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    The “Triple Witch Hour” at a Home Care Agency  

    The Triple Witching Hour

    Borrowed from the stock market, the term “triple witch hour” became part of our vernacular at the Agency; and unlike the stock market, which had a triple witch hour on one Friday afternoon every three months (a point at which futures and options contracts expired, bringing about heightened volatility and excitement), we had a triple witch hour –several hours really- every Friday afternoon. Thus we prepared all week for the dreaded hours on Friday afternoons.

    The Agency’s “responsibility”

    Mrs. Mullen lives on her own, cared for by our live-in caregiver, Juanita. She is wheelchair-ridden, paralyzed from the waist down as a result of a stroke she had almost a year back. She has a loving and capable daughter, Linda, who is an attorney. Linda would have been the perfect person for Mrs. Mullen to live with, except that Linda lives in Delaware, miles and miles away.

    We’ve had this relation with Mrs. Mullen ever since she came out of the hospital following her stroke. A short time later, Juanita became the primary caregiver, and every time Juanita wanted to take the weekend off, usually every other week, we would send another caregiver to fill-in, also as a live-in. We thus provided services at the Mullen residence on a continuous basis, without interruption.

    Relieving the primary caregivers

    On Friday afternoons, our weekenders would be showing up to replace weekday caregivers at client homes throughout the area. Since most of our clients were like Mrs. Mullen in the “may-not-be-left-unattended” category, we were thus assigned to provide uninterrupted services at many of our clients’ homes. We therefore had many “Juanitas” who had worked day and night from Sunday to Friday and who were, on Friday afternoons, looking for their fill-in relief caregivers to arrive and take over for the weekend.

    Not only were we to provide for the safety and wellbeing of our clients, but we also had to –simply had to- relieve the weekday primary caregivers who, having worked hard all week, would have made rigid plans for the Friday night –plans that we better not upset. For if the relief worker didn’t show, they would have to stay on the job until we could find someone else to relieve them, and that might take several hours at best.
    That set the tone for the “witching” factor: caregivers calling in late at the last minute or, worse, no shows on the part of the weekend relief caregivers.

    Care Coordinators on their knees

    The task of scheduling caregivers to be at certain homes by no later than set time falls on the Care Coordinators, or Care Managers as they are at times referred to. At our agency, we had three Coordinators, and it wasn’t rare that we overheard a Coordinator “begging” a caregiver to drop what she had and rush to a certain patient’s home. And that wasn’t because the Coordinator didn’t have other caregivers who could go to that patient, it was because only that particular caregiver had the requisite knowhow to meet the needs of a certain patient. Besides, she would have typically been to that patient before, with good knowledge of how to get to the patient’s home and how to provide good care and companionship once she is there.

    Thus if wheelchair-ridden Mrs. Mullen was also say over 200 lbs in weight, we couldn’t just send any caregiver there. It had to be someone who could execute smart transfers for a person of that weight, apart from the patient’s other needs. To relieve Juanita at Mrs. Mullen, of the dozens of caregivers we had, perhaps only a handful a) lived within commuting distance from the Mullen residence, b) could do that kind of lifting, and c) happened to be available at the last minute for a 48-hour live-in assignment.

    Our clients’ needs

    Short term forgetfulness, cognitive impairments, Alzheimer’s, paraplegics, advanced Parkinson’s, and people who were very frail, those were some of the folks in our charge, their sons and daughters at work and living separately, frequently in other states. They represented the ultimate in responsibility to all of us the agency -care recipients who could not be left unattended –not even for 10 minutes. Thus by Friday afternoon of every week we worried mostly about them and, in particular, about those whose next of kin, or “responsible party” as we referred to them, were out of town. And even among those, there were always a handful who could not be staffed by just any caregiver –they required attention by the very special only.

    We prepared all week for the witching afternoon

    Over time, we learned how to “attack” the Friday witches: we prepared well. We prepared all week, and we had contingency plans for all eventualities. Most weeks, we were able to go home on Friday evenings by 7 or 8 PM, having tucked in everyone with their rightful caregiver. Lisa would be squarely booked for Ms. Francis who loved her and who would throw a tantrum –at 92 years of age- if we sent anyone else. Mrs. Kulowski, who fussed and cussed whomever we sent for the weekend, would finally get exhausted and go to sleep, only to wake up altered and easy going the following morning. I remember one fateful Friday afternoon though when I felt like the Oxygen had been sucked out of my lungs –out of our whole office.

