Choosing a home care agency can be daunting. Here are a few tips to help you make an informed decision. First, it is important to know what kind of care you or your family member requires. Home care can range from light housekeeping to skilled nursing. Here are some categories of care:
- Skilled nursing care or medical care – Injections, medication administration, oxygen, and assistance with medical equipment.
- Rehabilitation – Improve range of motion, increase strength, and assist with improving completion of activities of daily living.
- Hospice – Comfort care and end of life care in collaboration with hospice healthcare professionals.
- Personal care – Bathing, eating, dressing, and transferring.
- Housekeeping and chores – Meal preparation, cleaning dishes, laundry, shopping, and errands.
- Night care – Twenty-four hour care. Attention should be paid to the breakdown of the healthcare professional’s schedule for around the clock care. For example, how long will an employee be awake and how long are they required to rest?
- Transportation – Transportation to and from appointments or transportation to social functions. Consider the owner of the vehicle that will be used and any special equipment that will be required. Speak with your car insurance provider if someone else will be driving your car.
- Companionship – Supervision and social visiting.
Learn a little about the agency that you are considering:
- How long has the agency been in the business?
- Consult the Better Business Bureau for any complaints.
- Find a list of services provided by the agency.
- Are there a minimum number of hours the agency requires the care workers to be booked for?
- Does the agency provide for couple care?
- Must a doctor authorize a client to receive home care?
- Does the company accept insurance?
- Is the client responsible for travel costs for healthcare professionals?
- Are there additional fees?
- How to pay for services?
- When to pay for services?
Employees
- Education level for care workers employed by the company.
- Licensing requirements for employees
- Screening process for employees
- How is someone paired with a healthcare professional?
- What if a client does not get along with healthcare professional?
- What if a healthcare worker calls in sick?
These are a few things to consider when hiring a homecare agency, and is by no means complete. It is crucial to research any home care agency before you hire them.
Note: It is important be aware that the state of Washington requires a Registered Nurse to complete a home visit once every six months for those receiving home care services, even if those services are as limited as laundry services or companionship. This is to make sure the home environment is safe for the care workers as well as the client and provides a method to monitor for abuse.
After hanging up with his mother, Alex, is concerned about his mother assisting her friend Georgia at home. Since Georgia broke her hip, she has been having difficulty bathing by her self. Alex spends some time on the internet doing research to try to find out a little bit about home care. Alex finds a company called Health People that assists with care in the home. This company’s website states they assist with personal care such as bathing, medication reminders, meal preparation, shopping assistance, laundry, and they also assist with getting to and from appointments.
Alex calls Health People to set up an appointment to discuss the details of possibly assisting Georgia at home. Alex thinks that Health People may be useful if he is not able to drive his mother, Rosemary, to the doctor or to assist her with her shopping. Rosemary is doing well at home, but Alex likes the idea of having a back-up-plan to assist his mother as she ages. Rosemary loves living at home in her house, and Alex hopes that he can assist her to stay there.
The next step is for Alex to tell his mother about Health People. He and Rosemary then need to broach the subject with Georgia. Alex feels that it may be beneficial to talk to Georgia with his mother present. Alex is aware that sometimes people do not like strangers in their house, but a new person can offer stimulating and needed companionship.
In the last post of Rosemary’s Diary, Rosemary’s friend Georgia, is using a walker after her hip surgery to help prevent her from falling. When assistive devices are needed for adults who have had surgery or generalized balance difficulties, there are a few things to keep in mind. The Washington State Department of Health has published an information guide for adults over the age of 65. This guide includes basic walker information and tips on choosing and using walkers.
- Walkers are often made of lightweight aluminum and can support 50 percent of your weight.
- Choosing the correct walker of the right height and style is important to prevent falls, and should be done by a physical therapist or physician.
- A physical therapist can also assist with initial training for safe walker use.
- Walkers are most commonly available with two wheels, four wheels, or without wheels.
- Walkers may also have brakes, seats, specialized grips, and baskets.
