Amanda Lambert, Leslie Eckford

Aging with Care

Your Guide to Hiring and Managing Caregivers at Home

• Gebundenes Buch

Produktbeschreibung

Finding the best and most appropriate in-home care for an aging loved one can be confusing and time consuming. This guide helps readers through the process of hiring a private caregiver, assessing needs and resources, and making difficult choices. Using real stories throughout, the authors reveal the benefits and pitfalls of in-home care.

Produktdetails

• Verlag: Rowman & Littlefield Publishers
• Seitenzahl: 266
• Erscheinungstermin: 10. November 2017
• Englisch
• Abmessung: 231mm x 150mm x 30mm
• Gewicht: 540g
• ISBN-13: 9781442281639
• ISBN-10: 1442281634
• Artikelnr.: 47877630

Autorenporträt

Amanda Lambert is an Aging Life Care Professional, and Certified Care Manager who has worked for over 25 years in elder related services. She has worked in mental health, home health, and most recently care management and consultation. She is co-author with Leslie Eckford of Beating the Senior Blues: How to Feel Better and Enjoy Life Again. She is certified as an Advanced Aging Life Care Specialist through the Aging Life Care Association (formerly the National Academy of Geriatric Care Managers); a nationally certified Master Guardian; and a Care Manager Certified issued by the National Academy of Certified Care Managers. Amanda and Leslie have a website, Mindfulaging.com, where they post observations and articles on caregiving and policy, aging research, assisted living, technology, healthy aging, and the global challenges associated with taking care of elders. Amanda has presented to numerous professional groups through the years on a wide variety of topics. Amanda has been the chairperson of the Utah Gerontological Society; on the board of trustees of the oldest non-profit assisted living community in Utah, The Sarah Daft Home, and served on numerous other committees that advocate for elders. Amanda received an Outstanding Achievement Award from the State of Utah Division of Aging and Adult Services for her work in protecting the rights and safety of vulnerable adults. Leslie Eckford is a licensed clinical social worker and registered nurse who has focused most of her practice on Geriatric Mental Health in inpatient geriatric hospital units and in community mental health centers. She is the co-author with Amanda Lambert of Beating the Senior Blues: How to Feel Better and Enjoy Life Again. Leslie has worked with geriatric mental health care teams including at the University of Arizona and the University of Virginia Medical Centers managing the treatment of psychiatric illnesses.  Leslie has been a speaker in the community about topics affecting the lives of older adults including: Suicide in the Elderly, Resiliency and Aging, Issues of Intimacy in Older Years, and Hoarding.

