In-home care can fill a variety of needs

by Carol Bradley Bursack


In-home care is one of the most flexible types of care for the varying needs of our aging loved ones. As a family caregiver with multiple elders to care for, I used in-home care for both short-term and long-term situations. While getting used to "strangers" in the home was an adjustment for my elders, the advantages were worth the stress of change. How can an in-home care agency help you and your loved one?

Prior to my need to find care for my elderly neighbor, Joe, after he dislocated his shoulder, the closest thing I'd seen to "in-home care" was the public health nurse who used to come to our home to give my grandmother her vitamin B-12 shot. That was decades before I became Joe's caregiver. I simply hadn't had a need to keep up with care trends.

After Joe's wife died, it became evident to me that Joe needed someone close by that he could count on. His only child, a son, lived on the east coast, while Joe remained in his native North Dakota. Joe's total hearing loss didn't make life any easier for him, as his only contact with his family was by mail. He had some long-time friends to check on him, but that was it. I as his neighbor felt a draw to help him, so I did.


Joe had a history of falling, but his first serious fall happened while he was out in his garage. That time, he dislocated his shoulder. I rode the ambulance with him, accompanied him through all of his medical work, and then chatted with a social worker who insisted we get him some in-home care, at least temporarily.


Learning the Ropes: Nursing Care is Generally Covered by Medicare while Custodial Care is Not


My education about how the modern world of caregiving works began with this meeting. We set Joe up with a personal medical alarm, something that I went on to use while caring for other family members. I am a strong proponent of those alarms, and even more sophisticated versions that are now on the market.


We also signed Joe on with an agency that supplied a nurse who came to his home, plus some "custodial caregivers." Custodial care is the non-medical care that many elders need. The people agencies hire for custodial care are often, though not always, Certified Nursing Assistants. Some of these CNAs have extra certification to give medications, others don't.


We had a steep learning curve on the differences between these types of care. After the Medicare statements started to come in, we learned that custodial care is seldom covered by insurance, though Medicare does cover nursing care prescribed by a doctor. By the time we had this sorted out, the nurse was done, since Joe's shoulder was healing well. When he saw he must pay out-of-pocket for the folks who did light housekeeping and basically kept him company when I wasn't there, he stopped the service. Still, they were helpful while they lasted.


Please don't discount the importance of one main benefit drawn from custodial care - someone to "keep them company." If I hadn't been able to visit Joe every day, he would have benefited greatly from this type of care. Generally, when an agency has someone in the home, they not only keep the elder company, they do light chores. They often take the elder grocery shopping or run the errands themselves. Many are certified to help with bathing, dressing, toileting and other tasks.


Eight Hours a Day of In-home Care Can Be Expensive but Helpful


My widowed uncle was the next of my loved ones to need in-home care. He had suffered a series of strokes, but was, in general, doing fairly well. We, his family, could care for him some, and we always took him to his medical appointments, but he wanted and needed companionship so we hired an agency to provide eight hours a day of care. He wore a medical alarm at night, and we spend a great deal of time with him.


During this time, I saw in action the benefits of what is now called "consistent assignment," which means that the agency (or facility) tries to assign the same caregivers to residents so they get to know one another well, and can have a friendly relationship.


Think what it would be like to have a different person, someone you've never seen before, appear at your door in the morning, wanting to come in to care for you. While it's smart to have a rotating care team because people do get sick and take vacations, it's very advantageous to have the individual team members stay the same. My uncle had three caregivers who rotated shifts. He had his favorite caregiver, but still, they were all acceptable to him and became his friends. This arrangement worked well until he had a major stroke and needed to move to a nursing home.


In-Home Care Agencies Can Provide Personal Care an Elder May Not Want a Family Member to Do


My mother-in-law needed help bathing, yet she wouldn't let me help her. She was a very modest woman, and the idea of a family member bathing her was understandably humiliating to her. For that reason, she fibbed about changing clothes and about taking showers.


We knew we had to do something, so I engaged an in-home care agency to come in one or twice a week to give her a bath. While she wasn't thrilled with this arrangement, as she was becoming very paranoid about "strangers," when it came to baths, she preferred this caregiver to a family member. She viewed the agency worker, I believe, like she would view a nurse in the hospital - someone detached from personal relationships. She did what the "nurse" told her to do.


I continued to give my mother-in-law all other care until her creeping dementia became too great and she needed nursing home care. However, for a period of time, this in-home agency worker coming to her home to bathe her was an arrangement that worked fairly well.


Reasons to Consider In-home Care Are Diverse


Companionship: Companionship is vital for a human to thrive. In-home care agencies can provide this human touch with consistent assignment and loving care.

Personal care needs - Some service that the family can't provide, or that the elder prefers an outsider to give, such as bathing, nail trimming, dressing and toileting are examples of personal care needs.

Medication supervision - Even if the agency worker isn't licensed to dispense medications, the caregiver can generally supervise the taking of the medication, reassuring the family that medications are taken on schedule.

Errands - Grocery shopping and other errands can become an enjoyable outing for many seniors, if they have a companion who can go with them. If the elder prefers not going along, the caregiver can often run these errands themselves.

Light housekeeping and cooking - Sharing a simple meal with someone can be a pleasure, while eating alone is often lonely. A caregiver who has become a friend can share a meal, thus helping an elder feel connected to humanity.

Safety - The obvious reason for having a caregiver around is for the elder's safety so that if the care receiver should fall, have a seizure, or have some other health emergency, the agency worker can provide CPR or other needed help while awaiting emergency help.

The timing and the reasons for in-home care is different for every elder and every situation, because the elder's needs are ever changing. Some have more family available to help than others. However, in-home help can be a vital piece of the puzzle when an elder is not able to fend for him or herself, yet is not ready or willing to go to assisted living or a nursing home. For my family, in-home care was an important part of the mix of care our elders needed.