How to Prepare for Home Care Needs

Carla Brooks’ 87-year-old mother wanted to remain in her home after she got out of the hospital, but Brooks knew she wouldn’t be able to handle a caregiver’s responsibilities, so she turned to a home health agency, Park Cities Healthcare of Irving.

By PAMELA YIP pyip@dallasnews.com
Staff Writer
Published: 17 October 2014 08:47 PM
Updated: 17 October 2014 08:58 PM
When an elderly loved one needs a caregiver, the first instinct for most of us is to take on the role ourselves.

You may be able to do that for a while, but can you keep it up? It can be challenging when your job and other responsibilities to your own family prevent you from staying with your loved one all the time.

One option is to hire an outside caregiver, either privately on your own or through a home care agency. There are pros and cons to both.

Carla Brooks’ mother collapsed from a benign brain tumor in 2012 when she was 87. After she was discharged from the hospital, she wanted to remain in her home but needed 24-hour care.

“I knew I couldn’t [do it] because I work full time and my job requires some travel,” said Brooks, a finance executive and resident of Heath. “She was a fall risk. You needed someone with the knowledge of palliative care to be able to give them the best care, and I couldn’t do it.”

But Brooks knew exactly what type of caregiver could fill that role.

“I had to have someone — what I would call a baby sitter — who could sit with Mother and made sure that she had her meals and things like that. But I needed someone who could administer medication, as well as keep good track of her vital signs,” Brooks said.

She hired Park Cities Healthcare in Irving, a home health agency that provides services for seniors in their homes.

“It was very important to me because they could monitor her,” said Brooks, whose mother died in February. “When she started to get ill, they were on it right away; therefore her quality of life, as well as her life expectancy, was lengthened due to the fact that they found things right away.”

Your loved one’s needs

Finding the right caregiver depends on matching your loved one’s needs with the correct services or skills provided.

Does your family member need help with bathing, dressing and other hands-on care and activities such as shopping and cleaning? Or does he or she need medical attention?

Does he or she have cognitive problems that pose a safety risk?

Sharon Quick, president of Park Cities Healthcare, gave other questions to consider.

“Have they had multiple hospitalizations in the past year? Have they had a rapid decline in their ability to care for themselves at home? Are they improperly managing or forgetting their medications, losing weight, or having multiple infections such as bladder or respiratory? Are they having to visit the doctor’s office more frequently for these or other issues?”

The answers to these questions will help you find a caregiver who meets the needs of your loved one.

The different types

Depending on your needs, there are several different types of caregiver available. Here’s an overview:

Medical home health: “This can be the Medicare type, which supplies a nurse, physical therapist, occupational therapist, speech therapist and a home health aide only for short-term care and usually only after a hospitalization,” Quick said. “They do not supply around-the-clock caregiving.”

Payment is through Medicare and private insurance, she said.

Families should be aware that Medicare doesn’t pay for independent caregivers, nor will it pay for long-term care provided by an agency. It will only pay for intermittent care.

Private caregiving services: This is home health care that you pay for yourself.

“This is medical caregiving staff, which is around-the-clock care and includes nursing,” Quick said. “If your loved one needs medication management, or has issues that can rapidly change, such as pulmonary disease, congestive heart failure or dementia, which require an RN to work with the patient’s physician — taking orders and changing medications — this is the level of caregiving service you need.”

Those caregivers not only provide patient care, but also cooking, cleaning and transportation. The cost ranges from $17 to $24 an hour and is paid for out of pocket or through long-term care insurance.

Personal assistant service: Sometimes called companion care, this is also private pay, around-the-clock caregiving service, but of the nonskilled type. This is provided through a companion care business.

“The staff is good for cooking, cleaning and basic companion care but are not allowed by law or staffed to provide nursing care,” Quick said. “They are allowed to remind the patient to take their medications but are not allowed to handle them. If your loved one just needs someone a few hours a day to come in and cook for them, tidy up the house and run errands for them, this is a good service.”

The cost ranges from $16 to $24 an hour.

Private hire caregivers/sitters (domestic staff): This is a growing option for people, with costs ranging from $15 to $29 an hour. It doesn’t include any nursing or medication management.

Quick and other experts say families need to be careful with this.

“Private-hire caregivers may or may not actually be certified to work in health care,” Quick said. “Unlike agencies, private hire caregivers are not required to have tuberculosis testing or required vaccinations, nor do they proffer their criminal record and background checks. None that we are aware of are insured/bonded.”

Dee Wadsworth, gerontologist at Preston Hollow Presbyterian Church, agreed, noting that these workers don’t have backgrounds in health care.

“Especially of concern to me is body mechanics — safe transfer from bed to walker, toilet, shower, etc.,” she said. “Additionally a certified home health aide is just that — a trained person to aid those who have health needs.”

Problems can arise if the private-duty caregiver has to miss work, said Kay Paggi, a Dallas geriatric care manager.

“The caregiver becoming ill is a real problem,” she said. “The companion does not want to lose money by not coming to work but if she does come, there is the risk of infecting the care receiver.”

Paggi said it’s safer to use an agency because it can send a substitute when a caregiver is ill.

“Companion agencies are able to place companions in your home 24/7 or any number of hours that you think are needed,” she said. “They are well aware that consistency is optimal and will work to use the same companion, or team of companions, consistently.”

In any case, make sure you ask lots of questions about a caregiver’s background and experience and whether the caregiver would be compatible with your loved one.

“Can they handle an elderly person who says ‘You fluffed my pillows incorrectly’ or ‘There’s dust there’ or ‘I want it this way’?” Brooks said. “There are going to be parents like that.”

Where to get help

The Texas Department of Aging and Disability Services licenses and regulates home health agencies in the state. 512-438-3011; www.dads.state.tx.us