Best Practices for Seniors and Knowing When It’s Time to Transition

Aging doesn’t have to mean giving up the comforts of home or independence. In fact, many seniors are choosing to age in place, enjoying the freedom and familiarity of their own surroundings for as long as safely possible. With the right strategies and support, maintaining independence at home can be both realistic and fulfilling. However, it’s also important to recognize the signs when a transition to a senior living community may be the safer and more supportive option.

Best Practices for Staying Independent at Home

1. Prioritize Home Safety
Making small changes can have a big impact. Install grab bars in bathrooms, remove trip hazards like loose rugs, improve lighting, and consider adding a medical alert system for emergencies. A home safety evaluation from an occupational therapist or aging-in-place specialist can help identify personalized solutions.

2. Embrace Technology
From medication reminder apps and voice-activated assistants to video doorbells and telehealth appointments, today’s technology can empower seniors to manage daily tasks independently and stay connected with loved ones.

3. Stay Physically Active
Maintaining mobility and strength through regular exercise is crucial. Simple routines like daily walks, chair yoga, or tai chi can improve balance and flexibility, reducing fall risk and boosting confidence in daily activities.

4. Maintain a Routine
Sticking to a consistent daily schedule provides structure and can reduce feelings of isolation or forgetfulness. Planning meals, regular chores, and social engagements helps seniors stay engaged and in control of their day.

5. Build a Support Network
Even independent seniors benefit from a trusted circle of support. Family members, neighbors, community volunteers, or hired caregivers can check in regularly, assist with errands, and help monitor changes in health or behavior.

6. Know Your Limits and Ask for Help
Independence doesn’t mean doing everything alone. Whether it’s hiring someone to help with housecleaning or having groceries delivered, outsourcing certain tasks can preserve energy for what matters most.

When It May Be Time to Consider a Senior Living Community

While aging at home is a goal for many, there may come a time when more structured support is necessary. Recognizing the signs early can help ensure a smooth transition and improved quality of life.

1. Increased Falls or Near Misses
Frequent trips, falls, or unsteadiness are red flags. If mobility challenges begin to limit daily activities, a senior living environment may offer safer, more supportive accommodations.

2. Difficulty Managing Medications
If you or your loved one is forgetting doses, mixing up medications, or struggling to keep prescriptions filled, it could indicate the need for supervised care.

3. Poor Nutrition or Weight Loss
Cooking and eating well can become challenging with age. If there’s evidence of spoiled food, skipped meals, or weight loss, assisted living communities can ensure balanced, daily nutrition.

4. Personal Hygiene Decline
Neglected grooming, dirty laundry, or an unclean home may suggest that daily routines are becoming overwhelming, and support is needed.

5. Social Isolation
A decline in social engagement can lead to loneliness and depression. If getting out of the house feels too difficult or unsafe, a community setting can provide built-in companionship and activities.

6. Cognitive Decline
Forgetfulness, confusion, or wandering behavior could be signs of memory impairment. Memory care or assisted living communities offer tailored environments to support cognitive health.

Staying independent at home is achievable with careful planning and a proactive approach to health and safety. However, recognizing the signs that more support is needed is just as important. Choosing to move into a senior living community isn’t about giving up independence—it’s about gaining the right kind of help to thrive. Whether aging at home or considering a new living arrangement, the goal is always the same: to ensure safety, dignity, and a life filled with purpose and connection.

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Fighting Holiday Depression and Anxiety: A Guide for Seniors

At CareAvailability, we understand the holiday season can be a time of joy and celebration, but for many seniors, it can also bring feelings of loneliness, sadness, or anxiety. Changes in family dynamics, memories of loved ones who have passed, or even the stress of holiday preparations can take a toll on mental well-being. Recognizing these challenges and finding ways to fight holiday depression and axiety is crucial for maintaining mental health during this time of year.

Understanding Holiday Depression and Anxiety

Holiday depression and anxiety are common among seniors for several reasons:

• Isolation: Seniors who live alone or are far from family may feel left out of holiday celebrations.
• Grief: The holidays can trigger memories of loved ones who are no longer around.
• Stress: Managing travel plans, financial pressures, or even attending events can feel overwhelming.

The good news is there are proactive steps seniors can take to combat these feelings.

Tips for Managing Holiday Depression and Anxiety

1. Stay Connected
   • Reach out to family and friends via phone, video calls, or in-person visits.
   • Join community events or holiday gatherings at senior centers, churches, or local organizations.
2. Set Realistic Expectations
   • It’s okay to simplify traditions. Focus on what brings you joy and avoid overcommitting.
3. Practice Self-Care
   • Maintain a healthy diet, exercise regularly, and get enough sleep.
   • Try mindfulness exercises like meditation or deep breathing to reduce stress.
4. Volunteer
   • Helping others is a great way to shift your focus and feel a sense of purpose. Local charities often need volunteers during the holidays.
5. Limit Alcohol and Sugar
   • Overindulgence in alcohol and sugary treats can worsen mood and energy levels.
6. Talk About Your Feelings
   • Share how you’re feeling with someone you trust. Sometimes, simply voicing your concerns can help you feel lighter.

