The 2010 U.S. Census revealed interesting information about our fastest growing age group, aging Americans (people 65 and older). For example there are 53,364 centenarians (people 100 and older), which is an increase of 5.8% since 2000. There are 1.3 million older Americans, which is 3.1% of our population, living in skilled-nursing facilities. The trend that is quite disconcerting, though, is that 11.3 million non-institutionalized older Americans, or 29.3% of the population, live alone. The proportion living alone increases with advanced age. Among women aged 75 and over, for example, almost half (47%) lived alone.
ComForcare, (a non-medical private duty home care agency), received a call one day from a social worker apprising us of an imminent discharge who would need the “special” type of services ComForcare usually provides when someone will be living alone. Mrs. Smith, 80 years old, was at the end of her 100 days of Medicare benefit, forcing her to make the decision to go home rather than stay in the nursing home and pay privately. Though still quite weak, Mrs. Smith had no medical reason to stay in a nursing home. She lived alone and her husband had passed away a year ago. Her son, Joe, lives in Florida, and the other, Jim, lives two hours away.
Joe called and spoke directly with Phyllis, one of the ComForcare owners. He sounded very stressed and overwhelmed. The first thing Phyllis did was to let him know that his family’s situation is not all that uncommon and with a little education, he would feel better about what to do. As long as Joe was willing to be accessible and assist in decision making, Phyllis told him ComForcare will take care of the rest. She mentioned to Joe that the family may benefit from the services of a Geriatric Care Manager, a resource Joe had no knowledge of. She explained what they did and referred a trustworthy professional.
Phyllis learned that his father was a war veteran and informed Joe about potential VA benefits a surviving war veteran spouse may receive to help pay for home care. Lastly she shared with him how “hands on” she and her husband Zack are when caring for a family’s loved one and they will be the “eyes and ears” for him through carefully selected home health aides, frequent home visits, and a well-managed care plan. You could feel Joe’s stress level drop a few notches. Joe committed to review valuable information on ComForcare’s website, be accessible via phone and email, and keep his brother informed.
What really helped Joe was the amount of information he received throughout the process, especially in the initial assessment stage. Phyllis and Zack, with years of experience in home care and caring for their own long distance relatives, kept Joe informed and educated on key aspects of the care his mother would require. The first step was to get Mrs. Smith comfortable with the care she would receive and that is achieved through frequent face to face visits at the sub-acute center by the owners and their nurse. Phyllis would talk with Mrs. Smith about what was important to her in getting back to a “normal routine” such as planning her days, good nutrition, daily exercise, and going to the hair salon. Zack would speak to her about how safe her home needs to be and what long term care planning looks like to live in a healthy, financially, and legally sound environment. Though Zack is not the expert in subjects outside of home care, over the years his experience and relationships with individuals who are the experts has helped him educate his clients on how to get trustworthy and appropriate assistance. The nurse would gather medical history and talk with her care providers to create the most appropriate care plan.
Mrs. Smith allowed Zack to go to her house and conduct a fall prevention home inspection before her discharge. He was pleasantly surprised to find that Joe’s brother Jim volunteered to show him around. The height of Mrs. Smith’s bed and toilets, how many steps were in the entire house, bathroom and shower access, and lighting are examples of important information needed to prepare for a safe transition home. Zack shared this information with Joe and also with the physical therapist so that they adequately prepare Mrs. Smith for her discharge. The home needed grab bars in all the bathrooms and at the garage door entrance. Those items, along with an emergency response system, were installed prior to the discharge through a trusted resource Zack gave to Joe. Joe was able to coordinate scheduling and payment long distance while Zack helped supervise.
The home was extremely untidy, a borderline unsanitary “hoarding situation” and a fall risk. Again, working with Joe, a plan was put in place and a trustworthy resource was provided. Joe liked that ComForcare suggested Mrs. Smith be part of the “cleaning and organizing” process so that she does not feel she is “losing control” of her independence and has a say as to where furniture and clothes can be moved. Plans were also put in place to handle picking up prescriptions, filling pill boxes, taking inventory of refrigerator and pantry food, setting doctor appointments, transportation arrangements, and weekly shopping. All of these activities are critical to a smooth transition of care back home.
Back at home, Mrs. Smith, through the assistance of her home health aides, was able to slowly get back to her “normal routine”. ComForcare talked to her and Joe about the importance of long term care planning. She did not have any advance directives in place and her will seemed to be outdated. ComForcare suggested a trusted resource, one that could help her legally establish a sound long term care plan that would involve her sons as health advocates and powers of attorney, establish advanced directives, apply for the home care VA benefit, and design a financially sound estate plan which may include how to become eligible for medicaid if the need arose.