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Home Care
Home care can be a cost-effective alternative that is more acceptable to clients than facility placement. Homemakers manage the housekeeping and shopping tasks; home health aides provide personal care. Decide which level is needed. Homemakers cost less than home health aides. Other support services, such as meal and transportation programs, are available in most communities.1,2
Home health aides or homemakers are available through agencies on an hourly or daily basis. Live-in aides are an option if there's a separate bedroom available. Families should be specific about the worker's responsibilities and schedule, and plan an introductory interview before service begins.1,2
Private hiring of aides and homemakers requires interviewing, planning, and supervision of applicants. Stronger candidates have been trained and have high school educations and drivers' licenses. Sources of help are family members, newspapers, churches and senior centers. Request and follow up on three references.1
Written contracts and consistent outside monitoring of in-home help is essential. Aides should document care activities and the patient's response in writing every day.1
Other Options
Adult day care provides supervision and recreation for clients in a congregate setting 4-8 hours during the day, usually Monday through Friday. Generally, patients must be continent, behave within appropriate guidelines, and have the stamina to be transported to the site and stay for several hours. Look for a facility close to home with trained personnel, a written schedule of activities and participants with similar interests as the client.7
Custodial care costs in facilities are high and not covered by Medicare. In 2008, the average monthly expenditure for a nursing home bed was $5,600 for a semi-private room and $6,300 for a private one. Typical assisted living care costs $3,000, while adult day care is $1,700 per month. One can expect to pay $29 per hour for a home health aide and $18 for a homemaker.8 Medicaid, long-term care insurance, Veteran's Administration programs and/or private funds generally cover custodial nursing home expenses.1 One must meet low-income guidelines to be eligible for Medicaid. Access more information on Medicare and Medicaid at www.medicare.gov/LongTermCare/Static/Home.asp and www.cms.hhs.gov.
Typical payers of assisted living costs are long-term care insurances, private funds and some veterans programs. Information on veterans programs is available at www.va.org. Occasionally, Medicaid will cover assisted living costs and often home care expenses for low-income individuals.1,2 Download free information from the Area Agency on Aging at www.n4a.organd www.eldercare.gov.
Teaching families the basics of long-term care and assisting them sort through the maze of options is an important nursing responsibility. With nurses' support, elders and their families can enjoy happier and healthier lives.
References
1. U.S. Department of Health and Human Services. (2007, April 10). Long-term care. Retrieved March 2, 2009 from the World Wide Web: http://www.medicare.gov/LongTermCare/Static/Home.asp
2. Mayo Clinic. (2008, Jan. 17). Long-term health care: Plan ahead. Retrieved March 21, 2009 from the World Wide Web: http://www.mayoclinic.com/health/long-term-care/HA00054
3. Eliopoulos, C. (2005). Rehabilitative care. In C. Eliopoulos (Ed.), Gerontological Nursing (6th ed.). Philadelphia: Lippincott Williams & Wilkins.
4. Zukerberg, C.L. (2007). Assisted living care. In A.D. Linton and H.W. Lach (Eds.), Matteson & McConnell's gerontological nursing: Concepts and practice (3rd ed.). St. Louis: Saunders.
5. Alzheimer's Association (2008, Nov. 12). Senior housing finder. Retrieved March 14, 2009 from the World Wide Web: http://www.alz.org/we_can_help_senior_housing_finder.asp
6. Eliopoulos, C. (2005). Nursing in long-term care facilities. In C. Eliopoulos (Ed.), Gerontological Nursing (6th ed.). Philadelphia: Lippincott Williams & Wilkins.
7. Rose, A., Segal, J., & White, M. (2009, March 9). Adult day care centers: A guide to options and selecting the best center for your needs. Retrieved March 20, 2009 from the World Wide Web: http://www.helpguide.org/elder/adult_day_care_centers.htm
8. U.S. Department of Health and Human Services. (2009, April 13). Paying for long-term care. Retrieved March 20, 2009 from the World Wide Web: http://www.longtermcare.gov/LTC/Main_Site/Paying_LTC/Costs_Of_Care/Costs_Of_Care.aspx
Lois Gerber of Port Orange, FL, has more than 35 years of experience as a community health nurse in direct patient care, teaching and consultation.
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