When to Seek Professional Help

If feelings of depression or anxiety persist or worsen, it’s important to seek professional support. Symptoms to watch for include:

• Loss of interest in activities you once enjoyed
• Persistent feelings of sadness or hopelessness
• Difficulty sleeping or changes in appetite

Resources for Mental Health Support

Here are national organizations that provide mental health resources and support for seniors:

1. National Alliance on Mental Illness (NAMI)
   • Website: www.nami.org
   • Helpline: 1-800-950-NAMI (6264)
   • NAMI offers resources, support groups, and advocacy for individuals dealing with mental health challenges.
2. Substance Abuse and Mental Health Services Administration (SAMHSA)
   • Website: www.samhsa.gov
   • Helpline: 1-800-662-HELP (4357)
   • SAMHSA provides confidential support and information for mental health and substance use issues.
3. Eldercare Locator
   • Website: www.eldercare.acl.gov
   • Helpline: 1-800-677-1116
   • This service connects seniors and their caregivers to local resources, including mental health support.
4. Crisis Text Line
   • Website: www.crisistextline.org
   • Text: HOME to 741741
   • A free, 24/7 text line that connects you with a trained crisis counselor.

The holiday season doesn’t have to be a time of struggle. By taking proactive steps to connect with others, care for your physical and mental well-being, and seeking professional help when needed, seniors can find joy and peace during this festive season. Remember, you are not alone, and there are many resources available to support you.

If you or someone you love is struggling with mental health during the holidays, don’t hesitate to reach out for help. Your well-being is the greatest gift of all.

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Crafting a comprehensive and personalized in-home care plan is akin to creating a masterpiece. It requires a deep understanding of the individual, their unique needs, and their aspirations. A holistic care plan goes far beyond addressing medical and clinical needs. It is a work of heart, tailored to each Client’s specific preferences and lifestyle, creating a nurturing environment that fosters well-being and independence.

A Holistic Approach to Care

When developing an in-home care plan, it’s important to consider a range of factors that contribute to the overall well-being of our loved ones. These factors delve into their lifestyle, personal preferences, and emotional and mental health requirements. Here are some key areas to consider when creating a comprehensive care plan:

1. Meal and Taste Preferences

Understanding our loved ones’ dietary preferences and any restrictions they may have is crucial in ensuring they receive proper nutrition. This could include food temperature, taste, and texture preferences.

2. Environmental Allergies

Identifying and minimizing exposure to allergens in the home environment is essential for individuals with sensitivities. This includes ensuring proper ventilation, using allergen-proof bedding, and keeping the living space clean and dust-free.

3. Sensory Needs

Considering home temperature, sound levels, and lighting preferences can help create a comfortable living environment for our loved ones. Some may prefer a quieter setting, while others may enjoy listening to music, conversation, or sounds of nature.

4. Mental Health Needs

Incorporating activities that promote mental well-being, such as exposure to natural sunlight, listening to music, practicing meditation, or engaging in favorite hobbies, can greatly benefit our loved ones’ mental health.

5. Sleep Preferences

The care plan should consider factors such as bedtime routines, room temperature, amount of light/dark, and sleep environment.

6. Home Safety Concerns and Trip Hazards

Identifying and addressing potential safety hazards in the home, such as clutter, loose rugs, or poorly lit areas, is essential for preventing accidents and ensuring a safe living environment.

7. Companionship Needs

Acknowledging the importance of social interaction and companionship, incorporating activities like storytelling, looking through photo albums, playing games, crafting, or engaging in other shared activities can help combat loneliness and foster emotional well-being.

8. Emotional Needs

Recognizing and responding to our loved ones’ emotional needs, such as offering reassurance, appreciation, and affirmation, can significantly improve their overall emotional health and fulfillment.

9. Spiritual Needs

If our loved ones have spiritual or religious beliefs, incorporating practices that align with their faith can help provide comfort and support during challenging times.

Beyond the Basics: Tailoring Care to Individual Needs

While the foundational elements of a care plan are essential, the personalized touches truly make a difference. That said, also consider these additional factors when crafting a comprehensive plan:

Cultural and Linguistic Preferences: Respect, honor and celebration for cultural traditions is important, ensuring that the care plan is developed in a culturally sensitive manner. It is also essential to prioritize clear and effective communication, using appropriate translators or interpreters when needed to bridge language barriers.