    Because of a lot of flu going around, we had what came close to being a tsunami of call-outs: one caregiver after the other calling out sick. We worked our database, tapped our short lists, made a hundred calls and, after all that, we were left with two caregivers that we simply could not find reliefs for.  We decided that people from the office staff would fill-in. Nothing else we could do. We would go ourselves because the caregivers in attendance there had both done two weeks in a row non-stop, so we simply had to relieve them. At the very last minute however, one of our Coordinators pulled the hare from the hat and produced first the one, then both of the needed caregivers. The point nevertheless was that if all else failed, and it never did, we, the office personnel, would have to fill the gap.

     

  • Baby Boomers

    Baby Boomers In a Classic “Double Whammy” 

    The secret was out by the turn of the millennium

    People mostly referred to it as the “double whammy”, although I’ve also heard it called the “vortex”.  If you combine a whirlwind with a large, twirling funnel, you get a vortex into which people get sucked. Thus, by the turn of the millennium, boomers born in the late 1940s were turning into their early 50’s in large numbers. They were typically at or near the peak of their careers, with dual, real-time responsibilities to parents as well as children. I was in at-home eldercare at the time, a vantage point from which I was privy to the unraveling of many a family who suddenly found themselves grappling with the whirlwind.

    By Jennifer N. Brok in The Evolution of the Aging Population: “10,000 baby boomers entering the Medicare age every day, heralding a seismic shift in demographics worldwide. By 2020, there will be 115 million seniors in America.”

    The women usually ended up with the heavy lifting
    Thus Jennifer Huxley received me at her door one afternoon and promptly broke down in tears. We had spoken on the phone the day earlier when she recounted a story I was only too familiar with. Her father-in-law had died unexpectedly, leaving behind a mentally impaired wife he had been looking after. From that point on, it was the daughter-in-law, not the son, who had to put a hold on all facets of her life to take care of this 80-year old who could not be left unattended –not even for 10 minutes.

    By Laura Carstensen, director of the Stanford Center on Longevity: “The norms that told us when to get an education, when to marry, when to retire evolved when we lived half as long as now; In those norms, we’re raising kids, reaching the peak of our careers, and taking care of aging parents, all at the same time.”

    The Huxleys in the clutch of the vortex
    “She was suddenly in my lap the same day he died,” Jennifer said. “When I called you yesterday, I had no idea what to do.” Then she continued, “She’s here now, with the caregiver you sent, but there is no way we’re going to be able to afford a full-time caregiver.” With two daughters of college age, and with Jennifer’s in-laws having –not uncharacteristically- outlived their resources, Jennifer and her teacher husband found themselves suddenly staring at the prospect of having to spend down from paltry savings. And while most families manage to cope with the added responsibility, the hands-on caregivers –usually the women- suffer from stress and often neglect their own health, according to experts.

    By Ken Dychtwald Ph.D. Gerontologist and public speaker: “…for others, this “longevity bonus” will be fraught with pain and suffering. Large numbers of tomorrow’s elders could wind up impoverished, left stranded by an absence of financial preparedness and dwindling old age entitlements.”

    The path ahead for baby boomers (born between 1946 and 1964)
    Experts say the number of adult children taking care of their parents will increase as people live longer. According to a 2011 study done by MetLife Mature Market Institute, there are nearly 10 million children over the age of 50 who care for their parents. That figure has more than tripled over the past 15 years. And, according to the U.S. Department of Health and Human Services, the demand for informal caregivers – family, friends and neighbours – is expected to grow by more than 20 percent in the next 15 years as baby boomers age.
    Long term care (LTC) insurance
    “Life expectancy is going up. The National Institute of Aging says that by 2040 life expectancy for men will be 86 and for women 91.”

    Medicare, Medicaid, and an individual’s health care insurance do not reimburse for long term care. To avoid a crisis, the adult children of seniors and their parents had better have a plan that assumes life beyond the mid 80’s for the seniors. Long term care insurance is definitely a vehicle to look into. If the parent is still in their 50’s or 60’s, the premium for a policy can be thought of in terms of a monthly car instalment. When that parent later begins to need care at home or at a facility, the policy kicks in. How much the policy covers will depend on the type purchased. For example, a policy could be for 5 years only, or for life; it can be for up to 8 hours a day, or up to a daily dollar value, with a policy cap. There are hundreds of LTC insurers, and the policy for each family needs to be shopped much like a car is.

    Choices and costs for eldercare in 2012

    • For an 80-year old who is semi-independent, count on $16/hour for an agency caregiver, perhaps $10/hour if hired privately, and let us say help for 6 hours/day, 7 days/week; the annual costs would be approximately $35,000 for an agency hire, or $22,000 for a private hire; add to that the cost of maintaining a home and living expenses.
    • For an 80-year old who is totally dependent, count on a 7-day live-in caregiver, at $160/day from an agency, and $90/day if hired privately; this comes to $58,000/year for an agency hire, or $33,000/year for a private hire, plus the above referenced home and living expenses.
    • For an 80-year old at a middle class assisted living facility, count on at least $4,500 a month, inclusive of all the add-ons, for a total of $54,000/year.
    • For a person of any age, the national average daily rate for a private room in a nursing home is $250, or $90,000+ a year.
  • Seniors In Their Homes

    Meals On Wheels Service Can Keep Many Seniors In Their Homes

    Many older adults need only a little support to stay in their homes, but when that isn’t available they can end up in an expensive nursing home where they don’t need most of the available services. According to a new study, states that invest more in delivering meals to seniors’ homes have lower rates of such “low-care” seniors in nursing homes, after adjusting for several other factors.

