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Support Services
The majority of very frail or disabled people want to continue to live at
home. Feeling part of family life and the community is important. Sometimes
however, their remaining in the community puts a burden on the family;
usually one particular family member, called the primary caregiver. If the
caregiver is to cope with increasing care demands, she must have support;
that support may come from a range of sources - other family members and
friends, or what is known as the "formal support system."
Before caregivers are able to deploy the formal system, they must have
identified their needs, either with or without the advice of a professional,
know what services are available and how to access those services.
If the care-recipient is an adult, then, where feasible, she should be
included in the planning process. They know what they want, but you may have
a better idea of what is possible.
Some basic guidelines are presented to enable caregivers to identify which
agency or professional may help and what services they provide. To meet care
needs, several services may be required.
We have set out questions you may have and attempted to answer those
questions, through our Question (Q) and Answer (A) format.
Homemaker and Home Health
Aide Services
For many families the first hint they have that their parent or other
relative is no longer able to cope adequately, without some help, is the
person's inability to do shopping, cleaning, other chores and attend to some
of their own personal care needs. At this stage, the service which may enable
the person to function longer in the home, is what is called the homemaker
and home health aide service.
Homemaker Services
Q. What is a homemaker service?
A. It is a service which for a fee, will provide help with shopping, cooking
and household chores.
Home Health Aide Services
Q. Who can help if a person can no longer bathe, dress, or take
medication unaided?
A. The Home Health Aide will help with this kind of care and report to the
Home Health Nurse about the person's progress.
Q. Who provides the above services?
A. Homemaker-Home Health Care Agencies. Some hospitals provide these services
for their discharged patients.
Q. What about charges?
A. Charges vary. In some instances, Medicare, Medicaid, or health
insurance cover such services, but only under very specific, limited
circumstances. Some agencies accept only persons who can pay privately;
others offer a sliding scale fee.
Q. What qualifications do homemaker/home health aides have?
A. Generally they are trained in household and personal care. They work under
the direction of a health professional, a nurse or a social worker.
Q. Where can I find information about these services?
A. Through community service agencies; the local Area Agency on Aging, and
listings in the telephone Yellow Pages under Health Care Services.
Q. What are some of the questions for you to ask when trying to answer
the ability of the Agency to meet the needs you require to be met?
A. Is the Agency bonded and licensed?
Is the Agency a member of the Better Business Bureau or the Chamber of
Commerce?
Ask for and check out the Aide's references.
Check whether the Aide is trained to perform the duties that are needed.
Inquire whether the Aide will be supervised. By whom? Know how to reach
the Supervisor?
Before the Aide starts work, settle all arrangements about such
things as tasks, hours, payment, transportation costs, supervision and your
expectations.
Learn who will be liable if there is an accident in your home or if
something is stolen.
Maintain regular contact with the Aide's supervisor. Tell her if you are
not satisfied.
Chore Services
Q. What is a Chore Service?
A. This service offers help with chores around the house - heavy
house-keeping, yard work and minor repairs.
Q. Where can these services be located?
A. Check private agencies listed in the Yellow Pages. In many areas, there
are community or church sponsored programs. Ask at your local social services
agency or Area Agency on Aging.
Q. What about fees?
A. Fees will vary according to the agency, the work done, number of hours,
etc. Check with the local social service agency and Area Agency on Aging to
see whether financial help is available in your community.
Emergency Response Systems
Q. What is an Emergency Response System?
A. These systems provide contact with local authorities such as police or
rescue squads, if there is an emergency.
Q. What is the value of such a system?
A. Where used, they can provide a greater sense of security. But the system
should never be operated in isolation. It should only be part
of a care package. Batteries should be regularly checked.
Q. Are these systems costly?
A. The cost depends on the complexity of the system.
Q. Where can I find information about Emergency Response Systems?
A. Contact your local social services agency or Area Agency on Aging. The
service may also be listed in the Yellow Pages under Emergency Alarm Systems.
Friendly Visiting
In many cases, disablement may lead to social isolation, loneliness and
then on to depression. For some older people who have always liked company, a
Visiting Service may help to alleviate the loneliness.
Q. What exactly can such a service do?
A. It can provide companionship and emotional support. Many visitors do
errands, answer mail and generally take an interest in how the very frail of
disabled person is coping.
Q. Where can I find out about these services?
A. Churches, synagogues, the local social service agency or the Visiting
Nurses' Association should have information.
Home-delivered meals
Home-delivered meals can keep elderly, frail and/or disabled persons out
of an institution.
Q. What is a home-delivered meals service?
A. Hot, nutritious meals are brought once a day during the week to people who
cannot make their own. Other arrangements generally have to be made for
weekends. Provisions may be made for special diets.
Q. What is the cost?
A. Some services are free, others have to be paid for, on an ability to pay
basis. Where there is a fee, charges will vary from area to area.
Q. Who provides these meals?
A. Most services are paid for and operated by voluntary organizations, such
as churches, nursing homes and senior centers. Some are provided through
private agencies.
Q. Where can I get information?
A. From the local Area Agency on Aging or social service agency.
Nutrition Services
Eating a good diet is fundamental to good health and maintaining strength.
Q. Where can I get information about nutrition?
A. From a doctor, a qualified nutritionist or a dietitian.
Q. Are there any places where nutritious, reasonably priced meals are
available for older people?
A. Congregate dining sites are located in most areas. At these sites, the
person gets a hot meal and can also take part in the socialization and
activities that go on at the dining site.
Senior Citizen Centers
These centers provide a social gathering place for older people in the
community.
Q. What is a Senior
Center?
A. A place which provides socialization, recreation, meals, counseling and
advice on financial matters.
Q. Where are these centers located?
A. In churches, synagogues, housing projects and nursing homes; or they are
separate facilities.