Personal Interests and Hobbies: Incorporating a Client’s passions and interests into their daily routine can significantly enhance their quality of life. By understanding their hobbies, a care plan can facilitate meaningful activities and experiences that bring seniors joy and fulfillment.

Pet Companionship: Emphasize the importance of pets in senior citizens’ lives and strive to create a pet-friendly environment. Work closely to understand their pet’s needs and ensure their well-being is considered in the care plan.

Adaptive Functioning Support: Care plans can explore ways to leverage technology to enhance quality of life. This may include using assistive devices to improve mobility or communication, or facilitating virtual connections with loved ones through video calls.

Comprehensive Care Planning for A Life Well Lived

A commitment to create a personalized, robust care plan that reflects all aspects of aging in place is essential, as is collaboration and working closely with families and healthcare providers to gather detailed information.

Open communication and active listening are essential building blocks for every unique care plan. This holistic approach promotes not just physical well-being but also emotional and mental wellness, ensuring that Clients receive the support they need to thrive.

The Importance of Regular Reviews and Adjustments

Life circumstances can change. Care plans are living documents regularly reviewed and updated to ensure they meet the Client’s evolving needs. A collaborative approach involving open communication and active listening is essential for creating a truly effective, personalized care plan.

Personalized and Detail-Oriented Care

A well-crafted care plan is more than just a document; it’s a roadmap to a fulfilling and independent life. By addressing the holistic needs of our Clients, we empower them to thrive in their own homes. Our commitment to excellence and personalized care ensures that every Client receives the support they deserve to live their lives to the fullest.

By tailoring care plans to address not only medical needs but also emotional, social, and spiritual requirements, caregivers can provide holistic support that nurtures the overall well-being of their loved ones. This person-centered approach acknowledges the unique identity of each individual and empowers them to lead a fulfilling and enriched life in the comfort of their own homes.

A Growing Need for Care

An in-home care plan goes beyond enriched lives and increased well-being. 44% of in-home care recipients need help or assistance with at least one daily activity, with many of this 65+ group receiving nursing services, personal care, or therapeutic services. Establishing a care plan can further help this growing need by identifying health risks, providing peace of mind, addressing chronic needs, and maintaining a sense of independence.

Other In-Home Services

The Caring for Family of Companies also offers a variety of other in-home services that play a crucial role in strengthening and creating a comprehensive care plan. From meal preparation to medication management, transportation assistance, housekeeping, and companionship, each service is designed to address specific aspects of a Client’s daily life and support their unique needs.

By incorporating these services into a comprehensive care plan, Caring for Family of Companies ensures that every aspect of an individual’s well-being is taken care of, promoting a sense of security, comfort, and independence in the familiar surroundings of their own home. With this holistic approach, Clients can enjoy peace of mind knowing that their overall care is well-coordinated and tailored to their specific needs.

A Partnership for Success

The creation of an in-home care plan that addresses a wide range of needs, from medical and clinical to emotional, social, and spiritual, requires a personalized and detail-oriented approach. By focusing on the uniqueness of each individual and tailoring care plans to their specific requirements, we can provide the highest level of support and ensure that our loved ones are able to live comfortably and happily in their own homes. The dedication and personalized care provided by the Caring for Family of Companies exemplify the importance of creating a work of heart in caring for our loved ones.

Contact your nearest branch – whether you are seeking in home caregiving services in Beaverton, Portland, Clackamas, Eugene, Salem, Central Oregon, Bend, Astoria, or Hood River – to learn more about our personalized in-home care services and how we can create a care plan tailored to your loved one’s unique needs.

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Caregivers often bear the responsibility of providing transportation, with over 40 percent of older and disabled adults relying on family, friends, or neighbors for rides. A 2021 survey by the National Aging and Disability Transportation Center (NADTC), administered by USAging and Easterseals, found that around three-quarters of caregivers list providing or arranging transport as one of their primary duties.

According to USAging, the national association for Area Agencies on Aging, approximately 600,000 older adults give up driving each year. This transition can create challenges for aging or ill loved ones, making it harder for them to attend medical appointments, shop for necessities, visit family, or participate in social events. Consequently, this increased isolation negatively impacts their health and well-being.

To address these challenges, it’s important to explore alternative transportation options. While available services vary by location, several programs and services are generally accessible across the country to help older and disabled individuals maintain their independence and social connections.

Understanding Different Services

Transportation plays a crucial role in maintaining the independence and quality of life for seniors. As individuals age, driving may become more challenging or even impossible due to health issues or other limitations. Fortunately, there are various transportation options specifically designed to meet the needs of older adults.

