We've compiled most frequently asked questions about eldercare and provide the answers you need. This is the first in a two-part series.
1. Am I up to this? And, what if I'm not?
Everyone has his or her limits as a caregiver. It's important to respect yours. I often remind family members of their responsibility to an aging relative: You are responsible for providing a safe, healthy living environment--wherever that may be: your home, their home, the nursing home. It's impossible to do it all, so look to the community, family, friends, health care professionals and volunteers to fill in the voids. You also may find it helpful to write your own Caregiving Mission Statement.
2. How much will this cost?
A large misconception exists that the government, through Medicare and/or Medicaid, will pay for the care of an aging relative. Medicare, the federal insurance program typically for persons 65 and over, has very limited benefits to cover long-term care needs, either in a home or in a nursing home. Medicaid, a federal- and state-funded program typically for low-income persons, pays for some of the costs of in-home and nursing home care--as long as an aging relative's income is low enough to qualify for benefits. (If you have a concern about your parents--one parent is the family caregiver, the other, the care recipient--then contact you local Area Agency on Aging to learn about your state's Spousal Impoverishment Program. Assets can be protected in order to provide for the caregiving spouse.)
The majority of costs associated with a chronic illness or disability are assumed by the family and/or the care recipient and/or private insurance (including long-term happinesslifetime.com care insurance). According to our latest annual family caregiver survey, about 50% of respondents spent as much as $500 per month on services (home health, medications, supplies).
Many at-home care recipients depend on help from home health aides, trained professionals who assist with personal care, such as bathing and dressing, and provide light housekeeping, prepare meals and sometimes provide transportation. Home health aides can be hired through a home health agency or privately, by the family. According the U.S. Labor Department, home health aides, on average, earn $8.95 per hour. The cost of hiring a home health aide through an agency will be higher, somewhere in the range of $14 to $20 per hour.
Some families prefer to hire a home health aide privately as a way to save costs. If you opt for this, check with your (or your care recipient's) homeowners insurance agent to ensure adequate coverage of an in-home employee and with the IRS about tax implications. Also, consider a hiring a service that can run background checks. In addition, be sure you have a back-up plan in case the aide becomes ill, quits or just doesn't work out.
You can purchase monthly agreements from companies that offer medication reminders and personal emergency response systems. These services can range in cost from $10 to $90 per month or higher, depending on the service plan.
Adult day services may cost from $60 per day and higher; sometimes the cost includes transportation. Meals on Wheels are available on a sliding fee scale, depending on care recipient's income level. Each community (local or state level) offers myriad services, usually available on sliding fee scales.
The average cost of semi-private room in a nursing home is $183, although much depends on geographic location and care needs. Average length of stay in a nursing home is 2 and 1/2 years. However, many older adults use nursing homes for temporary stays, to recover from a hospitalization (Medicare provides coverage for a short-term rehab stay) or for placement so the family can take a break.
Room and board in an assisted living facility (an aging relative lives in an apartment-like setting but can still receive assistance with personal care) may cost from $20,000 annually and upward. Residents often occur additional costs depending on their level of care.
In addition to the cost of room and board in nursing homes and assisted living facilities, care recipients also assume the costs of medications, supplies and personal care items.
3. How long can I expect to do this?
In our most recent survey, family caregivers told us that they expect to be a caregiver for at least five years.
Because this is a long-term commitment, planning for the future is key. Take into account your care recipient's financial resources, your emotional resources and the community's resources. All these connect to make caregiving doable.
4. Who can I contact for help?
The ElderCare Locator can refer you to the Area Agency on Aging in your area (or your care recipient's area): 800-677-1116. In addition, you can contact your house of worship, the local United Way (an organization that funds programs that may help you), your state's Department on Aging, Easter Seals, National Family Caregivers Association (1-800-896-3650) and Children of Aging Parents (1-800-227-7294). Sometimes, your township (or your care recipient's) will offer services that can help, including telephone check-in, emergency response or transportation. You also can visit BenefitsCheckup at benefitscheckup.org benefitscheckup.org to learn about programs and services that can help.
5. How do I know when my family member can no longer live safely at home?
I'm asked this question regularly: How do I know when it's time to make a change?
I urge family caregivers to put systems into place which help to avoid a crisis. Personal emergency response systems, adult day services, home health aides, telephone check-in services, Meals on Wheels, volunteer programs all help keep your care recipient safe.
In addition, AARP has checklists available to help you make changes in your care recipient's living environment (eliminating throw rugs, improving lighting, modifying the bathroom with grab bars and bath chairs): [aarp.org/universalhome/home.html]
Often, a care recipient will resist changes. Usually what's behind the resistance is fear. Respect and recognize that these changes will be difficult for your care recipient. Start slowly, involve your care recipient, when appropriate, in any discussions and decisions, ask for your care recipient's commitment to try any services for a month. Allow your care recipient to vent, without judgments or recriminations. Reassure your care recipient that these services will keep him or her at home, safely--that you want to work together to achieve this goal.
If your care recipient still refuses, then back off, at least for the time being. However, don't give up. Contact local organizations for information about their services, costs and availability. In case a crisis occurs, you'll have the information you need about community services in order to make good decisions about your care recipient's future.
6. I don't like the aide (or volunteer or nurse or companion) that the agency sends. Am I stuck?
Nope! Call the agency and speak with the social worker or supervisor. Explain your concerns and ask for suggestions. If you believe the situation cannot be resolved with the current aide, ask for a different aide. Personality conflicts are not uncommon and the supervisor will work with you to find an aide that best meets your needs--and your care recipient's.
7. What is respite care?
Respite care refers to services used by a family caregiver in order to take a break. Respite care may be offered through a local organization (Lutheran Social Services, based in suburban Chicago, has a volunteer program structured to give the family caregiver a break) or through a state-funded program (New Jersey and Pennsylvania have respite care programs). Or, respite care could refer to a short-term placement in a nursing home for the care recipient while the family caregiver takes a much-needed vacation.
Use respite care regularly, so that when you really need respite care (to take a much needed two-week vacation) you'll be confident in the providers and staff who will care for your care recipient. You'll relax and enjoy your time away when you can trust those caring for your care recipient.
8. This is so depressing! I didn't realize I would feel this way. What can I do?
Often, family caregivers overlook an important part of their experience: the grief they feel at the losses suffered by the care recipient, by the family and by themselves.
It is depressing, which is why taking regular breaks is important. It's also critical to maintain some hobbies and interests you enjoy. Rejuvenating yourself on a regular basis will help you manage the experience.
In addition, finding support will help you unburden yourself, which will lighten your load. You can join a online support group and/or a group in your community. A member of our one groups told her brother she had joined a support group. He responded: A problem shared is a problem halved. !
You can also contact your Area Agency on Aging or your house of worship for lists of groups in your area. Or, call Children of Aging Parents, which sponsors a network of groups, at 800-227-7294.
In part two, we'll tackle the tough family issues, including getting help from other siblings and dealing with an uncooperative care recipient.
Visit Caregiving.com to learn how to write a Caregiving Mission Statement, create a back-up plan, find information on financing care, read tips on managing depression and join an online support group.
Denise M. Brown, a professional caregiving coach, began working with family caregivers in 1990. She debuted Caregiving.com in 1996, which enjoys about 24,000 monthly visitors.
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