Chapter 7

CAREGIVING

Today, one in four American families care for an older relative, friend, or neighbor. An estimated 25 to 40 percent of women care for both their older relatives and their children. Half of all caregivers also work outside the home. It is no wonder then that caregivers often need help. Depending on your work, living, and family arrangements, there are a number of things you can do to make caregiving easier.

Ways to Make Caregiving Easier

• Work Options and On-the-Job Training Programs. If you are a working caregiver, it is important to discuss your needs with your employer. Telecommuting, flextime, job sharing or rearranging your schedule can help to minimize stress. Increasingly, companies are offering resource materials, counseling, and training programs to help caregivers.
• Involving Older Children. If you have older children living at home, they may be willing to assist your older family member. Such responsibility, provided it is not overly burdensome, can help young people become more empathic, responsible, and self-confident. It can also give you needed support.
• Asking Other Family Members to Help. You can and should ask family members to share in caregiving. A family conference can help sort out everyone's tasks and schedules. Friends and neighbors may be willing to provide transportation, respite care, and help with shopping, household chores or repairs.

Sources of Information

If you need additional information and assistance in caring for your older relative or friend, you can contact:

• The Area Agency on Aging serving your older relative or friend's community. They can provide information about in-home and community services. Information also is available about benefit and assistance programs for older persons with limited incomes. These include:
  • Subsidized housing,
  • Food stamps,
  • Supplemental Security Income,
  • Medicaid, and
  • The Qualified Medicare Beneficiary program which covers the cost of the Part A and B insurance premiums, deductibles, and coinsurance for low-income older persons.

In addition, the AAA can direct you to senior center and adult day programs. These programs are particularly helpful to working caregivers who want a safe environment with planned activities for their older relative.

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 windows and other heavy cleaning.
• A homemaker may be supervised by an agency or you, and they provide 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 pay the agency unless eligible for Medicare/Medicaid. 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 help with the coordination of the care plan. If services are being covered under Medicare, your doctor, care manager, or arrangements with a home health care agency.

Selecting an Agency

Ask the following questions to evaluate an agency:

• What type of employee screening is done?
• Who supervises the employee?
• What type of general and specialized training have the employees received?
• Who do you call if the employee does not come?
• 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 provided?