Dependent Care

Dependent Care is the form of housing that requires 24 hour/day assistance or long-term care. This will typically be in some form of a nursing home. Long-term care is intended for those with disabilities or chronic, degenerative illnesses who require on-going support over a long period of time.

Just the term "nursing home" can be unsettling to many people bringing to mind some uncomfortable finality. Yet they are often the best housing option if a disabled person requires a variety of services. Most nursing homes are not skilled nursing facilities. A skilled nursing facility provides doctor prescribed services by or under the supervision of licensed nursing personnel. In most situations, they participate in Medicare in varying degrees.

The decision to move Dad/Mom to a nursing home will be made by their health care practitioners, the family and the overall condition of their health. The cumulative factors weighing on this decision will vary on circumstances unique to the individual and family.

Long-term care can be expensive. The folks may spend more on this care in a few short years than what they paid for their house! If you were thinking of taking care of Mom/Dad at home consider the costs associated with that. Just three home health care visits a week could cost $200 to $300 a week or $15,000 a year or more! Then consider if other care and services are needed.

For those who do remain at home there are local and community based organizations that provide services and some assistance in the home. However a good nursing home will offer a variety of services in one place including social and recreational activities often not available in a private home.

Most nursing homes are not skilled nursing facilities. A skilled nursing facility provides doctor prescribed services by or under the supervision of licensed nursing personnel. In most situations, they participate in Medicare in varying degrees.

Nursing homes typically provide care that is termed "custodial". This is generally considered to be help with personal and daily living needs. Help with walking, eating, dressing, bathing and taking medications are examples of custodial care. Medicare does not pay for this.

Finding the right nursing home
As the senior population grows it is anticipated that there will be an expansion in the number and varieties of nursing homes. Finding the right home for the folks will be a new and perhaps awkward experience. Start with the basics - what do they need regarding medical, personal, social and physical assistance?

There are profit and non-profit nursing homes with advantages and disadvantages to each or so it may seem. The daily fees (billed monthly) will vary greatly as will the services and programs offered. Here are things that should be considered:

Licensing/Certification
Every state has operator licensing protocol and standards. Ask to review this with the administrator who also must be currently licensed. Is the facility certified for Medicare and Medicaid? This is important.

The Facility

• Location. Is the facility accessible for frequent visits by family and friends?
• Bedrooms. Private or semi-private?
• Do they have a private bath? A window?
• What personal furnishings can be brought into the room? Dresser, chair, etc.
• Is the facility well ventilated and warm (70*)
• Are they readily accessible to other areas of the facility?
• How often do bed linens get changed?
• Do residents have easy access to a telephone?
• Is the facility clean and without heavy odors and scents masking odors?
• Are there grab bars in the bathroom and handrails in the hallways?
• Are the exits clearly marked and unobstructed?
• Are the hallways easily navigated by two wheelchairs or walkers?
• What are the activity areas like? Are rooms for socializing, crafts and other communal activities? Is there a secure lawn or outdoor area?
• Is the place well furnished and kept up?
• How does the dining area look? Does it appear engaging, a nice place to eat? Access for wheelchairs and/or walkers?
• What is the general appearance and demeanor of the residents? Do they appear to be clean and attended to?
• What is the general appearance and demeanor of the staff? Are they friendly and helpful with the residents?
• Visit the kitchen.
• Are the homes rules and regulations posted?
• What are the rules regarding visitation? The hours? Can you have lunch with Dad?
• What are the emergency procedures for accidents, injuries or sudden illness?
• Is a physician available for emergencies?
• Is the home affiliated with a hospital or have a transfer agreement with a hospital?
• How many residents are there in the facility?
• What is the level of support staff? Skilled, non-skilled?
• Under what circumstances would a resident be forced to move out?

Services
• What types of activities do they have? Trips to shopping, parks, etc.
• Do residents have involvement in planning of activities?
• Are there activities geared toward those with depression and those recovering from a stroke?
• Are there simple activities for the confused or dementia patients?
• Are there special events involving the family?
• Is help provided managing money?
• Is incontinent care provided? Cost extra?
• What social and community service and groups available?
• Are religious services available?

Nursing/Medical Needs
• Ask about things that are significant to Mom/Dad's medical needs. Have a list of specifics that you can ask at each facility visited.
• Speak to the Director or person in charge of Nursing Services about your parents care and nursing needs.
• Determine the level of experience and training of the staff regarding:
  - medications and possible side effects,
  - treatment for specific diseases, i.e., Parkinson's,
  - dealing with dementia patients and special activities for such,
  - working with patients who have suffered a stroke and recovery phases,

  Is the facility associated with a nearby hospital or have an affiliation with one? Do they have a transfer agreement?

  How are medications/drugs labeled and stored?

  Does the facility have an intercom system?

Finances
• What does it cost?
• How is the billing handled?
• Authorized to accept Medicare/Medicaid ?
• Are there extra fees for providing.
  - physician services
  - drugs and medications
  - physical or occupational therapy
  - incontinent care
  - special diets
  - personal care, i.e., barber or beautician

  What is the policy if the resident has paid in advance and leaves early?
  Is there a refund? Get this in writing. Remember - Your parent is the consumer - but you are the customer.