Inhaltsangabe

Introduction WAKING UP TO A NIGHTMARE What would you do if you realized
that the caregiver that you hired to take care of your elderly parents in
their house turned out to be stealing from them and exploiting them? Leslie
shares her horror story of realizing that the hired caregiver that she
knew, liked and trusted turned out to be robbing her family blind. She
describes her professional background as a geriatric nurse and Licensed
Clinical Social Worker and her dedication to supporting her parents to age
in their own home. She assumed that even though she lives far away from her
elderly parents, she would know enough to make the right choices. But all
of this was not enough to protect her family from being taken advantage of.
When she discussed her family's plight with her friend, Amanda Lambert,
also a geriatric professional as well as a certified geriatric care
manager, they realized that though they agreed on many approaches to home
care for the elderly, they diverged when considering hiring privately or
through a care agency. Thus, the idea for this book was born: to share our
professional and personal experience to assist others to make educated
choices about hiring employees to be elder caregivers for their family.
Chapter 1 FINDING MORE THAN ONE WAY HOME: TWO APPROACHES TO HIRING
CAREGIVERS While Amanda and Leslie agree about the value of aging at home
and promoting safety and quality of life for all elders, they have some
different approaches on how to hire the right caregivers for home care.
Even after the criminal caregiver fiasco, Leslie still prefers hiring
privately. Amanda has a different perspective related to her experiences as
a geriatric care manager. Amanda describes her duties in this professional
role, its definition and how she helps elders and their families navigate
the challenges of staying in place to age. The tremendous growth of people
who are over 65 and the increase in life expectancy is creating an Aging
Tsunami. As more Americans grow older, more can expect to eventually need
some assistance with daily care such as preparing meals, dressing and
bathing and mobility. Where will they get that care? In recent history,
older adults have been encouraged to move into assisted living or other
retirement communities. However, in poll after poll of older Americans,
they clearly express their desire to stay at home. Staying at home is one
thing, but being on the receiving end of personal care is another. Invasion
of privacy, and loss of control are considered in the context of real life
experiences of elders. Two different ways to hire a caregiver (private hire
or through a care agency) are presented with the Pros and Cons of each.
Families are encouraged to consider the needs of elders and their choice of
hiring the best caregiver on a continuum. Needs for assistance can change
as one's health does, thus impacting the type of caregiver that will be
best. Leslie describes the advantages of privately hiring a caregiver (more
control over who is chosen, less turnover and more consistency of care,
reducing cost of third party) and disadvantages (such as the need to vet
individuals for criminal backgrounds, time required for hiring process and
management). Amanda offers a contrasting perspective for hiring with a care
agency: the upside includes less hassle for the family, the agency will
take care of any sick calls and other unavoidable problems, and it saves
time. She acknowledges the downsides such as an increased hourly rate for
the consumer and higher rate of staff turnover which can be upsetting and
disruptive for seniors. Each chapter ends with Take Away Points that
emphasize the most important concepts for the family to consider as they
embark on increasing home support. (See Sample Chapter) Chapter 2 GETTING
STARTED: HOW MUCH HOME CARE DO YOU NEED? Knowing if or when to begin
considering care in the home can be complicated. Typically an event, or
trigger, can be the precipitating factor for family members or even the
elder themselves to realize that help is needed. The cost is potentially
staggering. Is it the right decision for you or your family member? Learn
some basic terms and vocabulary about home care as it differs from care in
a setting like a nursing home. Doctors may refer to home care in ways that
may be confusing and lead you to believe that all home care is covered by
some insurances when it is not. Refer to a useful sidebar to demystify the
differences between Medicare and Medicaid. This chart will answer your
burning question: which home care expenses do they really cover? Use our
Needs Scale to determine the type of home care that will assure your
successful stay at home. A Home Care Needs Scale will assist families and
elder persons to assess what care can be done by a family or friend versus
a professional caregiver. The best planning will figure out which
activities, such as medication management or bathing, are most important to
this individual. Emphasis is on flexibility. For example, it could be an
advantage in areas such as how and when to schedule caregivers. The Home
Care Needs Scale will help you determine if staying at home is a realistic
option for you. Instructive stories based on real elders' experiences are
incorporated throughout to learn how others initiated care in their home.
Having "the talk" with older family members will help everyone to reach
agreement about possible circumstances that trigger the need for care.
Talking openly with one's family about whether or not staying at home with
care is a viable option is a source of dread for many. With all the
parent-child dynamics in play, strategies for segueing into to and staying
on topic are critical. How to deal with elderly family who are resistant to
having any care at all. How to incorporate the Advance Directive as a tool
to ensure that a person's wishes are honored. Recognizing what each side