From public transit and paratransit services to ride-sharing apps and volunteer driver programs, seniors have access to a range of choices that can help them stay connected, access essential services, and remain active in their communities. Understanding these options is key to ensuring that seniors can continue to live independently and engage in meaningful activities as they age.

Public Transit

Fixed-route public transit refers to a transportation system with predetermined routes, schedules, and stops, such as buses, trains, or trolleys. These services operate along fixed paths, picking up and dropping off passengers at designated stops along the way.

For seniors and individuals with disabilities, fixed-route public transit can be a convenient and cost-effective way to travel, providing access to essential services, activities, and destinations within a community. However, there are navigational and accessibility-related challenges that may arise for these populations when using fixed-route public transit. To address these challenges, many fixed-route public transit systems offer specialized services or accommodations for seniors and individuals with disabilities:

1. Priority Seating: Individuals with mobility impairments may  find it challenging to board or disembark from vehicles, especially at stops without accessible features. Reserved seating near the front of vehicles can mitigate challenges for seniors and individuals with disabilities.
2. Accessibility Features: Waiting for and riding on fixed-route transit vehicles can be physically demanding for some seniors and individuals with disabilities, particularly those with mobility issues. Vehicles equipped with ramps, lifts, and other features can better accommodate mobility devices.
3. Travel Training: Seniors and individuals with cognitive impairments may find it difficult to navigate the fixed-route system, including understanding schedules, routes, and transfer points. These programs provide instruction on how to use the fixed-route system safely and independently.

Paratransit Services

Paratransit services are specialized transportation services designed to meet the needs of individuals who are unable to use traditional fixed-route public transit due to a disability or condition. These services are typically provided as a complement to regular public transit and are mandated by the Americans with Disabilities Act (ADA) for public transit agencies in the United States.

Paratransit services offer door-to-door or curb-to-curb transportation for individuals who are unable to access or navigate traditional buses or trains. This includes individuals with mobility impairments, visual or hearing impairments, cognitive disabilities, or other conditions that prevent them from using regular public transit.

To use paratransit services, individuals must typically qualify based on their disability or condition, as defined by the ADA. Once eligible, passengers can schedule rides in advance, usually with a designated paratransit provider. The provider will then pick up the passenger from their location and transport them to their destination.

Paratransit vehicles are often equipped with features to accommodate passengers with disabilities, such as wheelchair ramps, lifts, and securement systems. Drivers are trained to assist passengers with boarding, securing mobility devices, and other needs they may have during the trip.

Demand Response Services

Demand response transportation services for seniors, also known as Dial-a-Ride or paratransit services, provide flexible and on-demand transportation options for older adults who may have difficulty using traditional public transit. These services are typically operated by public transit agencies or private companies and are designed to meet the specific needs of seniors and individuals with disabilities. These services typically operate through the following formats:

1. Reservation-Based: Seniors can request transportation by calling a designated phone number or using an online booking system. Reservations are usually required in advance, typically 24 hours or more. 
2. Flexible Pick-Up and Drop-Off: Unlike fixed-route public transit, demand response services offer more flexibility in terms of pick-up and drop-off locations. Seniors can be picked up from their homes or other specified locations and dropped off at their destination.
3. Shared Rides: Demand response services often operate on a shared-ride basis, meaning that multiple passengers may be picked up and dropped off along the same route. This helps maximize efficiency and reduce costs.
4. Accessible Vehicles: Vehicles used for demand response services are often wheelchair-accessible and equipped with features to accommodate passengers with mobility challenges.
5. Affordable or Subsidized Fare: While fares for demand response services may vary, many agencies offer discounted fares for seniors and individuals with disabilities.

Non-Emergency Medical Transportation (NEMT)

Non-emergency medical transportation (NEMT) is a specialized service that provides transportation for individuals who require medical services but do not have access to personal vehicles or other means of transportation. NEMT services are typically used by individuals who need to travel to medical appointments, such as doctor visits, dialysis treatments, physical therapy sessions, and other non-emergency medical appointments.

NEMT services are often covered by Medicaid, private insurance, or Medicare Advantage plans, although coverage and eligibility criteria may vary. NEMT providers may include taxis, wheelchair-accessible vans, or vehicles dispatched by specialty brokers or community groups.

To use NEMT services, individuals typically need to schedule their transportation in advance, usually at least 24 hours before their appointment. The transportation provider will then pick them up from their home or another designated location and take them to their medical appointment. After the appointment, the provider will return them to their original location.

NEMT services often include accommodations for individuals with disabilities, such as wheelchair-accessible vehicles and assistance with boarding and disembarking. Providers may also offer door-to-door service for individuals who need assistance getting in and out of vehicles or navigating through buildings.

