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As any family caregiver knows, your commitment to your loved one is beyond question. Whether you’ve been providing care for a month, a year, or a decade, you’ve clearly dedicated yourself to ensuring that your loved one has the best care and quality of life possible for as long as possible.
There may come a time in any caregiving relationship, however, when outside help is needed to maintain that quality of care. This help may be necessary on a temporary basis or it may be crucial to keeping your loved one in his/her home. When that time comes, knowing just a little about the different aspects of home care will go a long way toward making you feel more in control.
What is Home Health Care?
Home care is a general term that represents a wide range of community-based services, from supporting someone who is recuperating from an acute situation, such as a hip fracture, to providing in-home healthcare services to an individual with an ongoing chronic condition such as Alzheimer’s disease or cerebral palsy.
While the skills and duties of home care personnel vary, all have one thing in common: they make it possible for care recipients to remain at home in a safe environment and, in some cases, to have more independence than they did before. In the process, they also provide family caregivers with a chance to replenish their depleted physical and emotional reserves.
Increasing numbers of patients need continuing professional medical services when they return home. Professional home health care services includes a broad range of care and support services for those who are recovering from a hospital stay, who are disabled, chronically- or terminally-ill, and need medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Home care services are typically provided by home care organizations. There are a variety of home care organizations, including Medicare certified home health care agencies, Visiting Nurse Agencies (VNAs); hospices; area agencies on aging, homemaker agencies; staff and private duty nursing agencies. Other companies may be utilized to deliver specialized services and products such as medical equipment and supplies, pharmaceuticals, and drug infusion therapy.
Home health care agencies or Visiting Nurse Agencies (VNAs) care for patients of all ages, from infants to the elderly. They offer comprehensive services from maternal/child health programs to hospice care (link to hospice page). These services can include, but are not limited to the following:
- Skilled nursing
- Rehabilitation therapies: physical, occupational & speech-language
- Medical social services and counseling
- Case management
- Home health aide services
VNAs can also offer specialized home health care such as:
- Parental and enteral nutritional therapy
- Infusion therapy
- Behavioral and mental health counseling
- Hospice and palliative care
- Home medical equipment
- Educational advice
- Wound care
- Pain management
- Home safety instructions
Who needs home health care?
- Older Americans who have health problems, but who want to maintain their independence in their homes with the support of a professional caregiver.
- Patients of all ages who return home after surgery, and need care, supervision or assistance.
- Patients who have complex treatments that require use of medical equipment and/or medication monitoring.
- Mothers and newborns, home from the hospital after 24 or 48 hours who are in need of further education, support and clinical assessment skills of a trained nurse.
- Young adults, recovering from accidents or injuries, who can manage on their own – if they know an experienced healthcare worker will be there when needed.
- Mentally ill adults who need support to remain in the mainstream of their community
- Adults who want their parents to have quality care at home.
- And millions of Americans with chronic diseases and disabilities, like Alzheimer’s, heart failure, kidney disease, or diabetes, who need careful monitoring but do not want or need to enter a nursing home or skilled care facility.
Who is a Caregiver?
A caregiver assists an older relative or friend who has physical or mental impairment. The surviving spouse or common-law partner is often the primary caregiver; however, others, including adult children, neighbors or friends may also qualify as primary caregivers in some cases.
Some examples are taking someone to the doctor or shopping; assisting him or her with bill-paying; providing emotional support; and/or assisting with bathing or dressing. You do not have to be living with the person or providing 24-hour care to be considered a caregiver.
Is home care right for my loved one or me?
It’s natural to want to stay at home as you grow older. However, taking a step back to look at the big picture can help you decide whether staying at home for the long term truly is the right step for you. Too often, decisions to leave home are suddenly made after a sudden loss or emergency, making adjustments all the more painful and difficult. Take a look at your options, your budget, and some of the alternatives.
Deciding whether to stay at home
Your home situation is unique, and several factors will weigh in on the best choice for you. Here are some of the issues in evaluating your options:
Location and accessibility.
Where is your home located? Are you in a rural or suburban area that requires a lot of driving? If you’re in an area with more public transit, is it safe and easily accessible? How much time does it take you to get to services such as shopping or medical appointments?
Home accessibility and maintenance.
Is your home easily modified? Does it have a lot of steps or a steep hill to access? Do you have a large yard that needs to be maintained?
Do you have family and friends nearby? How involved are they? Are they able to provide you the support you need? Many older adults prefer to rely on family to provide help, but as your needs increase, they might not be able to fill in all of the gaps. It’s important to consider proximity to community services and activities as well.
If it becomes difficult or impossible for you to leave home without help, isolation can rapidly set in. You may not be able to participate in hobbies you once loved, stay involved in community service that kept you motivated, or visit with friends and family. Losing these connections and support is a recipe for depression.
No one can predict the future. However, if you or a loved one has a chronic medical condition that is expected to worsen over time, it’s especially important to think about how you will handle health and mobility problems. What are common complications of your condition, and how will you handle them?
Making a budget with anticipated expenses can help you weigh the pros and cons of your situation. Alternate arrangements like assisted living can be expensive, but extensive in-home help can rapidly become expensive as well, especially at higher levels of care and live-in or 24-hour coverage.
Involving loved ones in home care services
Everyone has different family structures and support. In deciding your own options, take a look at your own family structure, culture, and the expectations you and family members might have. You may have already made alternate plans, preferring to keep family as little involved as possible.
Perhaps you and your family want to work out a system where caregiving by family is your primary support for staying in the home. Or it could be that work, health issues or location of your family may not make this feasible. Your family could live far away and prefer that you live with them or move close instead, which would mean giving up a local support system.
While this conversation may not be easy, it’s better to discuss these issues earlier than to wait for an emergency when options may be more limited. An independent opinion, such as a home assessment by a geriatric case manager or consulting with other professionals, can be helpful in defusing family tensions too.
You have the final decision as to where you want to live, but input from family members is also helpful. Are they worried about your safety or a health problem such as Alzheimer’s that will eventually require heavy care? Listening to concerns and keeping communication open is key.
Even if you have strong family support, be open to the idea of having other help too. Many people have an initial feeling of “not wanting strangers in the house.” But caregiving can be physically and emotionally exhausting, especially if it is primarily on one person such as a spouse. Your relationships will be healthier if you are open to the idea of getting help from more than one source.
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