How to Search for Services and Support
When it is clear that Elder Care is needed the first question to consider is, where will it be provided? Where to Plant Pop!
Be forewarned. This stuff is heavily marketed on the "Internet Marketing Machine". You need to find unbiased information sites and be able to wade through the jargon.
So let's discuss the "where" details first ...
Sorting out Places and Types of Care is confusing. There are 10 types, each with different levels of service, expectations and costs. There is often a progression over time, from Home Care through steps of more help and more expensive care. The costs escalate from $10 thousand to $100 thousand a year. And sadly, in many expensive formal settings, the staff and aides are minimally trained and lightly supervised.
The number 1 finding on State inspection reports is… lack of trained personnel. Infection control is also an ongoing concern, causing expensive hospital visits.
Marketing companies are always inventing new names for these facilities, so beware that the actual C.A.R.E. may not be what you expect.
75% of Facilities are privately owned for profit.
Some things to consider before you start.
Avoid the "Rabbit Hole" effect. You search the internet and get sucked down, chasing every sales lead presented to you. You will end up bewildered, exhausted and confused. Worse, you give up and will settle for the next person who is nice to you telling you what you want to hear.
Many web sites appear to be independent sources of help but, in reality are just listing referrals that charge the providers to be listed and then get payed to Plant Pop.
Are the good ones listed or just the ones that pay for the listing? They then get a commission if you choose one.
An absolutely terrific non biased, non sale web site is www.payingforseniorcare.com. It has custom drop down menus to fit whatever your question or situation may be. Very comprehensive maze buster.
Set up a file early, yes, a paper file, to track your quest and diary your thoughts and impressions.
Again, the area of Long Term and Elder Care both private and governmental, is not very well regulated, underfunded, understaffed, and undertrained.
You need to consult Federal and State ratings and reviews available on the internet, for any services or providers that you are considering before you engage them.(There are links below). You should go beyond Nice Lobby and Fish Tank impressions. Even talk to relatives of current residents.
Types and Places for LTC Eldercare
Informal In Home Personal Care
Many folks start here. House and bath modifications may be needed. Family may take shifts and professional visits may need frequent scheduling. Faith based and community based services can be helpful. After 6 months, other options are often considered due to strain on family caregivers and or progression of need.
Communal Day Care
Provides a place to go for lunch and friends while giving a break to the caregiver or if they go to a job.
Purchased - In Home Care at Home
Family tries to arrange skilled care to visit in 2 or 3 shifts a day. This looks like "aging in place". Hired homemakers, companions and caregivers too. Costs become prohibitive. Nightmare to manage.
Become a tenant in a senior focused location with some services, lots of amenities, and fun. Younger. The ability to walk without assistance may be a factor in admittance or not being able to stay at the facility.
Small Informal "Care" Home in a Neighborhood
A small house that has few beds (3 to 5 or more) to provide limited care. Usually approved by the state and less expensive. Limited capability. Can be great or terrible.
A facility that feels less institutional than a Nursing Home with activities, meals, services that vary greatly between facilities even though inspected by State and Feds. Private or double apartments, limited nurse and doctor services and memory care. ER trips are common. Usually private pay. Continuous communication problems between family and staff. Moves for cause to other facilities happen due to behavior or lack of service.
Memory Care Facility
Lock down facility. Some say "Memory Rehab" but that’s impossible. Residents may be controlled by drugs, though less so lately. Pleasant calming surroundings.
Usually do not keep residents beyond the 4th of 7 stages of Alzheimer's. Then they go to a Nursing Home.
Nursing Home, Skilled
A facility regulated and inspected by Feds and States. They feel like and are run as institutions. There is a formal complaint system of Ombudsman run by the States.
The level of nursing and medical care varies between locations and times. Staff and directors come and go. Visiting doctors can be frustrated dealing with lesser trained aides. Some take MedicAID.
Graduated Care Community or CCC
A large facility that offers to move residents through different levels of care within the same campus. Minimizes anxiety of moves as elder and family are familiar with staff at each inter facility move. Very expensive with a large $$$ buy in up front. Long waiting lists are common.
Public Hospice and Private Palliative Care
Public service actually covered by Medicare for 6 months end of life. Private ones are also available and more personal and private pay. They are about comfort and pain free dignity.
Extended Care by Family at Home
Home care by family members sounds easy. After all, the Mrs or your Daughter cared for the kids. How hard can it be? Wrong! Just one example... the diapers and the messes are much bigger. Home care by family members can be extremely difficult, dangerous and stressful.
Dementia and Stroke present the worst problems and the worst stress. Meanness and combativeness can wreak havoc on the caregiver and the entire family. Lack of caregiver sleep is very problematic and leads to real decline in caregiver health as well. There is no expectation of getting better, no light at the end of the tunnel.
Short of a Nursing Home or a Dementia Care facility there are few instructions on how to actually how to provide Extended Home Care by Family. AARP.com has several sections that are helpful. Agingcare.com/caregiving is a gem. Detailed How to provide care books are practically non existent. One called "Caregiving at Home&auot; is 15 years old but still available from Amazon.com.