Ride-Sharing and Taxi Services

Ride-sharing and taxi services can be valuable transportation options for seniors, offering flexibility and convenience for those who may not drive or have access to public transit. These services can help seniors maintain their independence, stay connected with their communities, and access essential services and activities.

Ride-sharing services like Uber and Lyft, as well as traditional taxi services, offer on-demand transportation, allowing seniors to request rides quickly and easily using a smartphone app or by calling a taxi company. Many ride-sharing companies and taxi services offer accessible vehicles and accommodations for passengers with disabilities or mobility challenges, such as wheelchair-accessible vehicles or assistance with boarding and disembarking.

Ride-sharing and taxi services can be a flexible transportation option for seniors, allowing them to travel at their own pace and schedule, without the constraints of fixed routes or schedules. Using ride-sharing and taxi services can help seniors stay engaged with their communities, allowing them to attend social events, visit friends and family, and access local services and amenities.

Click here for full article and to see a full list of resources by state.

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Family caregivers of chronically ill older persons or those with disabilities are generous, compassionate individuals. They care for loved ones in the familiar surroundings of their own home or community. These caregivers are “on call” 24-hours a day, 7 days a week because they want to see their loved one remain in the comfort and security of their own environment. But at some point, even the caregiver needs a break, a rest, or a breather. The caregiver needs respite. Respite provides informal caregivers – usually relatives a break from their daily responsibilities.

Family caregivers save federal, state and local governments, which are faced with the challenge of covering health and long term care expenses of persons who are ill and have chronic disabilities, a great deal of money. If the work of caregivers had to be replaced by paid home care staff, the estimated cost would be $45 – $94 billion per year. In response to and in recognition of the distinct needs of caregivers, the Administration on Aging (AoA) of the U.S. Department of Health and Human Services is implementing a program that will soon begin to offer respite and other services to some caregivers who so desperately need a break.

The National Family Caregiver Support Program Offers Respite

The enactment of the Older Americans Act Amendments of 2000 (Public Law 106-501) established an important program, the National Family Caregiver Support Program (NFCSP). Funded at $125 million in fiscal year 2001, approximately $113 million has been allocated to states to work in partnership with area agencies on aging and local and community service providers to put into place multi-faceted systems of support for family caregivers. A specific component of these systems is respite. That could include, for example, respite care provided in a home, an adult day-care center or over a weekend in a nursing home or an assisted living.

Research has confirmed the benefits of respite. A paper compiled by Drs. Dale Lund and Scott Wright – experts in the field of caregiving analysis — states that respite benefits both caregivers and their loved ones. It further states that to be most effective, caregivers should consider accessing services early in their caregiving experience. Lund and Wright have found that caregivers need sufficient and regular amounts of respite, and it is important that the caregiver give sufficient thought as to how he or she wants to use that freed-up time, when and if it becomes available.

Respite can cover a wide range of services based upon the unique needs of the caregiver. It might involve medical or social adult day care and/or a short-term stay in a nursing home or assisted living facility for the loved one; a home health aide or home health companion; a private duty nurse or adult foster care.

For the caregiver, personal respite varies as much as the individual and could mean, for example: giving the caregiver a short break to attend a doctor’s appointment or to go shopping; allowing the caregiver the opportunity to nap, bathe, or otherwise rejuvenate him or herself; attending a church service or seeing a movie; taking a much-needed vacation; pampering oneself with a hair appointment or manicure; scheduling elective surgery; or simply visiting friends or relatives.

Listening to the Caregivers

In developing the NFCSP, AoA conducted a series of roundtable discussions with caregivers of older persons who have chronic illnesses or disabilities. These discussions were held in more than 30 cities across the United States, and allowed AoA to gain a more complete understanding of the day-to-day challenges faced by families caring for their older relatives, and to obtain additional insights into the types of services and supports that would respond to the needs of these and other caregivers. It was clear after listening to these caregivers that respite is a necessity. Here’s what some of the caregivers told AoA:

“I took a vow when we got married 54-years ago, and I intend to carry it out. My only fear is that I will die from exhaustion before she does, and who will care for her then?”
— Caregiver husband; Chicago, IL

“It has been a challenge going through this alone. To be able to have someone help me . . . for just one-half hour or one hour to put her [mother] in bed, or get her up in the morning . . . this would be helpful.”
— Caregiver daughter; San Francisco, CA

“Respite is my number one need. I’ve been caring for Mom for seven years . . . in that time, I have had one vacation for 3 days.”– Caregiver daughter; Milwaukee, WI

Many caregivers noted hardships and problems including physical and mental strain and feeling burned out or overwhelmed. Some felt they did not have enough time or energy to meet the demands facing them and that caregiving takes away from their personal lives. AoA, through the state and area agencies on aging (AAA), adult day care centers, and some community- and faith-based organizations, offers respite services to caregivers. The degree and types of respite services offered are discretionary in each state and often vary widely from state to state.

