Options For Elder Care

STEADY RISE IN NURSING HOME AND ASSISTED LIVING RATES CONTINUES IN 2010 ACCORDING TO ANNUAL METLIFE MARKET SURVEY

Nursing home and assisted living rates rose significantly from 2009 to 2010, according to the Market Survey of Long-Term Care Costs. Private room nursing home rates rose 4.6% to $229 per day or $83,585 per year, while assisted living rose 5.2% on average to $3,293 per month, or $39,516 per year. These increases come on top of increases from 2008 to 2009 when both nursing home and assisted living costs were up 3.3%.

Costs for home health aides and adult day services were unchanged in the past year. Home health aide costs remain at an average price of $21 per hour, while adult day services costs are still $67 per day.

The market survey, which includes state and major area details, can be downloaded via: www.MatureMarketInstitute.com.

Hiring In Home Caregivers for Older Adults in Pittsburgh

When your parents start having difficulty with every day tasks, most families feel the solution is to bring in someone to assist in caring for your parent in the home. This may not always be the best course of action as there are numerous medical, environmental, psychosocial and financial issues that have to be considered to assure in-home care is the best option. Options For Elder Care has the expertise to complete this evaluation to assure the best long term decision is made www.optionsforeldercare.com.

A qualified caregiver overseen by a RN who has the clinical knowledge to establishing a professional plan of care and offer direction to the caretaker would be in the best interest of the older adult.

CARETAKER QUALIFICATIONS:

You will see several terms utilized to describe In Home care providers and you may see the job descriptions overlap. Caretakers of all types do not have the education to function independently without over-site by a qualified professional.

1. Certified Nursing Aides (CNA): Have medical training and must pass an exam to get certified. CNA's can check vital signs, care for wounds, transfer techniques, and help with activities of daily living (ADL's) like bathing and dressing. CNA's typically received training under a registered nurse. When working in the home most are agreeable to assisting with household tasks and meal preparation.

2. Home Health Aides: May have some formal training provided by aemployer or can be "self taught" with experience. Typically Home Health Aides can assist with ADL's but did not receive formal training on medical issues. They can also assist with household chores and meal preparation.

3. Personal Care Attendants/Companions: Usually will not provide direct patient care but rather companionship. They can assist with cooking, cleaning, and shopping.

OPTIONS IN CARETAKER FINANCIAL ARRANGEMENTS:

• Hiring a Caregiver directly: Hiring a home care aide through word of mouth or through the classified is usually the least expensive option and the one families think will solve all their problems.  This arrangement can creates legal liabilities for the family which becomes the employer. For instance, you can be held liable for any injury that happens on the job including medical and disability. If you choose to hire them as a contractor you will need to file a 1099 on any wages you pay over $600. You will need to conduct a background check, check prior employment history, complete drug testing, and most importantly, arrangements of this nature may not be the long term solution you are looking for. If you treat them as an employee you will be responsible for paying taxes and benefits such as Social Security and Medicare, income tax withholding, and unemployment tax.This industry has a high turnover rate and there is not a back up should this person leave unexpectedly or become ill. There are always bad apples who will take advantage of vulnerable clients - so make sure you do not unwittingly hire one! It is a good idea to make sure the individual you are hiring is a CNA so you know a registered nurse has trained the person in the basics of care. With that said, hiring someone on your own can be a good idea if you have the time to be the employer, medical education to over see the caretaker, and strong endorsement from someone you know who has used their service.
• Agency Caretakers: The rate an agency charges for staff tends to be higher but agencies will pay for the FICA taxes, cover worker's compensation insurance and screen potential employees backgrounds. You want to make sure the agency bonds and insures their caretakers and that their caretakers have received training on CPR and first aid skills. Most agencies have a large number of caretakers so you may be able to "try out" a few to find a good match. Additionally, the agency should offer you a guarantee of a substitute caregiver if your primary one is sick or on vacation. A quality agency will have a RN who follows up on the care plan, oversees and offers advice to the caregiver.

SETTING CLEAR EXPECTATIONS:

Caretakers are employees, do not try to make them your friends - keep it professional. If your employee thinks of herself as your pal, she may likely take liberties of a friend, not an employee of vulnerable adults.

Set clear expectations as to what she should be doing every moment she is working for you.

• Use a notebook all can write in regarding the care provided for a client
• Have a RN develop a plan of care and assure there is a method for the caretaker to record that she is following the plan of care.
• Should the caretaker bring their own lunch, should they remain 100% awake when working the night shift, run errands, shop, clean, cook?
• What personal care should they provide and using what methods.

As RN Geriatric Care Manager the most common call I receive is from adult children who have concerns about their parent's safety and are looking for in home care to solve this concern. The adult children want to know how much care their parents need and how they can get their parent to accept it. Most of these calls are precipitated following a crisis such as a fall or hospitalization.

In most instances, a parent will not acknowledge they need nor accept the idea of a "stranger in their home." Adult children frequently try to convince their parents they need in home care, resulting in a frustrating experience. In many cases Geriatric Care managers must mediate between the older adults desire to remain independent and their adult children concern for their safety. Through my 35 years of experience I have learned how to work with older adults in ways that respect their need to feel in control of their lives along with helping them recognize that accepting help actually allows them to maintain independence.