    The more states spend on home-delivered meals under the Older Americans Act, the more likely they are to help people who don’t need nursing home care to stay in their homes, according to a newly published Brown University statistical analysis of a decade of spending and nursing home resident data.

    “Despite efforts to rebalance long-term care, there are still many nursing home residents who have the functional capacity to live in a less restrictive environment,” wrote gerontology researchers Kali Thomas and Vincent Mor in the journal Health Services Research. “States that have invested in their community-based service networks, particularly home-delivered meals, have proportionally fewer of these people than do those states that have not.”

    Nationwide in 2009, 12.6 percent of nursing home residents were considered “low-care,” meaning they did not need much of the suite of services that a nursing home provides. That proportion had declined from 17.9 percent in 2000 because of a variety of efforts, including OAA programs as well as Medicaid-sponsored home- and community-based services (HCBS).

    But the percentages every year vary widely between the states. A major reason for that state-to-state variation turns out to be the difference that home-delivered meals can make. The researchers wrote that their analysis boils down to this ratio: For every $25 per year per older adult above the national average that states spend on home-delivered meals, they could reduce their percentage of low-care nursing home residents compared to the national average by 1 percentage point.

    Thomas and Mor’s calculations didn’t merely associate each state’s meals spending with its percentage of low-care residents in nursing homes. They also statistically controlled for the overall decline over time and a wide variety of factors that might also have affected the rates. Those factors included state spending on Medicaid HCBS, as well as a variety of long-term care market pressures, such as excess capacity or nursing home reimbursement rates, that could create incentives for nursing homes in different states to pursue or forgo relatively profitable low-care residents.

    The data included state spending on OAA programs and performance information from each state between 2000 and 2009 as well as variety of public health and nursing home data sources compiled by Brown University’s Shaping Long-Term Care in America Project. In all, 16,030 nursing homes were included in the research.

    After all the analysis, home-based meals, which served more than 868,000 people in fiscal 2010, emerged as the only statistically significant factor among OAA programs that affected state-to-state differences in low-care nursing home population. Home-delivered meals account for the bulk of OAA spending.

    Other factors keeping low-care residents out of nursing homes in some states included a high proportion of residents receiving skilled nursing care, which provides nursing homes with higher revenues. Factors that drove more low-care residents of some states into homes included high nursing home capacity and a high percentage of residents with not-so-lucrative Medicaid funding.

    Meals mean a lot

    Lead author Thomas said that as a Rhode Island Meals on Wheels volunteer and the granddaughter of a Meals on Wheels beneficiary, she was not surprised to see that the program has such a significant impact.

    Until her grandmother died in October, she was able to live at home despite suffering from macular degeneration that made it impossible for her to cook.

    “My 98-year-old granny was able to remain at home, independent in her house until she died, and we have always, even before I did this research, attributed that to Meals on Wheels,” Thomas said. “She lived four hours away from any family and refused to leave her house. We had comfort in knowing that every day someone was in her house to see how things are.”

    Drivers, after all, not only bring food every day but also observe the condition of their clients. If the elderly beneficiary doesn’t answer a delivery, drivers report that. The volunteers therefore provide food and a “safety check” for many older adults.

    For retired journalist and state worker Bill McNamara, 90, of Warwick, R.I., Meals on Wheels helps because he and his wife Catherine, also 90, have developed arthritis in recent years that makes food preparation too difficult. Since 2009 they have lived in an in-law unit of their son’s house, but because his son and daughter-in-law both work, McNamara said, asking them to prepare all their meals would be a significant burden.

    Instead, Meals on Wheels of Rhode Island provides that service, McNamara said. The food is great and the drivers work hard to ensure consistent and timely delivery, he said. They even faithfully worked around the recent obstacle of the road being closed for a time.

    “We feel it’s even better than we would have anticipated,” McNamara said. “We look forward to hearing the bell ring.”

    For many seniors, especially those who don’t live with such a supportive family like the McNamaras, research shows that meal delivery is what allows them to remain where the ring of the doorbell is for their own door.

    Source: www.medicalnewstoday.com

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  • Homecaresandiego

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    Basic Facts you should know
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