When is it time for professional in-home care?
People with Alzheimer’s disease go through a lot of changes—something that you, as a caregiver, know all too well. Sometimes those changes are overwhelming. How do you know when it’s time to seek the help of a professional caregiver?
Karen Carnes, BSN, RN, MSN, Chief Clinical Officer, Interim HealthCare, offers some insight and advice on making this difficult decision.
Preserving Your Memory: What are some of the reasons why caregivers seek professional inhome care for people with Alzheimer’s disease?
Karen Carnes: Caregivers have a difficult time understanding and coping with the changes they’re experiencing with their loved one who has a diagnosis of Alzheimer’s. They know something is different. They have the intellectual explanation of what’s going on, but now they’re actually beginning to live with the changes in their loved one and they don’t always know how to handle it.
It could be that changes are just beginning or that the changes are not so pronounced that the individual needs to be in a medical facility. Often these individuals are perfectly capable of being at home, but the caregiver doesn’t know how to provide the care that’s now needed.
PYM: Are there signs to look for that signal when it might be time to seek in-home care?
KC: When that caregiver begins to have feelings of frustration or even anger over the challenges they face, it’s time to seek help. It’s perfectly normal to have these emotions; but when that caregiver begins to have these feelings of frustration, it is wise to get help certainly before they get overwhelmed.
PYM: What is involved in in-home care?
KC: Home care can provide a variety of services depending on the specific needs of the individual. Care runs the gamut from a once-weekly visit to a professional caregiver in the home 24/7; services can be provided by home care aides, nurses, therapists, or social workers.
Services can begin with a home-care aide providing basic personal care and assistance with activities of daily living like bathing and dressing. This is necessary because often the family is no longer able to or comfortable with providing these tasks. They have become tired or overwhelmed or they are just not comfortable doing this for their mother or father, someone who’s traditionally been their own caregiver.
If it’s a fairly new diagnosis or the individual is starting on new medications or different combinations of new medications, it’s very helpful to have a nurse visit in the home. A nurse is trained to provide medication monitoring. Medication monitoring requires the nurse to observe, document and report to the individual’s physician the individual’s response to the medications, including any side effects. The nurse also counsels the individual or their caregivers regarding potential side effects.
Trained in-home caregivers can also help family members deal with the new habits, moods, and behaviors by teaching specific care techniques both for these emotional outbursts as well as wandering behaviors and other habits that are quite common for individuals with AD.
When the individual begins to have a physical decline and can’t bathe, dress or get around, physical and occupational therapists work with the family. It’s not always the individual with AD, but often the family that needs to learn how to assist the individual out of bed, with bathing and even techniques to assist the individual with eating.
A social worker can also play an important role in teaching coping skills to family caregivers. New challenges with a loved one require new emotional skills that family caregivers may have never previously acquired.
PYM: How is in-home care paid for?
KC: Well, it depends and people should always confirm their own coverage. Generally, there are some Medicare benefits available to individuals if there’s a short-term need for a nurse or a physical or occupational therapist and the individual is homebound.
There may be Medicaid coverage for individuals who qualify, depending on the state and county in which the individual resides. Of course, paying privately is always an option. Many families find that hiring a home care agency to send an aide to provide personal care and support services is quite affordable and well worth the expense.
PYM: What are some things to keep in mind when seeking an in-home care provider? Are there certain things to ask when interviewing caregivers?
KC: The community reputation of the home care provider should always be researched. Other questions include how long they’ve been in business, are they accredited by an outside accrediting body, and has the home care agency provided special training for the caregivers to work with patients with Alzheimer’s or other dementia. If the family wants to be able to take advantage of the Medicare benefit, that home care agency must be Medicare certified.
When interviewing for a caregiver, individuals should ask about the kind of training the caregivers have, how often a supervisor checks on the caregiver (in person and by phone) and how will the home care agency bill them. It’s also very good to know in advance what kind of system the agency has for successfully covering the agreed-upon shifts or visits when the assigned caregiver is not able to make it that day due to illness or vacation. A final important discussion is the agency’s process for handling situations where the family or individual doesn’t get along with the aide.
PYM: How does the person with AD adjust to having inhome care? What can help make the adjustment easier?
KC: Not everyone with Alzheimer’s or dementia reacts positively to a stranger in their home. The earlier in the disease that a stranger is introduced, the easier it is and the first contact is extremely important. The adjustment is always easier in a nice, calm atmosphere with loved ones present to introduce the new person into the environment. Often individuals with Alzheimer’s disease don’t remember names, but if they have a calm, positive experience in a safe environment with their usual caregivers (family, loved ones) present, it’s much easier to begin that relationship and continue it positively on an ongoing basis.
PYM: Any tips for having a positive relationship with the in-home care provider?
KC: There should be frequent communication and contact by supervisors, either onsite observing interactions or with phone calls to both the in-home caregivers as well as to the family members. Through this constant contact, the supervisors can assess if the case continues to be within the scope of an individual caregiver’s expertise or if it is advancing more quickly than anticipated.
The individual is our primary concern. But the individual is also part of a family unit and AD affects that entire family unit. Certainly Interim HealthCare isn’t on site full time—at least initially. So we have to monitor how the family is handling the situation. Through frequent communication, we become partners in handling the disease; we teach them about medication management and daily living skills for themselves and for their loved one with Alzheimer’s.