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Certified Senior Advisor

By Kate Dougherty
Certified Senior Advisor

To have your questions answered,
please email kdougherty@professionalhc.com.

PLANNING & SCHEDULING HOME CARE

Dear Katy - I'm scheduled for double ankle surgery in two months, and need to do some advanced planning since I live alone. What's the best way to start? M.L., Murray, UT

Dear M.L. - The sooner you get things arranged, the less stress you will have going into your surgery. List the important information your doctor has provided. How long is your recovery? How long will you be immobile? What follow-up appointments will you need? Then contact a home care agency to have an assessment specialist meet with you in your home to develop a plan of care that outlines the specific types of assistance you expect to need. Most agencies do not charge any fee for the assessment service. Since recovery times vary, you will not be "locked into" any schedule or term of service, and can adjust the caregiver's hours and duties as you recover.

Dear Katy - One of my uncles is almost 80 and lives alone, and appears to doing ok. I try to drop by and visit him as often as possible. What should I be watching for that would indicate that he needs some in-home care? T.F., Oakland, CA

Dear T.F. - This is a question I often hear from families. Everyone ages at a different rate and many people can remain independent well into their 80s. Some things to look for when visiting your uncle include: Is his house tidy? Does he have adequate groceries (not just frozen dinners)? Have you noticed any weight loss? Has his personal hygiene declined? Are there any concerns with his memory? These are just a few things to consider. A great resource is his primary care physician. Often PCPs will be the ones to initiate the idea that some help might be needed in the home.

Dear Katy - My 85 year old dad is quite sharp, but moves slowly these days. How do we prepare for or anticipate his care needs? D.P., Layton, UT

Dear D.P. - The best way to anticipate your father's needs is to keep in contact with his doctor. While he is sharp mentally, it sounds like his physical health is declining. If your father is otherwise healthy, the doctor can give you an idea of how his ability to care for himself will decline over time. Now is the time to start discussions with your dad about getting some help for him. If you haven't already had the conversation, this might also be a great time to talk to him about finances and how or where he sees himself in his final days.

Dear Katy - I would love to arrange for occasional home care for my elderly parents. Mom seems interested but Dad says they don't need any outside help. Do you have any suggestions that will help him understand my concerns? D.M., Walnut Creek, CA

Dear D.M. - The first step is to truly understand why your father is so resistant to help. You need to ask questions but more importantly, really listen to the answers. Often, when one person is accepting and the other is not, it's because the willing party is acting as a caregiver. A great approach is allowing him to see that he has always been a provider and now it is his turn to have someone take care of him. Help him to see that this is a way for them to stay in their home and keep their independence.

Dear Katy - Mom requires 24-hour care. We are a large family that will mix our caregiving with outside assistance. What's the best way to manage all of this? A.G., Salt Lake City, UT

Dear A.G. - The first step is for someone in the family to be responsible for overseeing the 24-hour care. This person should get everyone's availability and put together a calendar that shows who will be with your mom at any given time. This calendar would be posted at your mom's house as well as distributed to all family members. From this calendar, you will easily be able to determine when you might need some outside assistance. One thing to consider is that if family members are flexible but don't want to devote too much time, schedule them so that the "gaps" in family coverage are as consistent as posssible. If you can give a regular schedule to an agency, they will have greater success sending you the same people.

Dear Katy - Our mom is in a skilled nursing facility, but frequently needs help to and from doctor's appointments. How quickly can we arrange for this type of service when she needs it? T.K., Monterey, CA

Dear T.K. - Check with home care agencies in your area. Transportation can often be arranged in a few hours, but the more notice given is always better. I recommend that you give the agency 24 hours notice. This allows them to meet with your mom ahead of time so she knows what to expect and feels com-fortable with the whole process. A regular planned schedule can be set up, or the service can be used on an "as needed" basis. You can see pricing and sample transportation plans that our company offers at professionalhc.com/short-term-personal-care

Dear Katy - We're looking at assisted living facilities for my dad. We'd like to arrange for a private caregiver to come in, as well, serving more like a personal assistant. How can we make sure to get the best possible arrangement for him? M.M. Salt Late City, UT

Dear M.M. - I always recommend that families do an "on the job" interview. Agencies can arrange for you to interview candidates prior to them starting, but it's hard to get a good feel about a person in a brief interview. This why most agencies will meet with families to conduct a thorough assessment and develop a plan of care. This is not only to fully understand what activities you would like to have completed for your dad, but also to get a sense of what kind of personality might best suit him. After this is completed, the agency will match him with a care provider. If at any time you would like to change your care provider, this can easily be arranged.