- Walkers often fold to fit in cars or busses
Tips to use a Walker Safely
- Take small steps
- Keep the walker close to your body
- Wear nonskid slippers, socks, or shoes
- Remove throw rugs and clutter from the floor
- Keep your head up while walking to maximize your balance
- Keep both hands on walker, if you need to carry items attach a basket to the walker
- As you walk, move the walker ahead of you one footstep at a time and make sure walker is firmly balanced before you proceed
How to Get up from a Chair While Using a Walker
- Pull the walker in front of you and slide yourself to the front of the chair
- Make sure the walker is level
- Stand up slowly with both hands gripping the walker.
- When you stand up give yourself some time before you walk to make sure that you have good balance.
- Move the walker forward one step and walk towards it
How to Sit Down in a Chair While Using a Walker
- Use your walker to back up to the chair until your legs touch the back of the chair.
- If your chair has an armrest, use one hand to find the armrest of the chair while leaving one hand on the walker (This step varies based on chair).
- Slowly sit down
- Slide back into chair
There is no replacement for having professional assistance and training with medical equipment. The above is a brief overview and is by no means complete. For more information see your physician or physical therapist.
Once Rosemary and Georgia are inside the foyer of Georgia’s expansive two-story house. Rosemary notices some changes in the house. Georgia has always been a flamboyant collector and exuberant fan of knitting and bead projects. Georgia was always piling up things along the floor in the hallway that she said she ‘would get to later’. The hall has been cleared and Georgia’s many projects have been put away.
Georgia is using a walker after her hip surgery. It appears to Rosemary that Georgia is getting along well with her walker, and seems to be overjoyed to have a visitor. Rosemary informs Georgia that she has bought her some groceries and makes to go out to the car to get them; Georgia states that she will help her pack them in. Rosemary opens the door wide enough for the walker and follows Georgia out to the front step. Georgia thankfully only has one step in front of her house and expertly guides herself down the step with her walker, and makes her way to Rosemary’s station wagon. Rosemary unloads the groceries and is not sure how Georgia is going to carry any groceries while holding on to her walker with both hands. Georgia senses Rosemary’s hesitation and carefully bends over to pick up a grocery bag by the handles. Georgia then places the bag on a little seat situated in the middle of the walker. Rosemary is astonished; she did not notice that the walker had a seat. The two ladies finish bringing in the groceries and they finally get a chance to sit down and talk in the kitchen after Rosemary makes them some tea.
Georgia talks and talks and talks about how nice it is to be home again and how she missed all of her things and how she never had any privacy at the rehabilitation center. She liked all of the opportunities to make friends and be social, but Georgia complains that staff and other inpatients would just walk in her room at all hours of the day. Georgia tells Rosemary that she had a friend from her dancing days clean up all of her projects from her hallway, so she would not fall now that she is using a walker. Georgia tells Rosemary that the physical therapist completed a home assessment before she could come home to make sure that she would be safe. All of her projects were relegated to cardboard filing boxes from the office store and placed in a spare bedroom. Georgia appears sad about this but brightens when she tells Rosemary about a new dance she would like to learn. Georgia reports that she will not be using the walker forever, but just until she can get her strength back. Rosemary asks if there is anything else that she can do for Georgia now that she is home. Georgia sips her tea and after a very brief pause, Georgia explains that she is having trouble getting into the tub by herself and asks Rosemary if she would be willing to come over to help her take a shower a few times a week.
Several days later, Rosemary receives a call from Georgia who is now at the Pine Cone Creek Rehabilitation Center. Georgia tells Rosemary that she will be staying there for about 2 weeks so she can heal, get back on her feet, and complete her physical therapy for her hip fracture. Georgia reports that her daughter Jillian went home yesterday and she would love to see Rosemary.
Rosemary finds Pine Cone Creek Rehabilitation Center in the phone book and writes down the address and telephone number. Rosemary calls the rehabilitation center to get directions but cannot understand the person who answers the telephone, so she finds an old map that she has not used for years. On the kitchen table Rosemary unfolds the limp map to find the street she is looking for. Once she finds it she circles it with a pen so that she can easily find it while she is driving. Rosemary carefully folds the map so that she is able to just see the circled area. The map is so big it takes up most of the table and she would not be able to see out of the windshield if she leaves it completely open. One second thought, Rosemary feels that she should pack the phonebook too, just in case she loses the piece of paper with Pine Cone Creek’s address on it.
