MedScope: Medical Alert Systems

I was at church when I got the call that my mother had fallen and was taken to the hospital with a possible broken hip. I immediately knew that I had to be with her - to hold her hand and reassure her that everything was ok. My mother had suffered with dementia for over 10 years. Her memory was mostly of her parents and siblings but every now and again she’d surprise us with her moments of “clarity”.

“No need to ask those questions”, I pleaded with the nurse as she began her determined assessment of my mother. “Do you know what year it is?” the nurse asked. As I was intervening to help this young professional understand my mothers’ condition of dementia, it occurred to me that my mothers’ dignity was in question.

At this very moment I realized just how important the role of being a daughter was at this stage in my mothers’ last days. After years of caring for her 10 children it was our time to care for our mother as if she were our own child. Roles were now reversed and guaranteeing our mothers’ dignity became increasingly more important.

“I need to ask these questions – it’s my job”, insisted the nurse. As I persevered to discontinue those questions that were obviously upsetting my mother, she became irritated with both of us. How dare, I, a daughter of 42 years interfere with her expertise? The ‘experienced care-giver’ became insolent with me and asked me if I wanted a new nurse. “Absolutely”, I replied, explaining that the tone she was using with my mother was not acceptable. Within minutes we were greeted with the sweetest nurse who took my mother’s hand in hers, and gently kissed her cheek. Mum instantly warmed up to her – smiling, even through the adversity of all her pain.

When our parents age and become dependent upon us, for both physical and emotional survival, we become parents of our parents. Ensuring that their well-being is properly and lovingly cared for is a full-time job. And it is our job. While not all care giving staff are disrespectful, it only takes one to break their spirit and attack their dignity. This is an unnecessary invasion, preventable with an unconditional love and a gentle kindness.

It’s ok to question and be concerned about the care that your loved one is receiving. In fact, it’s essential. If you don’t, there’s a slim chance that others will assume that vital role. Stand up for what is right. If you have children, remember they learn what they live. Watching loved ones being cared for with a devotion of respect is a teaching experience that no school or university can match.

I am blessed to have such dedicated siblings who took turns sitting with mum for every minute of every day. We cared for mum with a tender and heartfelt love - not all that different from how you would love a newborn baby- caressing her cheek as she slept; combing her hair with our fingers as she looked lovingly into our eyes.

Not long after her stay in hospital, mum passed away – most peacefully, with children near her side. I know that in her heart she felt a proudness in knowing that her children were there to ensure her dignity was kept in tact – and yes – that someone cared.

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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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Part 2 of 2:

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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Part 1 of 2: 

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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