COST & INSURANCE

Dear Katy – If I need help in the home, will Medicare pay for it? M.G., Walnut Creek, CA

Dear M.G. – It depends on the type of help that you need. If your doctor has prescribed clinical help that would be administered by a registered nurse, physical therapist, or occupational therapist, Medicare will pay. Also, while under the care of an in-home clinicain, a home helath aide can be assigned under Medicare coverage for bathing and certain other types of personal care. Medicare will not pay if you need help with activities of daily living like non-prescribed personal care, meal preparation, medication reminders, housekeeping and such. The only insurance that does cover these services is long term care insurance which is privately purchased.

Dear Katy - We heard that veterans and their spouses or widows may qualify for in-home senior care assistance. Where can we get more information? C.S., Sacramento, CA

Dear C.S. - This is a great question because veteran's benefits are severely underused. I recommend contacting your local VA to learn more about the "Aid and Attendance" program. There are also several non-profits that work with veterans to process their claims. If you would like more information on these organizations, please email me at kdougherty@professionalhc.com.

Dear Katy - If a professional caregiver is hired, do I need to sign a contract that states the minimum amount of hours that are required? K.M., Livermore, CA.

Dear K.M. - Not all agencies require a contract. Contracts are generally created to benefit the agency, not the consumer. If you choose to sign a contract, study the contract very closely and read the details. If an agency requires a minimum number of days per week or month, continue your research into other options. Many agencies can be used "as needed" and wouldn't require any long term commitment.

Dear Katy - How often are we billed, and is there a deposit? N.U., Layton, UT.

Dear N.U. - Most agencies require an upfront deposit before home care services are rendered. In many cases, the deposit will be refunded at the end of your relationship with the agency. Each agency differs in terms of billing but many will charge you on a weekly or bi-weekly basis. If you sign a contract, please make sure to review it carefully and ask for a hard copy for your reference.

CAREGIVERS

Dear Katy - If we work with an agency that provides in-home senior care, will we get the same caregiver each day, or will we have to get used to a lot of different people? J.G., San Mateo, CA

Dear J.G. - It really depends on the amount of service you need each day. If you require extensive hours or 24-hour care, it is only practical to have more than one caregiver coming on a shift basis. But most agencies will certainly strive for continuity with the staff that is providing the elder care, especially when effort has been made to match the right personalities and care needs. The caregivers like it that way, too. Due to the nature of personal care giving, especially with bathing and close physical contact, familiarity and routines make everything much more comfortable for the elderly person receiving care.

Dear Katy - I think my widowed mother could use a companion. How does an agency go about matching up the right person? S.T., San Jose, CA

Dear S.T. - Your mom is going to be spending quite a bit of time with this person, so it's important that they connect. Most reputable agencies will take the time to meet your mother and learn about her, her interests, and qualities that she would look for in a friend. Once all of this information is gathered, the staffing supervisors can match your mom with the perfect fit. However, like any relationship, we don't always "click" with everyone, so it is important for your mom to know that she always has the option to try someone else.

Dear Katy - What happens if the caregiver for my senior parents doesn't show up on time? D.F., Layton, UT

Dear D.F. - This is an important question when you are interviewing agencies. Ask them how they manage this type of situation. As with any employment arrangement, unforeseen circumstances can interfere with a schedule. Our agency uses a phone-in time card system that alerts the scheduling supervisor if someone does not check in at the appointed time, so that a supervisor can immediately come by to care for an elderly client until the caregiver arrives or a replacement is arranged. This also guarantees that clients are accurately billed for the actual hours worked. It is one of the major advantages of working with an agency, the assurance and peace-of-mind that back-up staffing is an integral part of the service, especially for frail seniors.

Dear Katy - My mother has a caregiver who comes several times a week. But I don't think they get along very well, even though Mom hasn't complained to me about anything specific. What do you advise about this? D.R., Pleasant Hill, CA

Dear D.R. - First, discuss your concerns with your mother. If she is interested in interviewing alternative caregivers, your agency should be able to immediately arrange for her to meet and try out others. Personality conflicts can happen in any situation.

Dear Katy - We're considering live-in care for my dad. This will be new for us. How long before most people get comfortable with a live-in caregiver? R.M., Ogden, UT

Dear R.M. - It usually takes a week or two for everyone, including family members, to become accustomed to new routines and the round-the-clock presence of a live-in caregiver. I also reassure families that while this is new for them, it is not new for professional caregivers. They are accustomed to the situation and know how to make the transition to having someone in the home as easy as possible. The primary goal of home care agencies is to allow their clients to remain as independent as possible for al long as they can, so the caregivers will give as much space as a client needs.

