Chapter 2

SERVICES

If you are a caregiver and need help, assistance may be available in your community. Most of the programs and services mentioned in this guide are for adults 60 or older, and are federally funded through the Older Americans Act. Contact your local Area Agency on Aging to get information about these services and other programs in your community. The goal of these services is to support the caregiver so that he or she can continue as the primary caregiver.

Services that you might find helpful include:

• Information
• Assistance
• Counseling/Support Groups/Training
• Respite Care
• Supplemental
• Attendant and/or Personal Care
• Homemaker
• Nutrition Counseling
• Bathroom Items
• Chore
• Repair/Maintenance/Renovation
• Transportation
• Grandparents or Relative Caregivers Services

Service Definitions:

Information: Group services, including public education, information at health fairs and other similar events. (Outreach interventions for the purposes of identifying potential caregivers and encouraging their use of existing services and benefits.)

Assistance: Information on an individual basis to gain access to services.

Counseling, Support Groups or Caregiver Training: Provision of advice, guidance or instruction about options and methods for providing support to caregivers.

Respite Care: A brief period of relief or rest for caregivers. It can be in the form of in-home respite, adult day care respite, or institutional respite for an overnight stay on an intermittent, occasional, or emergency basis.

Grandparents or Relative Caregiver: Services may include Information, Assistance, Individual Counseling, Support Groups, Training, Respite, or Supplemental Services. The child being cared for must be younger than 19. The grandparent or relative caregiver must be 60 years or older, live with the child, be the primary caregiver, have legal custody or guardianship or be raising the child informally.

Supplemental Services: Other services provided on a limited basis such as: Attendant and/or Personal Care, Bathroom Items, Chore, Homemaker, Nutrition Counseling, Repair/Maintenance/Renovation, or Transportation.

Transportation: Is a vital service to older persons with limited mobility. Many public transit systems are fitting buses and other vehicles with hydraulic lifts and other aids to assist older persons and others that have physical disabilities. To arrange transportation for an older person in your community, contact your local Area Agency on Aging or public transportation provider.

Nutrition Counseling: To help improve health and control a range of conditions and diseases. Older persons who participate in a group meal program have an opportunity to socialize, receive nutrition education, and take part in other activities, including health screenings. Older persons who are homebound may be able to receive a home-delivered meal. To find out about meal programs, contact your local Area Agency on Aging. If these home-delivered meals are not available, see if your grocery store prepares food orders for pick-up or if they provides home-delivery service. Many local restaurants deliver meals without additional charge. Some even offer senior discounts on meals. Some offer special low-fat and low-salt meals.

Chore: Your local Area Agency on Aging may be able to arrange for chore services or put you in touch with religious, scout or other volunteer groups that provide one-time or occasional services to older persons who need help.

Attendant and/or Personal Care: To supervise and/or assist with bathing, medication, dressing, personal appearance, feeding, transferring and toileting under the direction of a licensed health professional.

Bathroom Items: May include the purchase price and installation costs for toileting and personal hygiene items. These items may include, but are not limited to: grab bars, toilet riser, tub bench, commode, hand-held shower.

Repair/Maintenance/Renovation: These services can make homes safer and more energy efficient, which may result in greater independence for an older person with disabilities.

Senior Centers: A safe environment where older persons can take part in a range of activities led by trained personnel and where they can develop a network of friends.

Adult Day Care: This may be arranged for older persons with physical limitations and cognitive problems. Adult Day Care Centers can provide care in a safe, structured environment. Adult day care can also provide relief to working caregivers and respite for full-time caregivers. Most Adult Day Care Centers, like senior centers, are supported through public and non-profit organizations. There may be a fee, depending on the services needed.

Determining the Type of Care You Need

If you decide to hire a home care employee, you need to determine how much and what type of help your older relative needs. The following are descriptions of some of the types of home care personnel:

• Chore workers perform basic household tasks. Chore workers often do heavier types of cleaning such as washing widows and other heavy cleaning.
• A homemaker may be supervised by an agency or you and provides meal preparation, household management, personal care and medication reminders.
• A home health care worker may provide personal care, help with bathing, transfers, walking and exercise, household services that are essential to health care and assistance with medications.
  

General Eligibility Requirements for Home Care Benefits

Medicare may pay for home health care services through a certified home health care agency, if a physician orders these services.

Home health care agencies focus on the medical aspects of care and provide trained health care personnel. For a patient to be eligible for services paid for under Medicare, they must need skilled nursing assistance, or physical, speech and/or occupational therapy. Home health care workers are a supplement to this care. If your older family member or friend needs additional hours of care or requires custodial care, they may be eligible for services under Medicaid.

Home care agencies, which can be nonprofit or for-profit, recruit, train and pay the worker. You are responsible for paying the agency. Social Service agencies, in addition to home care services, may provide an assessment of the client's needs by a nurse or social worker, and they can help with the coordination of the care plan. If services are being covered under Medicare, your doctor, care manager, or discharge planner will probably make arrangements with a home health care agency.

Selecting an Agency

Ask the following questions when evaluating an agency.

• What type of employee screening is done?
• Who supervises the employee?
• What types of general and specialized training have the employees received?
• Who do you call if the employee does not arrive to provide service?
• What are the fees and what do they cover?
• Is there a sliding fee scale?
• What are the minimum and maximum hours of service?
• Are there limitations in terms of tasks performed or times of the day when services are furnished?