The National Aging Network

Under the authority of the Older Americans Act, AoA leads a national aging network to plan, coordinate, and provide home and community and faith-based services to meet the unique needs of older persons and their caregivers. AoA’s aging network includes: 56 State Units on Aging, 655 Area Agencies on Aging, 236Tribal and native organizations representing 300 American Indian and Alaska Native Tribal organizations and 2 organizations serving Native Hawaiians, plus thousands of service providers, adult care centers, caregivers, and volunteers.

Who to Contact for Help

Local AAA is one of the first resources a caregiver should contact when help is needed. Almost every state has one or more AAA, which serve local communities, older residents, and their families. (In a few states, the State Unit or Office on Aging serves as the AAA.) Local AAA’s are generally listed in the city or county government sections of the telephone directory under “Aging” or “Social Services.”

The Eldercare Locator

AoA supports a nationwide, toll-free information and assistance directory called the Eldercare Locator, which can locate the appropriate AAA to help an individual needing assistance for their loved ones, relatives, or friends. Older persons and caregivers can call the Eldercare Locator at 1-800-677-1116, Monday through Friday, 9:00 a.m. to 8:00 p.m. Eastern Time.

“Taking time out, away from the care of an impaired person, is one of the single most important things that you can do to make it possible for you to continue to care for someone.” – Mace and Robins, The 36 Hour Day.

* Many caregivers experience immense stress and feelings of burden, high rates of depression, and feelings of anger and anxiety.
* Caregiving can adversely affect one’s physical health and ability to continue providing care leaving two impaired persons, rather than one.
* The emotional and physical strain of caring for a frail older relative is often exacerbated by worries over paying for care, particularly for nursing homes.

Research has shown that some caregivers must quit their jobs to give care, while others experience increased absenteeism, lower productivity at work, lost career opportunities, and loss of future earnings.

American Society on Aging

A unique feature of respite care is the help it offers to both the caregiver and the care recipient.

Respite care can allow time to go to the doctor or the grocery store, participate in a support group, or attend a class to learn caregiving skills.

Researchers have suggested that respite care can relieve the burden of the caregiving situation and allow families to continue to care for loved ones who would otherwise be placed in a nursing home.

For More Information

Working in close partnership with its sister agencies in the U.S. Department of Health and Human Services, the AoA is the official Federal agency dedicated to policy development, planning and the delivery of supportive home and community-based services to older persons and their caregivers. The AoA works through the national aging network of 56 State Units on Aging, 655 Area Agencies on Aging, 236 Tribal and Native organizations representing 300 American Indian and Alaska Native Tribal organizations, and two organizations serving Native Hawaiians, plus thousands of service providers, adult care centers, caregivers, and volunteers. For more information about the AoA, please contact:

U.S. Administration on Aging
http://www.aoa.gov
Eldercare Locator: 1-800-677-1116, Monday — Friday, 9 a.m. to 8 p.m. ET

Source: www.aoa.dhhs.gov

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In looking for a home health care agency, the following 20 questions can be used to help guide your search:

1. How long has the agency been serving this community?

2. Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.

3. Is the agency an approved Medicare provider?

4. Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations?

5. Does the agency have a current license to practice (if required in the state where you live)?

6. Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?

7. Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary?

8. Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?

9. How closely do supervisors oversee care to ensure quality?

10. Will agency caregivers keep family members informed about the kind of care their loved one is getting?

11. Are agency staff members available around the clock, seven days a week, if necessary?

12. Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?

13. How does the agency ensure patient confidentiality?

14. How are agency caregivers hired and trained?

15. What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?

16. How does the agency handle billing?

17. Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?

18. Will the agency provide a list of references for its caregivers?

19. Who does the agency call if the home health care worker cannot come when scheduled?

20. What type of employee screening is done?

More About the Screening Process

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have.

For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first. Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem.

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

* Illnesses/injuries, and signs of an emergency medical situation
* Likes and dislikes
* Medications, and how and when they should be taken
* Need for dentures, eyeglasses, canes, walkers, etc.
* Possible behavior problems and how best to deal with them
* Problems getting around (in or out of a wheelchair, for example, or trouble walking)
* Special diets or nutritional needs
* Therapeutic exercises
* In addition, you should give the home health care provider more information about:
* Clothing the senior may need (if/when it gets too hot or too cold)
* How you can be contacted (and who else should be contacted in an emergency)
* How to find and use medical supplies and medications
* When to lock up the apartment/house and where to find the keys
* Where to find food, cooking utensils, and serving items
* Where to find cleaning supplies
* Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure)
* Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them)

A Word of Caution …

Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

How Can I Pay for Home Health Care?