Dear Katy - Can we try out a caregiver for a couple of hours to observe whether my autistic son is comfortable with the person that the agency sends over? J.M., Santa Cruz, CA

Dear J.M. - Absolutely. Professional home care agencies understand that there are many factors that make a caregiver and client relationship work. While they try very hard to only send care providers who are trained and skilled based on your needs, they know that personality is essential to a successful pairing. If for any reason a caregiver doesn't work out, you can call the agency to send a replacement. As you are trying to find the right match, the agency will need to charge its normal hourly rates, since the employee must be compensated for his or her time.

Dear Katy - My elderly aunt is increasingly restless and irritable. How do professional caregivers manage difficult behaviors? T.H., Aptos, CA

Dear T.H. - I teach caregivers to really understand what is causing these challenging behaviors. I recently worked with a client who was becoming increasingly irritable and abusive in the evening after dinner. I recommended to the caregiver that she really pay attention to what was causing the behavior. Over the next two weeks, the caregiver was consistently documenting that it began during the meal and continued for some time after. After ruling out some possible causes (he didn't like the meal, the chair he was sitting in was uncomfortable, etc.) the caregiver finally realized that he was having trouble with his dentures which was causing pain when he was eating. Once she was able to eliminate this discomfort for him, the nightly ourtbursts stopped.

Dear Katy - I'd love to have some help with cooking, but we're particular about what we like to eat. What if we don't like a caregiver's cooking? J.J., Salt Lake City, UT

Dear J.J. - You should never settle for a caregiver. If there is anything that you are unsatisfied with about the employee, you should immediately notify the agency. The whole reason for employing a caregiver is to reduce stress in your life. It is the agency's responsibility to manage the caregivers. If it is something that can be easily fixed with a little feedback, the agency will be able to address the issue. However, with something like cooking, it might be best to replace the caregiver to find someone who cooks more to your liking.

Dear Katy - Do agencies require that each caregiver's competency be tested? B.N., Salt Lake City, UT

Dear B.N. - This is something to ask each agency. In our case, most of our employees have worked with us for many years, so our supervisors' confidence in their abilities is constantly reinforced by what we see them do in our clients' homes. For new caregivers, we do thorough screenings and have detailed conversations with their references. We also spend time determining that they do not overstate their skills, helping them understand that their jobs would be at risk to do so. When necessary, we do on-the-job training. We provide active training with skilled clinicians working directly with clients in their homes. Since we have cases that require a wide range of skills from minimal care to full care, we are able to carefully match caregivers accordingly. This is a goal for most agencies.

Dear Katy - If we decide to use a home care agency, how do I know that I can trust the people coming into my home? R.A., San Jose, CA

Dear R.A. - The easiest way to limit your risk is to go through an agency that is registered with the National Private Duty Association (NPDA). To be a part of this association, the agency must prove that they do background checks on their employees. These agencies are also required to prove that all of their caregivers are protected by worker's compensation insurance and are employees of the company (as opposed to employee of the client). As you are speaking with agencies, you should always ask if they are part of the NPDA.

Dear Katy - How is the caregiver's time-off arranged? M.S., Morgan, UT

Dear M.S. - This is one of the advantages with working with an agency. Each caregiver gives his or her schedule to the staffing manager, and then it's conveyed to each client and the client's family. When time-off is needed, a replacement caregiver will be arranged. Typically, an agency will try to make replacements as consistent as possible. If a caregiver is asking for time-off, an agency will do its best to first contact the caregivers who a client has had (and liked) in the past. The client or client's family have the option to interview the selected replacement.

HOME CARE SERVICES

Dear Katy - Define "Non-Medical Care" and what caregivers aren't allowed to do? L.M., San Francisco, CA

Dear L.M. - Non-Medical care is best described as assistance with activities of daily living. This would include personal care (bathing, dressing, assistance to the bathroom), light housekeeping, laundry, meal preparation, and transportation. Home caregivers cannot do anything that would be described as clinical or invasive. Most importantly, they cannot administer any medications. If the client requires insulin, or other injections, they would have to be administered by the client or a trusted member of the family. Also, a caregiver shouldn't be monitoring vitals such as blood sugar, blood pressure, etc.

Dear Katy - If we hire a caregiver for meal preparation, about how much time is usually needed to plan and prepare meals each week? R.G., Salt Lake City, UT

Dear R.G. - Meal preparation typically includes developing a menu, shopping and preparing the meals. If the intent is to have the caregiver do all of the above, I would recommend eight hours per week. This can either be split into two four-hour shifts, or one shift per week. This allows the caregiver enough time to prepare dinners and/or lunches for the week and package them and freeze them. The main thing to consider is how often you want your loved one to have a fresh cooked meal.

