Elder/Adult Dependent Care

Home and Day Care

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Many social service agencies and other health care organizations provide a variety of medical, nursing and personal services to help people stay out of institutions. Home care is also usually more cost-effective. Those who use home care services include people who are discharged from a hospital or nursing home but need additional care; the terminally ill who want to die in the comfort of their own homes; those with short-term skilled medical needs; and those who need assistance to live independently at home due to age, chronic illness, or disability.

Home services include any combination of health care, medical equipment, respite care, nonmedical homemaker and chore services (housekeeping, bathing, meal preparation), home-delivered meals, nutrition management, home repairs or weatherization, companion services, counseling and rehabilitation, telephone reassurance, and emergency response systems. These " custodial " services can be hourly, weekly, monthly or any other arrangement.

Home health care can also mean skilled services such as nursing, physical therapy, occupational therapy and speech therapy. Medicare will pay for skilled health care in the home when it is medically necessary to treat an illness or injury if the care is furnished by a participating home health agency; if the care needed includes intermittent skilled nursing, physical, or speech therapy; and if the patient is homebound and under the care of a physician who sets up a home care plan. Custodial care is not covered under Medicare when it is the only kind of care needed; that care is primarily for helping with activities of daily living and not considered skilled.

You can find home care through friends and relatives, family service agencies, AAAs, hospital personnel, physicians, nursing registries and medical organizations, especially if the need is a result of illness or disability.

An elder's ability to remain independent may depend on services that seem simple, but are critical. The least intrusive are volunteer services in which people make weekly visits, for example, or daily telephone calls. Check out home services such as the Department on Aging Assets Senior Companion Program, (510) 238-3080, which offers telephone reassurance and friendly visiting services; and look into the "gatekeeper" program, which uses community agencies to look for signs of neglect in elders (for example, through the Tri-Cities Elder Coalition).

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Home Health Agencies
Home care is also provided by private home health agencies, through physician referrals by way of the hospital discharge planner, and through public health departments. Workers can be registered nurses, therapists or home health aides. Homemakers and chore workers may provide services that preserve the dignity and confidence of your elder, preventing a slide into depression that can precipitate a decline and subsequent need for a nursing home.

If you go to a referral agency (home health care, visiting nurses), ask how long it has been in business and insist on references. Ask how the agency screens employees and monitors workers, and if there are substitutes when needed. Ask about the qualifications and training of workers, and whether the agency insures against misconduct. (Agency home health aides are certified and must complete a training course and pass a state test.)

Find out exactly how much you will be charged and how much the worker is paid. Insist on references and check them carefully. Get the phone number, address, driver's license and Social Security number of the prospective aide, and don't be afraid to complain to the agency if you are dissatisfied with the work. Home health agencies will consult with your elder's doctor and prepare a written plan of care. The supervising nurse will visit with you concerning this plan, and will discuss costs. If you are not satisfied, keep looking.

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Home Modification
Sometimes all it takes for an elder to remain at home are some modifications in the house itself. These can range from more lighting to installing grab bars in the bathroom. Financial assistance for energy bills can also help; PG&E has a program for eligible seniors called HEAP/LIRA through the Department of Community Services and Development (1-800-433-4327). They are open Monday through Friday, 8 a.m to 4:50 p.m. SBC can provide telecommunication devices. Senior centers and AAAs can often provide free or low-cost home modification services. Check with the United Way for volunteer groups who do these repairs.

Common adaptations might include:

• Raising toilet seats, or installing hand-held shower heads and bath benches.
• Rearranging furniture for easy passage or hiring a contractor to widen hallways or cover steps with a ramp.
• Replacing doorknobs with lever-type devices.
• Covering light switches with foam to make the lever longer and easier to reach or grab.
• Installing a security system if it will make your elder feel safer.
• Checking that doors and locks are easy to use and replacing them if they are not. (Doors should have dead bolts.)
• Removing all throw rugs and installing non-skid strips in bathrooms, on stairs, and other well-tracked areas.
• Setting up an emergency response system, especially if your elder lives alone. (Your Area Agency on Aging should know which hospitals have such systems.)
• Setting up a support system with neighbors, relatives and friends, postal workers, grocers, utility readers, bank tellers and others whom your loved one comes into contact with regularly. Some communities have these "gatekeeper" programs already in place.

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Adult Day Care
One of the fastest growing segments of the aging network is adult day care or adult day health care. Sometimes these services are known as respite care, because they give the caregiver a break while allowing an elder to remain involved in the community.

At adult day care, your elder will have some combination of social and art activities, a hot lunch and a place to be cared for while you are at work. Rates average $40-$100 a day, with discounts for those who qualify due to low income. Adult day care is not covered by Medicare but it is covered by Medi-cal.

Adult day health care is a more structured setting that includes medical monitoring, occupational and physical therapy, counseling, support groups for families, etc. For those who qualify, Medicare or Medicaid (Medi-Cal in California) subsidizes these costs.

There are specialty day centers for those with Alzheimer's and related dementia; they can be sponsored by hospitals, nursing homes, churches, mental health facilities, and city park and recreation departments. There are also more specialized facilities in "assisted living" communities.

You may find that your elder is resistant at first to going out of the house or to a new place. This isn't uncommon; make a deal to try it for two or three weeks. Usually by that time you'll know whether it works out; more often than not, it will.

If you're looking for adult day care:

• Decide what level of activity and care your elder wants or needs.
• Decide what you need (occasional free time, coverage while at your job, transportation, support, help in developing a care plan).
• Find a center by asking the doctor, checking the Yellow Pages under "Adult Day Care," "Aging Services," or "Senior Citizens Services," or calling your local Area Agency on Aging. Also check with social service agencies such as Catholic Charities, Family Services, and Jewish Family and Children's Services.
• Call the centers and ask for fliers or brochures, eligibility criteria, costs and discounts, a monthly activity calendar, menu and application procedures.
• Find out who is the owner or sponsoring agency, how long the center has been operational, hours and days of operation, staff credentials and ratio to clients.
• Discuss all aspects of respite or day care with your elder.
• Find out if the center is certified, if your elder relative can begin on a trial basis, and if the service is regulated by the state.
• When you visit, look to see if staff members seem cheerful, helpful and competent, if there are unpleasant noises or odors, if the clients are enjoying themselves, if there are safety features all around (such as handrails), and if there are any medical or therapy services.

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