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance. Medicare is the largest single payer of home care services.

For More Information

AoA recognizes the importance of making information readily available to consumers, professionals, researchers, and students. Our website provides information for and about older persons, their families, and professionals involved in aging programs and services. For more information about AoA, please contact: US Dept of Health and Human Services, Administration on Aging, Washington, DC 20201; phone (202) 619-0724; fax (202) 357-3523; Email: aoainfo@aoa.gov or contact our website at www.aoa.gov.

Medicare and Home Health Care

The Medicare program will pay for home health care if all of the following conditions are met:

1. The patient must be homebound and under a doctor’s care

2. The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)

3. The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient

4. The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”

5. The home health care agency providing the services must be certified by the Medicare program.

6. To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at: http://www.medicare.gov/.

Learn more About Home Health Care

There are several national organizations that can provide additional consumer information about home health care services. These include the following:

The National Association for Home Care www.nahc.org

The Visiting Nurse Associations of America www.vnaa.org

The Eldercare Locator www.eldercare.gov

To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging at 1-800-677-1116 to help connect you to these agencies.

Source: U.S. Department of Health and Human Services Administration on Aging, www.aoa.gov

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When trying to decide the best home care solution for your aging loved one, it helps to explore all your options. The information provided can help you explore the benefits of agency-based home care, answer some of your commonly asked questions, and help you understand what to ask when deciding on an agency for your care needs.

10 advantages of agency-based home care

1. Caregiver background checks, reference checks and ongoing drug screening
2. Liability insurance for accidents and wrongdoing, workers compensation insurance for caregiver injuries
3. Backup caregivers allow for continuity of care, no breaks in service, and having family/friend to manage
4. Access to RN’s, Case Managers, & schedulers
5. Continuing education and training of your caregivers on latest industry techniques
6. Industry and Department of Human Services oversight on best practices,
7. Quality assurance programs to ensure the standard of care
8. Access to long-term care insurance for those with policy in place
9. Access and assistance with obtaining Veterans Aid and; Attendance pension for home care
10. Peace of mind

Cost of agency-based home care versus private home care

If cost is a consideration for you, then you should know that agency-based home care does tend to have a higher average cost at about $38/hr while private home care may only cost, on average, $22/hr.

Commonly asked questions about agency-based care

Are “Home Health” and “In-Home Care” the same thing?
Home Health is a medical service for people who are homebound which includes skilled nursing, at-home physical therapy, pain and prescription management, and wound care. Home Care is classified as non-medical assistance with daily activities including personal care, meal preparation, light housekeeping, ambulatory assistance, medication administration, and nurse delegated care. Although agencies can manage medications and some minor wound care, they are limited in their medical services.

Will my Medicare or Health Insurance pay for my services?
No, both are medical insurances. The entire home care industry is non-medical. The only insurance that ensures a benefit for home care is Long Term Care insurance.

What questions should you ask an agency when deciding on care and why

Do you pay your caregivers as employees or as contract employees?
It is a State law that all agencies must employ their caregivers as employees.

Will I have the same caregiver every shift?
Any case that is 5 or fewer days per week and less than 8 hours and one shift per day, should be scheduled with one caregiver. Caregiver availability is a rising challenge so you may need a second caregiver, but you should see the same caregiver(s) on a weekly basis.

If I am unsatisfied with my caregiver what can I do?
You should have the ultimate choice in your caregiver. It is wise to try and work out issues, as caregivers want to please you and are willing to adapt, but if you don’t have a choice, look elsewhere.

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Senior Homecare Options: How to find the right fit for you

It’s never too early to choose a home care agency that you can rely on when life doesn’t go as planned. Whether it’s a little help around the house or more involved care, you should look for a home care agency that can safely meet all of your needs every step of the way.

Are you or a loved one resistant to the idea of receiving care?

Chances are that you just haven’t found the right agency. Simply starting the conversation with a reputable home care agency and building trust can do wonders for melting away resistance. We hope you find this guide helpful as you go forward in search of the right In Home Care Provider in your community.

When is the right time to hire home care?

Most of us want to remain as independent as possible. Sometimes, all that may be required is a simple medication reminder.  However, if getting ready for your day has become more difficult and you require some assistance with activities of daily living (ADLs) such as bathing, grooming and getting dressed, there are caregivers that can assist with these tasks.  The first step is realizing that you need additional support and then asking for it.

Asking for help and the fear of losing independence and control can be challenging.  There are community resources available to discuss these very topics, including: Registered Nurses and social workers.  These professionals are well versed on what resources are available in your area.

