MedScope: Medical Alert Systems

America has an abundance of elder-care facilities. The Yellow Pages are filled with businesses that specialize in caring for the elderly. They have life-care facilities that offer patients lifetime care, nursing homes that supply medical needs, and acute care for our loved ones. I’ve read that this type of extensive care can range form $2,000 to $ 4,000 per month. Some care facilities may charge as much  as $50,000  to $300,000 as a deposit for a lifetime care service.

These nursing homes are necessary, and I’m glad they’re available. However, like my Grandma before me, I believe there’s no better medicine for great-grandma or great-grandpa then to be a part of their daily lives, to see and hear the sights and sounds of a household, to smell the aroma of a favorite recipe simmering on the kitchen stove,  to hear the sound of a grandchild’s  tears and laugher- the whole nine yards of sharing the invigorating experience of life-in-progress.

In Grandma’s day taking in the elderly meant adding to an already crowded household. It meant three or four generations under one roof.  At times there would be slamming of doors, arguments galore and hurtful words screamed out in anger. It also meant there would be shrieks of joy, plenty of encouraging words, doors being opened, shared disappointments, comfort, hugs, and kisses while all the while he music of Puccini echoed down the hall. Most of all, it meant being a family.

I remember asking  Grandma how she tolerated having to care for her ailing parents as well as the inconvenience of so many generations crowding  her household?  Grandma smiled and responded with an old-world tale written by Jacob Grimm. It’s a generational story that has stayed with me all of these years.                                                                    

There once was an old man who lived in a village with his son and his son’s wife and child. The old man was deaf and blind and had trouble eating his food without spilling it. Sometimes, accidentally , the old man would drop his son’s fine china and break it. The son and his wife were disgusted by the old man and made him eat out of a wooden bowl behind the stove. One day the little grandson was working with some pieces of wood. When his father asked him what he was making, the little boy answered, “I’m making a wooden trough  for you and Mother to eat out of when I’m grown up.”  The next day, the old grandfather was back at the table eating outr of his son’s best china. Not another word was said on the matter.

The realization that we’re all going to be there someday is reason enough for compassion

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According to  the latest United State’s census, 29 percent of Americans are under age 18. At the other end of the spectrum, 13 percent are 70 years and older. A figure that is predicted to reach 30 percent by the year 2050.  

Those of us born during World War II suddenly find ourselves on the sunny side of that 13 percent. We remember our Grandparents’ and how, when they were our age,  we thought of them as being old and wise. Judging by the aches and pains in my joints every morning, I pretty much have the “old”  part down pat, but sometimes I wonder if I’ll  ever be as wise.

As I explore the world of senior citizen, I also discover that my role with my  parents is changing– that parent is becoming child and child is becoming parent. Hopefully, by the time you reach this stage in life, you’ve successfully raised your own kids, they’ve grown up, matured and moved out of your house and now have children of their own. While your kids were growing up, your parents were growing old. While the grand kids were becoming stronger, more independent, your parents were becoming weaker and more dependent.

They call this period in our lives the “golden years,” though I don’t know why. Perhaps it’s because, like gold, the days are fewer and more precious. Or maybe it refers to the “Golden Age” believed by Greek and Roman poets to be the time when one lives in the ideal state of happiness and prosperity.

Either way, neither of these definitions accurately describes these so-called golden years or helps to make the journey though them any less  complex, nor does it answer the Question, “When did parent become child and child become parent?”

I think the transformation begins when we stop asking and start telling our parents what to do: when we stop taking advice and start giving it: when we drive them to the doctor, dentist and grocery store: take them shopping for new clothes and shoes and insist they buy the most practical; take them to the market and suggest hamburger instead of steak because it’s easier to chew. It begins the first time we remind them to take their vitamins, wear a warm coat and stay out of the rain. It starts when we haven’t heard from them in a few days and we start to panic. You know: all the same loving, but aggravating, things they’ve been doing for us for more than half a century.

Role reversal isn’t anything new. It’s been going on since man began walking upright, pairing off and forming families. but how we deal with our elderly has changed, In Grandma’s day the elderly or infirm weren’t deposited in nursing homes; they were cared for at home by their adult children, just as their parents did before them and so on. If it’s at all possible, it’s a practice my generation will uphold.

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How do I choose a home care provider?
The questions below will help you choose the home care provider that is appropriate for your medical needs and family situation. Regardless of whether the care you seek is skilled or home support care, it is important that you know the answers to the following questions.

What should I consider when hiring privately or through an agency?

AGENCY:
*Is the agency performing criminal background checks?
*How long and what geographical areas are covered in the background check they perform?
*What are the experience levels and specialties of aides available?
*Will the agency be responsible for finding a replacement caregiver if my regular aide is sick or on vacation?
*What hours can I speak to someone from the agency?
*Is the agency licensed and bonded?

PRIVATELY:
*Should the family perform a background check?
*What is the aid’s previous experience?
*Who will replace my caregiver if they are sick or on vacation?
*Does the caregiver have any type of licenses or certifications?
*Do I have to do reference checking?
*Who will be my advocate if I have a problem with my
caregiver?

Points to consider when choosing a home care provider:

— How can I cancel the service I requested?

— How much is the cancellation charge?