If possible, two or more visits should be made to a prospective home at different times and days. Visit during a meal and sample the food. Try and get a sense of the facility. Are the residents engaged in activities and social interactions? What is the overall demeanor of the home? Could Mom/Dad be happy and well provided for here?

One can be apprehensive about placing Mom/Dad in a nursing home, which is understandable. Perhaps there is some subliminal concern about placing a parent, who has raised and nurtured you, in the care of others. This is about a link in the family that is being separated.

Your love and caring do not end when a parent resides in a nursing home. You are providing a professional level of assistance for their well being. You will continue to be involved with care. See Chapter - CAREGIVING.

When a parent is moved into the nursing home frequent visits should be made. An adjustment period of two to six months should be allowed to let Mom/Dad settle in. There may be problems. Mom may feel resentment about being placed in the home and demonstrate difficult behavior. Perhaps Dad doesn't like a particular resident. It is wise to monitor and assess their feelings and attitudes. Discuss their issues with them and bring them up with staff.

Resources to learn more on housing for the folks:
There is a myriad of services available addressing the elderly and housing issues. The Older Americans Act established the Administration on Aging (AoA) In the Department of Health and Human Services (DHHS) to, among other things, assist the elderly with housing issues.

The AoA has 57 State and Territorial Units on Aging, 655 Area Agencies on Aging (AAA), 221 Tribal Organizations, and over 27,000 service providers that deal with housing issues for the elderly. To get assistance with housing questions and concerns about Mom/Dad in their area, contact the AoA's NATIONAL ELDERCARE LOCATOR - 1 800 677-1116 or go to the AoA website at www.aoa.gov.

• The Administration on Aging - National Resource and Policy Center on Housing and Long-Term Care - 1 213 -740-1364 - www.aoa.gov/housing/publist.html has books and videos on Eldercare Housing. Prices: $7-15.
  For fact sheets (booklets) on housing call the AOA's National Aging Information Center - 1 202 619-0724 The National Council on Aging - has information on senior housing, long-term care and adult day care. 1 202 479-1200 - www.ncoa.org
• The American Association of Homes and Services for the Aging - provides consumer information on housing and long-term care. 1 202 783-2242 or www.aahsa.org
• The American Health Care Association - has good information on nursing homes, assisted living and financing of long-term care. 1 202 842-3680 or www.ahca.org
• U.S. Department of Housing and Urban Development (HUD) - Information about HUD sponsored housing and useful information on reverse mortgages 1 202 708-2556 or www.hud.gov.rvrsmort.html
• The American Association of Retired Persons - has considerable information on senior housing, consumer information - 1 800 424-3410 or www.aarp.org

  Home Health Care
  After hospitalization, it is determined that your parent may go home. It is likely that he or she will need some form of care. First, they will need some help from family or friends. This should be accorded some thought and planning. It is recommended that duties and responsibilities be delegated. It may help to prepare a list of what is needed and who can do what and times available.
  
  Growing old does not necessarily mean going to a "nursing home". In fact, only about 7% of our senior population will need the services of a skilled nursing facility and then it will be on average for less than six months. It is most likely that your folks will receive care in the home by family, friends, or a social service agency.
  
  If skilled health care is needed at home, Medicare will cover those services provided by a participating Home Health Agency. This is an authorized agency, public or private, that provides skilled nursing or therapeutic care in the home.
  
  There are criteria for getting Medicare assistance in the home:

  1. The doctor determines that home health care is needed and sets up a plan,
  2. The home health care agency is a participating Medicare agency,
  3. The patient is homebound, that is, they are confined to the home,
  4. The care required includes intermittent skilled nursing care, speech therapy or physical therapy.

What to Look For in a Senior Care Facility
There are a number of things to consider when selecting a nursing or senior care facility. One of the first things to consider is the expected length of stay. A skilled nursing facility can become expensive and in due course may not be the appropriate situation for the care of your parent. For example, Mom may have been placed in a skilled nursing facility for a particular medical problem which has now been remedied, in which case it would be time, under direction of the doctor, to move her. If a skilled nursing facility is required after hospitalization, the discharge planner can provide recommendations. Locating the ideal nursing facility may prove to be difficult. You and/or your parent will have to take a variety of factors into consideration: cost, acceptability and location are issues to be considered.

Depending on the type of facility (skilled nursing or custodial), there may be assistance from Medicare. Still there will be expenses incurred that must be considered.

Finding a facility that is acceptable to both yourself and your parent may prove to be a daunting task. A good approach is to talk with family, friends and neighbors. It is likely that people in your parents' age group can recommend some appropriate facilities. Perhaps a friend or relative is presently who residing in a facility may assuage some anxieties Other sources for locating an acceptable facility are hospital discharge planners, church and civic organizations and local senior service agencies.

Use a list such as this one to evaluate homes visited.

1.Housing Intro
2.Independent Living - At Home
3.Independent Living - Other Options
4.Semi-Independent Living
5.Dependent Care