Next, take some time to consider whether or not you’ll stay in your home or move to community.  Monthly charges range from $2,000 to $12,000 per month (depending on the level of care). Your financial situation and family support system will likely influence your decision to stay at home with extra help; or move to a community.  This is a tough decision and may require downsizing and selling your home.

How do I pay for home care services?

Although paying for home care can be expensive, there are many options for seniors and their families. Learning more about Medicaid, Medicare, long-term care insurance, and various state programs can help older adults as they navigate the financial aspect of long-term care.

• Medicaid: Funding for those with limited financial resources may receive assistance with some or all of their home care expenses from Medicaid.
• Medicare: Available to all adults 65 and older. However, Medicare is meant for acute health episodes, and not long-term care. Those that are homebound, need skilled services, and require intermittent help may be able to receive some home health care services under Medicare funding.
• Long Term Care Insurance:  Each policy is different, with some covering only nursing home costs- but many current policies allow for homecare services.
• State Programs: Older adults that do not qualify for larger government programs like Medicaid may qualify for more local state programs, because states have greater freedom in establishing requirements for their programs.
• Private Pay: Many families choose to perform many of the home care services for a loved one themselves. Yet, some seniors require skilled services. For families that do not meet eligibility requirements of certain programs, out of pocket funding may be unavoidable.
• Non profit support: There are many other non-profit organizations, volunteer groups, or faith based organizations that may also help. Check your local area agency on aging for more information.

Comparisons & Definitions for Care At Home

There are so many choices for caregiving services at home. Which one is right for me, my loved one or my client? Let’s define each avenue, looking at the differences to help you determine the best fit.

Full Service Home Care:

• Licensed Agency; Services not limited with memory loss or dementia
• Provides non-medical, skilled caregiving, case management & nursing services
• Required to screen, employ & supervise caregiver
• Cost based on services provided, comparable at non-medical level
• The most comprehensive package of services

Non-Medical Home Care:

• Limited to non-medical services, and companion care
• May provide medication reminders or assistance to oriented client only
• No skilled services provide, No Nurse on staff
• Required to screen, employ & supervise caregiver
• Cost comparable at non-medical level

Caregiver Registry:

• Licensed Caregiver Registry Agency
• Screens & verifies competency of caregivers
• Does NOT employ or supervise caregiver, client takes on employer responsibilities & risks
• No skilled care, case management or nursing services
• Cost Registry Fee + Caregiver Cost; comparable-higher at non-medical level

Case Management Company:

• Not Licensed to provide caregiving or nursing services
• Does not employ caregivers, client takes on employer responsibilities & risks
• Professional Case Manager’s & RN’s supervise, usually $70-$110.00/hour
• Cost Professional fee + Caregiver Cost; comparable-higher at non-medical level

CEP (Client Employed Provider) Program:

• Not Licensed; Caregiver Registry; State of Oregon; Medicaid
• Program does not screen, employ or supervise, client takes on employer responsibilities & risks
• Screens with Criminal Background Check only
• Operates much like an on-line listing service

Elder care tips: Ensuring a beneficial relationship with a care provider

Developing an elder care plan for your aging loved ones enables you to ensure your parents get the care and assistance that will meet their physical, cognitive, medical, mobility, and emotional needs on a daily basis.

While it is completely normal for you to want to take on all of the responsibilities of caring for your seniors, handling all of these tasks on your own would likely not work out in the long term. Trying to add all of these responsibilities to everything you already do to take care of your own personal lives can leave you exhausted and incapable of giving your best to any of your responsibilities.

Hiring an elderly health care services provider as part of your elder care plan enables you to entrust that professional with some of the responsibilities of caring for your parents so that you can focus your time and energy more efficiently and effectively.

Use these tips to help your parents enjoy the best relationship possible with their care provider:

1. Plan Thoroughly: 

Have a clear idea of what you and your parents expect from the relationship with your care provider. Clarifying these expectations enables you to pursue the factors of the relationship that you see as most important and allows you to narrow your focus when seeking out a care provider.

2. Think Family First: 

Before you get a care provider involved, consider your family contribution to the care plan first. Determine how much you can practically do for your parents and ask how much your siblings would like to do. This makes it easier for you decide how much responsibility the care provider will need to take so you can give clear guidelines from the beginning and avoid confusion.

3. Communicate Openly: 

It is important to see the elderly health care services provider as an employee rather than someone who is doing you a favor by taking care of your parents. Communicate openly with the care provider about your expectations, your standards of performance, and your feelings about their care for your parents so that they can continue to improve.

4. Support Individuality: 

You want to be an active part of your parents’ care, but in order to support a quality relationship, you need to give them the space and freedom to create and build that relationship on their own. Support your parents’ ability to get to know the care provider and enjoy spending time with them on their own terms, including participating in activities, going on outings, and creating their own approaches to handling care tasks.

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