— Who do I call if my caregiver is unable to work?

— What is their phone number?

— What are the fees?

— What exactly is covered by those fees?

— Will the agency respond to requests for “short notice” services?

— Is there an extra charge for these services?

— Is there a minimum or a maximum number of hours of home care service per day?

— Is there a minimum or a maximum number of days of home care service per week?

— Is there someone available to assist me 24 hours a day, 7 days a week?

— How long will it take someone to return my call after business hours?

— How do I make changes to the initial caregiver schedule?

— Do the aides provide transportation if needed?

— What type of screening does the agency perform?

— How long will I wait for service after placing my request?

— Will the same caregiver assist me every day or will it be somebody different?

— Will someone from the agency call to see if I am satisfied with the services provided to me?

— How often will they call and check-in with me?

— Will I be responsible for providing meals for the caregiver?

— Will my live-in caregiver require a private bedroom?

— Will my caregiver clean my house and do my laundry?

— Do I need to sign a contract with the agency?

— How long is the contract good for?

— What does it entail?

— Do I need to have a qualified, elder law attorney review this contract before signing it?

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Home care includes a wide variety of services—from skilled intravenous therapy to snow shoveling—all provided to individuals in their homes or in an assisted, nursing, or hospital facility. Home care often supplements the care individuals receive in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.
Whether performed in the comfort of their own homes or in a facility, home care helps seniors to maintain their independence. Additionally, home care prevents the full responsibility of caregiving from falling on friends and family. These services are intended to promote, maintain, or restore health and help individuals to manage the responsibilities of daily life. Aides and nursing professionals can be engaged privately or through an agency.

What types of Home Care are available?
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section.
Home Support Care – is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not yet require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments. Training and certifications will vary from provider to provider.
Skilled Nursing Care – is care that is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

How much will Home Care services cost, and who will pay for them?
Home Support Care – is traditionally a “private-pay” service, which means that it is an out-of-pocket expense for the customer. Prices range from $10-$20 per hour. However, most long-term care insurance policies will cover home support care. You should carefully review your long term care insurance policy with your insurance agent to be sure that the type and amount of coverage you will need will be covered. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.
Skilled Nursing Care – will be paid for by Medicare, a government program that covers some of the medical needs of seniors over the age of 65, as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Be sure to fully understand what Medicare and your health insurance policy will cover before making arrangements for skilled nursing care. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.
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We hear all the time about the “graying” of America, as Baby Boomers get set to retire. And these Baby Boomers, for the most part, plan to stay put in their own homes. In fact, a recent AARP survey examining the opinions of Americans over the age of 45 on current and future housing situations found that the majority plans to stay in their current residence for as long as possible.

Combine this information with the Center for Disease Control’s findings that falls are the leading cause of injury deaths among people 65 years and older and 60% of these fatal falls happen at home, and it is no wonder that there is a growing trend among homebuilders and remodelers to create “universal design” living spaces.

Universal design homes need to accommodate occupants with decreased health, vision, mobility, hearing, dexterity and income. There are a number of ways that new houses can be designed, or existing houses can be remodeled, to make life easier for people with such limitations, whether they be elderly or a teenager with a ski injury. And the bonus is that such modifications usually make the home more comfortable for everyone. The concept of universal design works for all.

Most issues related to universal design fit into one of three categories: convenience, safety/health, and economy. Designs for convenience include anything that makes life easier, such as automatic garage door openers, lighted switches, lever handles for doors and faucets, wheelchair ramps, home elevators and stair lifts, wider halls and doors, intercom systems, taller toilets, openings without raised thresholds (including shower stalls), among many others.

Safety considerations include adjusting water temperature to avoid scalding injuries, good lighting, installation of smoke detectors, placement of handrails and grab-bars, removal of slippery throw rugs and generally reducing clutter and obstacles.
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Before opening your home to any service provider, including in-home caregivers, you should take a few steps to make sure that you protect yourself and the caregiver. Taking these steps does not demonstrate a lack of trust in the provider, nor does it mean that they are not trustworthy. It is simply logical to make sure that you look after your assets. You should place any of the following items in a safety deposit box or other secure location:

• Small valuables

• Irreplaceable or sentimental items

• Small family heirlooms

Let family members know that you have removed these items from the house and that they are safe. By taking these simple steps, you can make sure that you, your family, and your caregiver do not have to face the problems that arise when precious items are misplaced.
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Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.

Coverage by other financing options will vary widely, but the follow services, programs, or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:
Ø Is the provider Medicare/Medicaid certified?
Ø If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).
Ø How many years has the provider been in business?
Ø Is the provider associated with a larger health care group or hospital?
Ø Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?
Ø Will the agency help you find the best homecare options for you?
Ø Does the provider have a written policy describing the patient’s rights?
Ø Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
Ø Will the provider give you written information describing how they commence and discontinue services to patients?
Ø What backup does the patient have if their caregiver cannot show up at the scheduled time?
Ø What are the internal complaint procedures?
Ø Will the provider give a list of citations they have received from state surveyors over the past year?
Ø Does the provider have a nursing supervisor on call and available 24 hours per day?
Ø How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
Ø What types of reimbursements will the agency accept?
Ø Will the provider give a list of references?

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