Rosemary packs up some magazines for Georgia to read, her phone book, her map, and gets into her car. Rosemary finds Pine Cone Creek Rehabilitation Center without any difficulty, partly due to the billboard-sized wood sign near the front gate. Rosemary inquires about Georgia at the main desk and she directed to her room. Georgia is not in her room so Rosemary asks a very young looking employee about Georgia’s whereabouts. Rosemary is told that Georgia must be in the group dining room. Rosemary is directed to the dining room and as she is about to enter, there is Georgia using a walker and being directed by another very young attendant, to purposefully place her walker ahead of her before every step. Georgia is so happy to see Rosemary, she is laughing and crying at the same time. Rosemary makes a mental note that Georgia looks very well and happy. Rosemary was worried about Georgia after the conversation she had with Georgia’s daughter Jillian. But her fears are relieved by the cheerful mood Georgia seems to be in. Back in Georgia’s room, Rosemary learns what it has been like to be in a rehabilitation center. Georgia states that she would rather be home, but does not mind the food and the people seem nice. Georgia tells Rosemary that she is enjoying meeting new people here and there is always something fun going on. Georgia does not seem to be upset to be here as she states that she is receiving daily physical therapy to get back on her feet. Georgia tells Rosemary that she expects to be here at least a month, which is two weeks longer than Georgia had originally told her. Georgia tells Rosemary that she is learning to use the computer and her daughter set up an email account for her so that they can keep in touch.
Rosemary sits at home that night after watching the evening news, she thinks about her day, about Georgia, and her own future. Rosemary writes in her Hello Kitty diary from her granddaughters.
Dear diary,
I had a chance to visit Georgia in the rehabilitation center today. I did not tell Georgia about the conversation that I had with her daughter, Jillian. While I was visiting Georgia I was thinking about Jillian’s worries about where her mother should live when she gets out of the rehabilitation center. Her daughter does not want Georgia to live alone at home and was asking me what to do. I don’t know what they should do. On the drive home today I was wondering what if this happens to me? What would I do, what would my son and daughter do? Maybe I should talk to them both. I am healthy now, but what happens if I am not?
The next morning is Saturday and over her solitary coffee and toast, Rosemary thinks about her friend Georgia recovering from a broken hip. Georgia told Rosemary that she has been keeping in touch with her daughter Jillian by email. Rosemary knows that the internet is available, but has not had much of an opportunity to use it. Rosemary imagines that her grandchildren are using the internet when they are clicking on their gadgets. Rosemary calls her son Alex to ask him about the internet. Rosemary asks Alex if he uses the internet and he tells his mother that he uses it for everything. Alex states that he can find the answer for anything on the internet even the menu for a restaurant. Rosemary wants to know what she can use it for. Could she talk to Georgia through the internet during her stay at Pine Cone Creek Rehabilitation Center? Alex tells his mother that she can keep in touch with her daughter and granddaughters as well as Georgia. They can send messages back and forth, share photos, and even trade recipes if they like. Alex seems exceedingly excited about this and is quickly talking to his mother about all the possibilities for her if she has the internet. Rosemary is worried about how much this will cost and how she will learn to use it. Without asking, Alex states that he will be over in the morning with his old computer to get her started. Rosemary is excited to keep in close touch with Georgia and feels that she is one step behind her friend who already knows how to use the internet.
Seniors, Computers, and Email
It comes as no surprise that more and more seniors are using computers to keep in touch with their families. Although it seems that computers are much more simple than they used to be, they can be daunting to a senior who has never used this medium to communicate. Seniors often report that they feel that they will “break” something or may do the wrong thing.
Email can be made much more simple for seniors with software such as Paw Paw Mail and Red Stamp Mail. This software provides an interface with large icons such as “Read Mail”, “Send Mail”, and “Photos” so it is easier for the senior to see what they are looking for. For more information see: pawpawmail.com or redstampmail.com
Remember to research thoroughly before purchasing anything online.
