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Living at Home vs. Assisted Living

Author: Helen Dennis, Specialist on Aging

Question: My healthy and independent 86-year-old mother was in a car accident and is recovering at my home. Her arm is in a cast, which limits what she can do. She is still a bit unsteady on her feet and clearly cannot shop, cook, drive or navigate stairs on her own. My brother, who manages her finances, insists she belongs in an assisted living facility. I think such a move will be the beginning of the end. Mother wants to return to her home with some in-home care. I agree.

How can I convince my brother that my mother’s voice should be heard, and where do I begin to find a good agency?

Answer: These decisions are difficult. Perhaps what is most important is your mother’s preference and a realistic assessment of what she needs in the short term.

Let’s begin with your brother’s strong opinion.

As manager of her funds, he may feel responsible for her present and future. Efficiency and effectiveness may be foremost in his thinking. If he assumes at some point your mother will need to move into an assisted living facility, he may think, “Why wait?” He may place efficiency over empathy and short-term needs.

You might consider consulting a geriatric case manager. This type of professional typically is a social worker who understands the physical and emotional needs of an older client and the physical environment of the home. The case manager likely will offer recommendations and options.

Now, let’s move to the topic of home care. It consists of two levels.

Home health care involves a skilled professional, such as a registered nurse, a licensed vocational nurse or a certified nursing assistant. They provide medical care in the home. Registered and vocational nurses conduct assessments of the patient’s condition, change dressings and give injections. Note: A vocational nurse cannot do all that an RN can do.  CNAs perform simple medical procedures such as taking temperatures and changing dressings.

Home care also involves a caregiver such as a home health aide who is trained to provide custodial support in helping with bathing, dressing, eating and housekeeping.

You might choose to go through an agency or hire someone independently.  If the caregiver is an independent contractor and your employee, you are responsible for withholding and paying various payroll taxes on behalf of the caregiver. If the caregiver is from an agency, the agency has that responsibility.

Assuming you go through an agency, here are several questions to ask:

  • Does the agency conduct a background check of their employees?
  • Will the intake professional meet with you and your mother in her home?
  • Does a supervisor review notes taken by the care provider? If the notes reveal any irregularities, such as decreased appetite, does someone follow up?
  • Does the agency belong to CAHSAH (California Association for Health Services at Home)? This is the California trade association for home- and health-care providers.
  • Does the agency offer its employees workers compensation or liability insurance? If the answer is no, the patient/client may be liable for injuries suffered by the care provider.
  • Do they provide an orientation and ongoing training for their employees?
  • Will the care provider be able to determine if your mother needs medical home care that requires a doctor’s order?
  • Does the agency have 24-hour access to voicemail or a live person?
  • Can they provide two references?
  • Ask for the contact person for questions about care or billing.
  • Ask the care provider and or supervisor, “What motivated you to choose home care as a career?”

And here are a few more suggestions:

  • Write down the duties you feel are important for the caregiver to perform, and monitor the performance.
  • Determine who develops the care plan and how it will be reviewed and revised, if needed.
  • Discuss if the caregiver has reliable transportation.

Regarding your brother, perhaps you might consider dividing responsibilities. He may be responsible for finances and you for the hands-on care. Yet, try to engage him in the home-care process.

Thank you for your important question. Best wishes in resolving the differences with your brother and for your mother’s full and speedy recovery.

Copyright 2010 Helen Dennis. All rights reserved.

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Time: June 25, 2010, 6:31 am

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