Dear Katy - My husband's elderly parents may soon need home care. Do home care agencies also help with other local resources for frail seniors? A.D., Vacaville, CA

Dear A.D. - This is an excellent question to ask agencies when you are evaluating your options. Home care agencies should have a huge referral network to help with local resources for your elderly parents. A reputable agency should be immersed in their local community and should have relationships with all types of service providers ranging from landscapers to financial planners. It is one of the benefits of working with an agency. They are able to function as consultants and advisors, in addition to supervising the care that is provided.

Dear Katy - Mom is home following knee surgery, Dad has some mobility problems with arthritis, and I live too far away to be much help. They're using a part-time housekeeper, and a neighbor drives them around. What are some other types of services that I could arrange for them? K.K., Los Angeles, CA

Dear K.K. - Now that your parents' needs are changing, you should start looking into someone who can provide a multitude of services. There are great resources out there for personal aides who can not only take over the housekeeping and driving, but can also provide assistance with personal care, meals, laundry, and other activities of daily living. This is much more cost effective than having several different people doing one or two things to help your parents.

Dear Katy - My 85 year old dad has lost a lot of weight in recent months and I know that he's not eating very much. His doctor says he's healthy but I'm beginning to get concerned. Any suggestions? T.M., Valejo, CA

Dear T.M. - If everything has checked out with the doctor, the next thing to consider is why your father isn't eating. Many times when I speak with families this is a problem. Appetite does decrease with age, but the majority of elderly people I speak with aren't eating either because they don't want to bother with cooking or they don't like to eat alone. In either of these cases, a personal caregiver could be of assistance. Someone could come in 1 or 2 days per week for a 4-hour shift. During this time, they could cook a nutritious meal, sit with your dad while he eats, cook and package up some meals for the remainder of the week, and maybe tidy up the house a bit. This is also a great way to "break-in" the idea of your dad needing more assistance as he ages.

Dear Katy - I'm going to need transportation to and from a medical procedure next month. What is the minimum amount of assistance that an agency typically provides? A.B., Murray, UT

Dear A.B. - Most agencies will typically try to do a four-hour minimum. But they will generally try to accomodate your needs if you really don't need the full four hours, though the hourly rates may be slightly higher. It is reassuring to have a professional attendant in these types of situations who will make sure you are comfortably situated once you are back home. Be sure to ask if the agency has special packages for this type of service. You can see sample short term care plans at professionalhc.com/short-term-personal-care.

Dear Katy - Managing Dad's medications is a big problem for us. Any suggestions? W.T., Ogden, UT

Dear W.T. - This is a very common concern for families. My first piece of advice is that it should only be handled by one family member. If more than one person gets involved there is almost always confusion on the status of refills, what has been taken, what isn't supposed to be taken anymore, etc. Ideally, you would want this to be someone who visits on a weekly basis and is able to attend most doctor visits. If this is the case, this person would know of any changes, would order refills, and sort the medications if necessary. If there aren't friends or family who can assist with this, there are still options. The first and easiest is to find a pharmacy in your Dad's area that will do bubble packs (sort the medications for you). Most pharmacies that do this also have delivery service which is an added convenience.

Dear Katy - My mother is no longer able to drive. How often is transportation provided and how far? S.R., Layton, UT

Dear S.R. - Agencies can usually provide transportation by car at any time of the week, but with a 24-hour notice. Agencies will check a caregiver's driving record and insurance to ensure the safest drivers. In many cases, a caregiver will drive their own car. However, with the consent of a client's family, they can drive the client's vehicle. Transportation can be provided for any distance during the day. Usually clients request driving errands such as doctor visits, medication pick-ups, laundry, and grocery shopping.

MONITORING HOME CARE

Dear Katy - How can I check the quality of care my mom will be getting from her caregivers? Any tips? A.T., San Franciso, CA

Dear A.T. - My biggest piece of advice is to be involved in your mom's care. Get to know the caregivers and the supervisors at the agency. If you see anything in the home that concerns you, report it immediately no matter how insignificant your observation may seem. Try to make visits to your mom's home to get a true understanding of what is occurring on a daily basis. (If you live out of the area, find someone you trust to make the visits.) Ask your agency if they do unscheduled supervisory visits, an important aspect of quality assurance. If they do not, find out how they manage their caregivers. Lastly, the agency should provide a chart book, and the caregivers should be noting all important information for you to review.

Dear Katy - Can family members access mom's daily chart? V.L., Sunnyvale, CA

Dear V.L. - Agencies typically arrange for family members to have full access to the charts, and the notes can be scanned and emailed if you wish. With a live-in caregiver, supervisory visits are usually once per month, and the client's charts are reviewed at that time. Most families find this is often enough. However, if you would like more frequent visits, that can be arranged.

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