Caregivers in the Home

CAREGIVERS IN THE HOME

**PHASE NEEDS INTERVENTION**
BEFORE DIAGNOSIS	Gather information Identification of Options Communications among family/friends Awareness of attitudes & diversity	Get education Discuss with physician Meet with lawyer, etc. Explore/visit options Enroll in research protocol Engage in counseling Case management
DIAGNOSTIC PROCESS	Understanding of process Awareness of treatments Future planning / financial & legal Identification of supports Exploration of research opportunities (drugs, treatment) Emotional support	Identify resources Case Management Convene family meeting Consider appropriate approaches
ROLE CHANGE	Understand disease implications Interactions/decisions among family Participate/evaluate effects of research Plan for daily activities Emotional Support	Education Family meetings Education Case management Support Groups, family & friends
CHRONIC CARE	Recognize and understand disease Impact of problems Medications & Treatment Continue planning Family interaction Stress of Caregiving	Education and training Case management Medical monitoring Carry out plans Family communication Stress management
CARE CHANGE	Awareness of alternatives Financial arrangements Care burden continues	Visit and evaluate options Case management Emotional support Counseling Support groups
END-OF-LIFE	Awareness of hospice options Understand end stage Autopsy implications Emotional burden	Visit & evaluate hospice Education Make arrangements Bereavement support

CONSIDERATIONS FOR CARE IN THE HOME

When care needs increase the following considerations should be made:

Observe, document and assess the situation. Define the needs. Involve persons (family and/or friends) who are in a position to make decisions with/for the individual.

Several types of care are available for care within the home:

         Personal Care:     bathing, dressing,
                            toileting
         Health Care:       medical treatments and
                            supervision
         Homemaking:        cooking, laundry,
                            housekeeping
         Companionship:     less skilled company
                            and supervision
         Hospice:           end-of-life care and
                            support
         Combination of Programs

The use of an agency will add costs, but may save the caregiver time and may offer a more reliable option. Independent hiring may save money, offer more flexibility but put a greater burden on the caregiver to supervise, hire, and fire the worker.

Options or organizations that provide resources may include:

Home Health Agencies

Area Agencies on Aging

Mental Health Departments or Community Centers

Public Health Centers

State or National Professional Associations

(e.g., Missouri League of Nursing, American Nurses Association)

When evaluating your resources consider:

Physical and emotional health required

Time required

Abilities, resources, and availability of friends and family

Finances: Insurance, Medicare, Medicaid, disability,Veterans'

benefits, state programs

Ask the following questions before you engage an agency or hire a worker in your home:

What treatments or services are provided?

How flexible or individualized are the services?

Is there a trial basis?

What are the costs of the services?

Is there a placement fee?

What are the billing procedures?

What are the staff skills?

What specialized training has been given to staff?

Are there interview opportunities?

Is there an accreditation or certification process?

Are references available?

What are the content and/or implications of contracts or agreements?

What are the legal responsiblities?

What is the employee insurance arrangement?

How does one report problems, through or to who?

How are employees screened (police report)?

CONSIDERATIONS WHEN MAKING CHOICES OF FACILITIES (adult day care or nursing home)

The following questions may be asked to make an informed decision regarding the care of a loved one:

1. What is the philosophy of care of the institution? (Medication/restraint/independence)

2.     What are the transportation issues? Where is the facility located? How far from family? How easily can the family transport the person?

3.     What programs or activities are available? (outdoor, community, etc.) Is there a wide selection?
4.     What medical care is available? Medical Director in house? Nearest hospital?

5.     What is the staff/resident ratio of care?

6.     What specialized training has taken place or is ongoing?
7.     What is the personal care routine?
8.     How are special problems handled? (e.g., wandering of confused persons)
9.     What is the professional staff? (Nurses/social workers)
10.     Are there infividual plans of care for differentlevelsof function and abilities?
11.     What is the meal and snacks area and routine?
12.     How are emergencies handled?
13.     How are safety issues handled (locked or secure areas for confused persons)?
14.     What is the criteria for admissions?
15.    What is the criteria for discharge?
16.    What other services are available (medical supervision/treatments, support groups, education, case management)?
17.    What is the feeling/appeal of the physical environment?
18.    What are the costs and for what services
19.    What are the policies related to particular behaviors (e.g., restraints of agitated patients)?
20.    Does the facility meet state licensure and Medicare and Medicaid certification?
21.    Is the family involved and informed appropriately?
22.    How are residents' rights or other potential conflicts handled?
23.    Is the size of facility and census right for your loved one?
24.    Is there a regular evaluation and assurance of quality of care?

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To contact site administrator, e-mail: Lois Fitzpatrick