Rosemary’s son gives her a ride to the hospital on his way to work. Rosemary inquires about Georgia’s room from the main volunteer desk at the hospital entrance. A silver-haired, red vested volunteer named Bob, states that he will take Rosemary to Georgia’s room. He offers Rosemary a wheelchair ride, as it is such a large hospital and he is worried about her getting tired. Rosemary declines but thinks that Bob might need a wheelchair himself; Rosemary has to wait for him to catch up as he walks so slowly shuffling his feet. While walking with Bob, Rosemary has time to notice how much he looks like Santa Clause with his white hair and red uniform.
Rosemary reaches Georgia’s room and finds her sleeping. Rosemary sits on a hard, folding chair in the corner of Georgia’s room for 20 minutes listening the sounds of the hospital and smelling the interesting smells. Georgia’s room is cramped with a bed in the middle that takes up most of the room, and a window that looks out onto the vertical concrete wall of the next wing. Georgia looks relaxed and peaceful while sleeping, which makes Rosemary feel at ease because she did not know what to expect after seeing Georgia in the ER yesterday. Georgia’s breakfast tray lay on the tray table untouched; Rosemary sneaks a peek to see what they are feeding Georgia and she finds chicken broth, tea and green Jell-O. Not what Rosemary was expecting, but she rationalizes that Georgia may need light food after surgery. Just before Rosemary sits down again, Georgia’s daughter Jillian arrives. Jillian has just flown in from Savannah.
Jillian appears to be flustered and is obviously distraught that her mother is in the hospital. Jillian’s loud voice wakes Georgia from her sleep. Georgia is drowsy but recognizes both Jillian and Rosemary. Rosemary offers to leave Jillian and her mother alone, but Georgia is looking tired, so Jillian quickly offers to buy Rosemary lunch at the hospital cafeteria. Rosemary chooses a muffin for it’s simplicity, thrift, and speed. Rosemary does not wish to stay long or order anything expensive since Jillian is buying her lunch. During their meal, Jillian talks endlessly about her concerns regarding her mother living alone at home in her current condition. Jillian breathlessly agonizes about her mother’s situation with tears in her eyes while pushing around her lunch on the plate. Rosemary thinks that Georgia should be part of this conversation because it is her life after all, but she lets Jillian go on and on about Georgia living alone at home. Jillian asks Rosemary what she should do about her mother. Rosemary feels uncomfortable with this conversation and squirms in her seat a little, but is not sure that Jillian will give her an escape route. Would her son be asking a perfect stranger to help decide where she should live if she could not care for herself? She never considered this possibility and feels a little scared. Jillian apologizes for putting Rosemary on the spot because she can see that Rosemary looks uncomfortable and has ceased talking. Rosemary and Jillian walk back to Georgia’s room, all the while Rosemary is contemplating their conversation.
Caring for Senior Adults from a Distance
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Georgia Suffers a Hip fracture
After what seems like many hours, the doctor and nurse come back into Georgia’s room to break the news that Georgia’s right hip is broken and she will need surgery. She will have surgery as soon as the surgeon finishes with the patient he is operating on right now. Georgia will wait in the emergency room; they are told it could be hours. Georgia tells Rosemary to go home and she will be fine, but Rosemary does not believe her and stays because Georgia has no family in town. She cannot just leave her there. Rosemary feels that Georgia needs an advocate here with her, someone to watch out for her. Rosemary feels that she should ask some questions of the doctor about hip fractures, but is not sure what to ask.
Hip Fractures
Hip fractures are very common. In 2006 there were over 300,000 hospital admissions due to hip fractures. Most hip fractures are caused by falling sideways on to the hip. Women sustain 75 percent of hip fractures, with the risk greatly increasing for both men and women over the age of 85.
Treatment
Treatment most often includes surgery, hospitalization for at least one week, and then rehabilitation. A hip fracture is considered a serious injury and sadly, one in five patients who have sustained a hip fracture will die within one year. The best scenario is prevention.
