help.
A good starting point would be to ask for recommendations from trusted friends, family, and medical professionals. They may be able to direct to you a local franchise of a national company (ex., Senior Helpers, Comfort Keepers, Visiting Angels, Honor, etc.) or to a local privately-owned agency. Your community senior center is another excellent source for recommendations. Senior centers may also maintain registries of independent caregivers.
Every county has a local Area Agency on Aging. These are federally funded programs that offer wide-ranging services and assistance to older Americans. Their social workers or case managers can work with you, at no cost, to determine your care needs are and provide recommendations.
A comprehensive, reputable guide for answering all of your questions about in-home care can be found through the Family Caregiver Alliance. This non-profit organization provides Facts and Tip Sheets specifically dedicated to hiring in-home care, including how to evaluate providers and how to work successfully with home care services.
After you’ve reviewed the information from the Family Caregiver Alliance, and once you have a couple of recommendations for home care options from reliable sources, contact the agency or individual to set up a phone interview to begin assessing whether this option is a good fit for your needs.
I’d like to add some tips:
As I mentioned above, Home Health Care is the only in-home service that is covered by Medicare and most other insurances since it is deemed medically necessary by a physician. Personal/home care is usually paid out of pocket since it is considered non-medical care. I’ll be honest with you – it’s expensive. Rates vary greatly depending on type of services, time of day, and geographic location, but the range is somewhere between $18–30/hour, usually with a 2-4 hour minimum. Most people rely on savings, annuities, or reverse mortgages to cover costs. However, there may be other options that can help:
Many of us are uncomfortable bringing in “the strangers,” as my mom called them, to our homes to provide intimate care for our loved ones. That concern is completely understandable. But, with your priorities being the health and safety of your loved one and your own well-being (don’t minimize the importance of this!), it may be one of the best options. Think of it this way: Hiring extra care may prevent a hospitalization or a trip to the emergency room. That in itself is well worth not only the financial cost, but any emotional discomfort. And, you may be pleasantly surprised to find that your paid caregiver may turn out to be a caring and compassionate addition to your bubble.