To find out more about  how Options For Elder Care can assist you with the in home care of your parent please refer to our web site: www.OptionsForElderCare.com  or          Phone: 412-443-1365

One in Three People Over 70 Have Memory Impairment

Duke University Medical Center

 

 

    
                                                                         

New study illustrates that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment.

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More than a third of people over age 70 have some form of memory loss, according to a national study by a team of researchers at Duke University Medical Center, the University of Michigan, the University of Iowa, the University of Southern California and the RAND Corporation. The group performed the first population-based study to determine the number of people who have some form of cognitive impairment, with and without dementia.

 

While an estimated 3.4 million Americans have dementia, defined as a loss of the ability to function independently, the researchers estimate that another 5.4 million over age 70 have memory loss that disrupts their regular routine but is not severe enough to affect their ability to complete the activities of daily living (ADLs).

 

"These findings illustrate that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment," said Brenda Plassman, Ph.D., associate research professor of psychiatry at Duke and the study's lead author. "Among the people aged 71-79, a sizeable number had cognitive impairment. This is an age at which most people expect to have many productive years ahead."

 

The frequency of memory loss without dementia increased with advancing age and with fewer years of education—similar to the trends seen in dementia.

 

Plassman explained that throughout the course of the study, individuals with cognitive impairment without dementia progressed to dementia at a rate of about 12 percent per year. On average, the mortality rate for the study group was 8 percent annually, but varied across the subtypes of cognitive impairment without dementia. Said Plassman, “While the overall rate of progression to dementia is in line with findings from other studies, the surprising finding here is that some subtypes of cognitive impairment without dementia progressed to dementia at much higher rates, around 20 percent, within one year."

 

Chronic Illnesses Named as Cause

 

Nearly a quarter of those with memory loss without dementia also had a chronic medical condition, such as diabetes or heart disease, that appeared to be the cause of the cognitive impairment. The researchers speculate that this group is one of the most underdiagnosed subtypes of cognitive impairment because doctors are likely focusing on the primary health issue.

 

"Given how common cognitive impairment without dementia is, physicians should be alert to this problem as they evaluate and treat the patient for other medical problems," said Robert B. Wallace, M.D., the study's senior author from the University of Iowa. "This may have significant ramifications because it means that patients may not be able to accurately portray their symptoms and may not retain important information about their treatment."

 

The data, published in the Annals of Internal Medicine, is from the Aging, Demographics and Memory Study, which is part of the larger Health and Retirement Study conducted by the University of Michigan Institute for Social Research and funded by the National Institute on Aging.

 

"As the population ages and works longer, understanding the extent of cognitive impairment in the older population is critically important," notes Richard Suzman, Ph.D., director of the NIA's Behavioral and Social Research Program. "Research is now beginning to suggest that interventions—such as controlling hypertension and diabetes or perhaps cognitive training—might help maintain or improve mental abilities with age. As such interventions are tested and widely applied, we should be able to track their impact through this type of research."

 

"With such a sizable number of Americans with some form of cognitive impairment, many of whom will get dementia, it's imperative to increase research funding that could lead to breakthroughs in Alzheimer's diagnosis, prevention and treatment," said William Thies, Ph.D., vice president of Medical and Scientific Relations for the Alzheimer's Association.

 

Co-authors on the study include Kenneth M. Langa, Gwenith C. Fisher, Steven C. Heeringa, David R. Weir, Mary Beth Ofstedal, James R. Burke, Michael D. Hurd, Guy C. Potter, Willard L. Rodgers, David C. Steffens, John McArdle and Robert J. Willis.

The Vision of a Geriatric Care Manager

I am a runner. That is how I solve my day to day problems. I find the solution for everything when I am on my five mile run at North Park.

After dropping my nine year old off at school I head for Panera's for my morning coffee. There is always a group to welcome me as I enter. The first hello is usually from John who had bypass surgery a few years back and is caring for his mother who is residing in a personal care home. Teddy is having problems with his right knee and will probably need a another knee replacement. There are other's, one caring for a wife with MS, another who's wife was just diagnosed with breast cancer. They all appreciate the advise of a RN Geriatric Care Manager.

After getting my caffeine boost, I am ready for my run and stretching in the parking lot by the boy scout house. There are the "regulars" like Bob and his wife who have been dealing with managing the care of their aging mother on their own for almost a year and Mark who is 90 with rheumatoid arthritis, but still walks 3 miles 5 times a week. As I make the five mile loop, I am stopped several times by the "regulars" for advice on medical or elder care concerns. I am not only assisting them with their concerns but solving my problems in this hour of running. After my run when I am cooling down in the parking lot there is  poor Paul. He  has a tiny dog, Buddy, who appears to have a very enlarged liver and extreme difficulty breathing. Paul and Buddy  are "regulars" to North Park. Buddy hangs out in the car until Paul is done running. Paul and I discuss Buddy regarding aggressive therapy vs palliative therapy. Buddy is in the geriatrics of his life and Paul comes to the decision he will do anything to make Buddy comfortable, but does not want to inflict any treatment that would cause pain or suffering. He also decides that he will not keep Buddy alive for his own personal need to have a companion, but try to make all decisions with what would be best for Buddy. We part on those words.

As I drive home I see a vision of Geriatric Care Management across the Continuum, but I wonder where does it start and when does it end? Let me think about this on my next run.

Until next time, my best,

Bobbi