Even the American Caregivers Association is not much help as they seem to just support the facility industry aide training dilema. Lots of web sites and books offer tips and support for the caregiver but fail to say much about how to actually provide care to Mom or Dad.
Federal Sources and Agencies
Start with the Federal, State and Local agencies. They are largely staffed by hard working folks who are not selling anything. After you have narrowed your search and BEFORE you visit a facility check the Quality reports available on most State websites. For the example resource for Texas click here and for Iowa click here
Medicare.gov Nursing Home Comparison - A national comparison site for local Nursing Homes, Assisted Living not included. Results often differ from State Inspection reports.
Longtermcare.gov by US Dept of Health and Human Services, is a comprehensive site, great resource finder. Labels it’s info from companies. Others do not.
National Association of Area Agencies on Aging - Find your State Area Agency on Aging (AAA) program with local offices serving all counties in every state. It’s a Federal program that also runs Aging and Disability Resource Centers.
AAA provides Free phone help on Medicare and Medicaid benefits, coordination of care, and Caregiver services. They also manage the State Ombudsman programs that mitigates in nursing home care problem disputes.
Search for Aging Services and Support
Each State has a department that acts as management and liaison with Federal programs and helps seniors and disabled folks.
For Information and Help look up your State by one of these names. Aging.... Department, Division, Agency, Unit, Board, Administration, Office, Bureau, Council or Commission that handles Matters of Aging and Disabilities. For example, the AZ Dept. of Economic Security, The WV Bureau of Senior Services or MN Board on Aging.
Beware of Marketing interruptions presented to you by private companies while you search.
County and City Resources
Most have some services and supports available. Many are based on income and ability to pay. Lots of programs and services from Senior Centers that have low cost lunches, Health and Activity offerings. There are income and other qualifications to consider, however.
New Technology also can help
The next few years will see an explosion of Affordable Technology solutions to help with health and status monitoring, and feelings of loneliness, helplessness and uselessness. This will be so important in light of the draconian Federal and State funding cut backs for in person extended care.
- Echo Show – Hands free picture computer visits and much more. "Hi Dad, How are you today, you look good". It’s Way beyond Skype.
- Biosensics Frailty Meter – wireless range of motion test to gage health from a distance, you OK, Mom?
- Care@home – about town monitor pendant Not just around the house anymore. No phone needed.
- Optando – Easy Skype for Geezers and Gals
- UnaliWear – Kenanga super smart watch actually acts as a caregiver. Funny name great job and user appeal.
- PillPack.com – A Month of pills in day packs mailed at no extra cost to home. Very convenient. De-confuses it.
- Depending on the word New… the old standbys of IChat, Smart phones and alert pendants still are an option.
Advances in care have been slow and we need to try to affect change in all care arenas through advocacy.
Geri - The future of Extended Care
Meet GERI (Get Effective Rehab Interaction)
Affordable Technology to the rescue. It communicates with the Doctor, the Person in Care and the Family.
GERI is not real yet. But her type of assistance interface may well save the day in the near future for Elder and Rehabilitative care. Why?
We now really do know how to make Cure and Care services more effective and less costly. We see glimpses of this future in current solution attempts and studies.
We actually know how to make improvements in re-admit and first admissions (Homes, Hospitals and Hospice) which can save up to 40% in costs and untold emotional and physical suffering of elders and Families. What will that save in Hospital admissions and other costs in the future? What savings in at home care?
Many factors will make this type of assistance the only alternative.
The Boomer Age Bomb will hit harder adding to the number of elderly needing Services and Supports.
Our Government will continue to duck financial responsibility in Elder care area.
Over worked, under paid, under trained Care workers will continue to abandon care careers.
The care Facility industry will make less profit and shrink causing very long wait times for admission.
GERI does lots of things. Mostly through voice activation.
"She talks you through your care per your diagnosis and needs." Manages your drugs and calendar daily.
Keeps you in picture contact with family, friends and help.
And alerts those who can help with any problems.
She is much more than just a push button to wear around your neck.
She's an interactive partner who knows your care plan and well being.
- Remote vital signs monitoring every day communicated to family for Doctor alert.
- Assurance that medicine is taken as directed.
- Foot balance status. (One fall and the ball game may be over).
- Notification of wakefulness (Sun downing all night? a real problem)
- Location monitoring while at home (Bed?) or at the local park.
- Foods selection and blood sugar level monitoring.
- Most important are reminders to follow Out of Hospital instructions when sent home.
Research studies have shown vast improvement in elder care groups who live at home and are monitored and managed to improve their life through providing proper care management. The largest improvements are seen in forestalling repeat visits to Cure facilities like ERs and Hospitals, which are sometimes needed but can actually be destructive to health, emotional and mental status of frail Elders. Huge cost savings to the Government and Health care industry are possible.
So when will GERI be ready? Most of these interactions and protocols are already offered as individual pieces of the puzzle. Problems in implementation will include patent shares, liabilities and Care Industry turf battles. And Government involvement will have to be overcome, too.
But many large and small players are already working on it.
It's gonna happen, soon. There is no other way. And it will make care much more efficient and affordable than it is today.