can be flexible about can further the process. This is an expensive
proposition. Individuals and families need to deal with the real costs of
home care. Talking about money between generations can be perceived as an
intrusion on one's privacy. Full access to varied factors (savings, equity,
net worth, overall health and prognosis) are necessary to create a budget
for the cost of home care. An unique plan of care for each person is
needed. While a certain amount of help for part of the day can be
manageable and less expensive than moving to assisted living, the price
soars with round the clock care. What to do if private caregiving is
something you and your family simply cannot afford. We discuss options for
care when finances are tight. Throughout, real life stories of how
different families have come to terms with the costs of staying at home are
shared. Chapter 3 FINDING THE RIGHT HIRED CAREGIVER FOR YOU AND YOUR FAMILY
Most elders and families have only a vague familiarity with the world of
caregiving. In order to hire a caregiver, it helps to start with the
basics: who they are, what their training is and where to find them. There
are a variety of definitions for certifications. Contributing to the
challenge in making a good choice of caregiver is the complicated lexicon
for home care workers. Caregivers can be CNAs, PCAs, medication techs and
more. The type of care that is needed may dictate the certification that is
most appropriate. There are significant differences in the typical training
caregivers receive in the United States. Skills level, oversight of
caregivers in the home, and background checks vary widely from agency to
agency and state to state. Knowing the typical training that caregivers in
the US receive for levels of certification will help in decision making.
There are more choices than ever before in looking for caregivers with pros
and cons of each path. Recently, there has been an increase in the number
of online companies that match the caregiver to the consumer such as
Care.Com and Carelinx.com. Thousands of agencies across the country are
vying for the business of providing caregivers. Some families decide to go
it alone and rely on other family members or people recommended from the
community. Each of these options has potential and each has its dangers and
complications. Interviews with the online services such as the CEO of
Care.com provide insights about the changing terrain for private hiring and
how the process is becoming more accessible and streamlined. Caregiver
interviews tell the story from the trenches. Caregiver interviews provide
insight into their unique and personal perspectives on working at agencies
versus working privately. Caregivers share their frustrations as well as
their passion for doing this kind of work. Chapter 4 BUILDING THE BEST CARE
PARTNERSHIP The hope of every family seeking a caregiver is to find "the
one" that is a good fit. It is a huge responsibility to be the family
manager who must have the time, the skills and motivation to be the
supervisor of an ongoing, at-home care program. A skills list clarifies
what individuals need to manage caregivers in the home setting whether
hiring privately or through an agency. Delegating and contracting out when
possible become essential tools. It sounds obvious, but the plan will not
succeed without the family elder being on board. Tips are outlined to
engage the elder family member in the search and to deal openly with their
desire and understanding of their need for caregiving. Negotiate a list of
the characteristics of the caregiver that you want to hire and reach
agreement on key expectations. How to assess resistance and objections from
the family about a caregiver. Sometimes, it is simple complaining but other
times it is more significant. Having strategies for a successful fit for
the elder and the caregiver includes effective communication between you,
your parent and the caregiver. Clear, direct and honest communication with
a caregiver will help avoid problems down the road. Have you really
explained to the caregiver how much your parent detests his or her constant
chatting, or have you just hinted at it? It is to everyone's advantage to
discuss concerns in real time. Chapter 5 KEEP YOUR EYE ON THE BALL Security
and legal protection are top priorities for families that choose to hire
caregivers. Families often set up home care quickly in response to changing
functional status of the elder. Reducing liability and increasing household
safety can be an afterthought. Even if you hire through an agency, you are
not guaranteed protection. From the beginning, smart family managers
require background checks, drug screening before and after employment, and
an employee contract. Nobody wants to turn their family home into a police
state, but there are some high tech and low tech approaches that can lend
added security and peace of mind. Long distance family members are wise to
consider camera systems. Learn how to build a circle of protection with
unplanned visits and enlisting friends, neighbors and family to be on
alert. Reviewing homeowner's insurance policies and agency policies are a
must. If you see a red flag, don't ignore it. Denial is a powerful enemy to
your family's security. Recognize your denial thoughts ("I'll just wait and
see how this turns out; I don't have time to deal with this now; it's
probably not as bad as it seems.") That feeling of discomfort is sometimes
your best indication that something is wrong. We outline a plan that will
help clue you into the bigger picture. Think ahead and take legal
precautions to prevent potential legal disasters. Chapter 6 YOUR HOME, YOUR
CARE Independence is a uniquely American ideal that shapes our attitudes
about aging. Dependence is a consequence of aging that most everyone wants