Prevention of Hip Fractures
- Weight bearing exercises that build strength and improve balance.
- Evaluate medications for side effects that cause dizziness.
- Schedule medications to promote a good night’s sleep without the need to get up to urinate.
- Regular eye exams
- Avoid fall risks in the home; remove throw rugs and clutter, use assistive devices such as canes and walkers when needed and use them appropriately.
- Make sure there is adequate lighting in the home and outside.
- Eat a healthy diet with adequate calcium and vitamin D which assists with absorption of the calcium for strong.
- Osteoporosis screening
For more information
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html
http://www.healthguidance.org/entry/9891/1/Osteoporosis-Calcium-and-Estrogen.html
Seniors at Home: The Value of Support from Family and Friends
Rosemary arrives at the emergency department. She is looking for her friend, but how on earth is she going to find her? As a senior living at home, she often must navigate unfamiliar territory on her own. There are a lot of people wearing hospital uniforms, but they are walking fast and looking busy. Rosemary sits in the waiting room for a while to see what happens. A very nice looking young man in a police uniform or maybe a security uniform, walks by and she asks him how to find her friend in the emergency room. He directs her to the triage booth, but they are busy so they ask her to sit down. Rosemary gets her turn and insists to the staff she is not sick but wants to see her friend. They call Georgia’s nurse and Rosemary is walked back to see her. Rosemary enters Georgia’s room to find it empty, the nurse states that Georgia is in x-ray right now and will be back in about 20 minutes. The nurse invites Rosemary to have a seat in the room to wait for her.
Rosemary sits on a very hard, cold folding chair, watching television in the room. Rosemary cannot figure out how to change the channel and is too short to reach the television on the wall, so she watches a sport fishing program. Georgia is wheeled back into the room and starts to cry when she sees Rosemary. Rosemary is concerned, but Georgia states that she is so happy to see her and she is not in too much pain as long as she does not try to move her leg. Rosemary suspects that Georgia is trying to be strong for her.
Support from Friends and Neighbors
Family members and adult children of seniors do not always live close by. Seniors living at home often rely on friends and neighbors for support in the event of a crisis until family members can arrive.
Rosemary is a close friend to Georgia and although Rosemary does not make medical decisions for Georgia, she is there to provide company and support for Georgia. If a patient arrives in the emergency room unconscious the presence of friends, family, and neighbors can assist the staff in innumerable ways. Friends and family provide medical personnel with information such as medical history, medications, and background information about the patient. Being present with a friend or family member in the hospital also provides a second set of ears for the multitude of information that is passed to the patient. It is a lot to take in when the patient is under stress, in pain, or if they have received pain medications that may alter their ability to think clearly.
Rosemary Goes for a Drive
In the afternoon, Rosemary feels like she should get out of the house and go grocery shopping to replenish the juice and soda that was used at the party. No one is scheduled to visit, but Rosemary wants to be ready just in case. Century Five Market is only two miles away from her home, but Rosemary feels like it is getting farther away. She drives a 1983 Ford LTC station wagon; it was top of the line when her husband purchased it. The car still runs well and it has very few miles on it for its age. Rosemary’s son pesters her to get a new car or let him drive her to the market. She likes to drive and does not want to bother her son with a silly thing like grocery shopping. Rosemary is concerned that she may need to take him up on his offer to drive her to the store; it seems like she is playing the lottery every time she takes her car for a smog check. Her car reminds her of her husband and the time that they spent together. Buying a new car would end that chapter of her life. She does not want to tell anyone this, because she will get the “it is time to move on” lecture. She still misses her husband.
Rosemary feels that she may need her son to drive her to the store in the future, but she wants to be independent as long as possible because her son is so busy. Secretly, Rosemary would like to know when her son is coming over next so she can plan for it.
Rosemary finishes her grocery shopping after a conversation with an acquaintance. She gets in her car and begins to back out of the parking space. Someone is honking at her. There is a car waiting for her spot and they seem very anxious to have it. Rosemary feels a little rushed, but backs out her long station wagon safely despite her short stature and inability to see over the back seat. Rosemary heads home driving slowly.
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