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 housekeeping, yardwork 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 or 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
dietician.
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
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 function 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.
Certified Therapeutic
Recreation Specialist (Recreation Therapist)
Q. How would I use a Certified
Therapeutic Recreation Specialist (CTRS)?
A. Research has determined that recreation is an
essential component for physical and mental wellness in all people, young and
old, well or disabled. A CTRS can help increase functional ability as well as
the ability to access and enjoy leisure activities in both care-recipients and
caregivers. A CTRS will access one’s functional abilities and needs and develop
specific recreation interventions that can help people, with and without
illnesses and disabilities, to become stronger physically, mentally,
emotionally and socially. Activities can be conducted 1:1 or for an entire
family. Additionally, they can help the caregiver plan some recreation
experiences that might bring relief and enjoyment to the helper as well.
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.