to avoid. As society adjusts to a more vibrant and vocal aging cohort, new
ethical dilemmas come into play. The "dignity of risk" concept suggests
that people have the right to make possibly unsafe decisions about the way
they live and assume responsibility for the consequences. For example, an
elderly person living at home wishes to forgo wearing oxygen at night even
though his doctor orders it for medical reasons. Does he have the right to
do this? Family members and caregivers can be stuck in the crossfire of
competing legal and ethical imperatives. Some care companies have policies
that place constraints on their employee caregivers so that they may not
allow the client to fail. We provide actual stories of these controversial
issues. Few families are in complete agreement about how to respond to the
question of freedom of choice in their parents' extended lifespan. Families
in this situation may differ greatly in their viewpoint generationally. We
provide a series of questions for you and your elder to discuss if there is
a difference in point of view. We tie this into the use of the advance
directive as a tool to clarify your elder's wishes.[G6] . Chapter 7 WHAT
CAN POSSIBLY GO WRONG? When families hire caregivers, it pays to take a
good, hard look at some of the pitfalls. Being forewarned is being
forearmed. Actual personal and professional stories provide an inside look
at what can and does happen. Hired caregivers can bring joy, and enhance
the quality of life of elders while relieving the burden on families. In
contrast, there are terrible caregiving outcomes - poor boundaries, lack of
confidentiality, bringing children and other relatives to work without
permission, and interesting explanations for failed drug tests, to name a
few. With careful planning most disasters can be avoided. Even the most
thorough pre-employment background checks do not discount the need for
ongoing attention and vigilance in knowing what goes on in the home when
you are not there. Identifying and embracing these responsibilities,
whether working with an agency or outside an agency, will make the journey
less stressful. Chapter 8 PLAN B: THROWING IN THE TOWEL One of the most
difficult decisions families face is when it is time to consider a higher
level of care. Every member of the family team, including the elder, the
family, the medical professionals and the caregiver, needs to have a voice
in the discussion. Knowing the circumstances under which it may be time to
discuss a higher level of care can make the conversation and transition
easier. Be clear with your elder family member and caregiver that you will
assess the living situation at regular intervals, such as a monthly or
semi-annual check-up, to make sure that the goals of care and health is
intact. Learn what some of the red flags are. Being vigilant about the
effectiveness of caregiver interventions may help to avoid difficulty
later. As challenging and time consuming as it may be, examine evidence of
a slow decline and what it may mean for the person's health. Family members
can assemble a team including a good geriatric physician who can provide
their opinion and possible options for continued support. Consider that
in-home, 24 hour care is expensive, complicated and intrusive. Compile a
list of triggers and conditions that may necessitate taking this step and
calculate the costs of 24 hour care compared with assisted living. Issues
of safety, risk, quality of life, and autonomy should be considered in
making decisions that are always in flux. Years of professional and
personal experience have taught us successful and unsuccessful approaches
to care in the home and the complications that arise from the day to day
management of caregivers. The reality is that for many families, the cost
of in home care will drive decisions. Chapter 9 THE MANY PLACES TO GO FROM
HERE The current state and future of caregiving is by necessity undergoing
tremendous change. For many, caregiving options as they exist today are
completely impractical and unaffordable. Many aging advocates are exploring
new ways of providing care in community such as the co-housing movement,
continuing care communities, and elder villages. Some health care systems,
such as the VA Medical system, have already established a Community
Residential Care model which provides housing for elderly individuals in
small apartment communities with regular care included. A look to the past
finds models of care that kept elders in the community. Older adults in the
past transitioned to living with extended family or a boarding house. With
imagination and initiative, these models can be updated and improved. There
are an array of new concepts, such as caregiver cooperatives that provide a
better quality of care. In all of the alternatives, the bottom line is that
elders should never be kept in isolation and benefit in numerous ways from
community contact, support and engagement in decisions that affect their
lives. Chapter 10 HOME, SWEET HOME In the final chapter, Leslie describes
the aftermath of the legal entanglement with the criminal caregiver. Living
at home with caregivers, even when circumstances are not so dramatic,
requires a flexible outlook and acceptance of change. Leslie's worst
nightmare comes to resolution. Learn how her family went from picking up
the pieces after having a deceitful caregiver, to building a team of truly
loyal and dedicated caregivers. Finding and assembling the right caregiving
team can have lasting positive impacts on an elder's health and well being.
Identifying not only the caregivers, but other people and places in your
parent's community (physical therapist, taxi driver, barber shop, coffee
shop) can enhance their regular activity schedule and can have a positive
impact on their quality of life. Spread the net wide to find activities in
unexpected places that can be modified for elders to be involved.