Q. How do I locate them?
A. Contact the local social service agency or the Area Agency on Aging.
Professionals
In addition to needing help from family, friends, and using social service
type services, an elderly and/or disabled person may need help from health
care professionals. Who are some of these professionals and how can they
help?
The Doctor
The doctor is generally the first professional with whom the disabled
person or her caregiver comes into contact. Whenever there is any feeling of
unwellness or any symptom appears, the doctor should be consulted. Some
people regard conditions such as failing sight, feelings of depression,
incontinence, difficulty walking, increasing forgetfulness and loss of
hearing as part of the aging process. Certainly there are physical changes as
one ages, but many conditions can either be arrested or treated and enable
the person to have a better quality of life.
The family doctor may make a diagnosis and then refer the patient on to
another professional who is equipped to design a care package, based on her
recommendations, to meet the person's needs or she may refer the patient on
to a specialist.
Q. When does the family doctor usually refer a patient to a specialist?
A. When her diagnosis indicates that the patient should be seen by some
doctor who specializes in the particular condition from which the patient is
suffering. There are doctors who specialize in geriatric medicine,
psychogeriatric medicine, urinary tract infections, rheumatism/arthritis
problems, oncology (cancer), endocrine diseases (e.g. diabetes) and a range
of other conditions. But the family doctor should remain the key person for
complete patient care. Too often a patient has too many specialists so the
primary care family doctor should coordinate all patient care.
Q. Why is it essential to follow through the doctor's treatment
recommendations?
A. Many conditions can in fact be successfully treated. Others can be
arrested or helped. If, for example, therapy has been recommended, and the
treatment is not followed through, or medications have been prescribed and
the prescription not filled, the condition will become worse, leaving the
person more debilitated and more dependent on the caregiver.
The Case Manager
Q. What does the Case Manager do?
A. The case manger (who may be a nurse or social worker) will design a care
package to meet the identified needs. The case manager knows how to identify
services and will implement the care package, monitoring for any needed
changes.
Q. Where can the Case Manger be located?
A. Case managers are not available in every area. Ask the doctor; check the
Yellow Pages under Human Services, County Health Nursing Service, Area Agency
on Aging and the Information and Referral Service in your area.
Q. Will a fee be required?
A. Yes, most of the time. If a fee is charged, get a written statement of the
fee and what services will be provided for that fee, before you
actually employ the person. However, some social service agencies provide
this service free of charge.
Home Care Professionals
This service may have to be invoked to take the pressure off the
caregiver.
Q. What is Home Care?
A. It is a range of health and supportive services, provided at home, for
people who require assistance in meeting their health care needs.
Q. Which services are included?
A. Skilled nursing, physical therapy, occupational therapy and speech therapy
are included. Additionally, personal care services such as help with bathing,
dressing, toileting, etc. are provided.
Q. Who delivers these services?
A. Nurses, therapists and home-health aides, through a home health agency or
public health department.
The Nurse
Q. What does the Nurse do?
A. The nurse's roles are multiple. First, she will visit the very frail or
disabled person at home to evaluate her condition, decide what nursing care
is needed, implement the doctor's medical treatment plan and monitor the
patient's progress. Where feasible, the nurse discusses the care with the
patient and with the family. Additionally, the nurse can alleviate a lot of
anxiety by helping the caregiver to better understand the course of the
disease, counsel her on coping strategies, counsel on stress management and
where indicated, how to enhance communication with the care-recipient.
Another very important function is showing the caregiver basic home-caring
skills. Among the skills she can demonstrate are how to lift someone who is
bed-bound, how to prevent bed sores, how to give injections, how to change
dressings and how to give medications. The nurse can also provide information
on home nursing equipment and where it can be rented or purchased.
The Physical Therapist
Q. What service does a Physical Therapist provide?
A. On the basis of the doctor's medical diagnosis and recommendations, a
physical therapist prepares a treatment schedule. In some cases, basic
exercises are given to restore strength and movement. Rehabilitation is very
important, not only from a physical point of view, but from the psychological
aspect. Sometimes the care-recipient will need a lot of encouragement and
help to carry through the exercise regimen. Therapy should increase
independence and alleviate some of the caregiving load.
The Occupational Therapist
Q. What is the role of the Occupational Therapist?
A. An occupational therapist assesses the person's ability to cope with daily
activities and movement. Walking aids, eating aids, bath aids and
adaptations, clothing with Velcro fasteners, ramps, rails, etc. may be
recommended.
The Social Worker
Q. What is the role of the Social Worker?
A. A social worker can help the family determine what kind of help they
require to meet the person's needs, directing and connecting the family to
personal social services and community services that can assist them.
Additionally, she is trained to counsel on stress management and on more
effective communication between the caregiver and care recipient.
General Information
Q. Where will I find information about healthcare services?
A. From doctors, hospital discharge planners, local health departments, Area
Agencies on Aging, nursing homes, and in the Yellow Pages under Healthcare
Agencies or Nurses.
Q. What is some basic information I should have about an agency before
using it?
A. In some states, such agencies must be licensed.
The agency should consult with the care-recipient's doctor and prepare a
written care-plan.
Then the supervising nurse should discuss the plan and costs with the
care-recipient (where feasible) and the caregiver.
Check that the agency's staff are properly trained and qualified and
licensed. Additionally, determine whether they are adequately supervised and
evaluated on a regular basis.
Check out the references of the agency and its staff.
Make sure the agency is insured against injury to its staff.
Ask for a copy of the complaints procedure.
Determine how much the service will cost. Make sure the care-plan is
approved by the doctor and that the agency is certified to be reimbursed
through Medicare and Medicaid or your care-recipient's insurance company.
Check that the services will be available when you need and want them.
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