Why Stay At Home?

By Care For You •

Home Care for Seniors: Why Stay At Home?

What should be done to help the older adult who lives alone and needs assistance, or lives with someone but needs more assistance than that caregiver can provide? If the person has a chronic condition requiring skilled nursing services, the answer is fairly simple: an assisted-living facility or a nursing home. But most situations are more complicated.

People can live at home, with varying degrees of independence, far longer than most families realize. Fully 80 percent of the residents of assisted living facilities and nursing homes do not need all the services that the facility provides—or even a fraction of them. They are there because they or their families did not know of a good alternative.

But there is one. Consider this true story.

caregiver for elderly Care for You® began working with Mr. B, a 76-year-old, in October 2003, initially assigning a male Companion for three hours per day, five days per week at the request of his niece. Care for You® was referred to Mr. B’s niece by a social worker. At the time, Mr. B was in rehabilitation in a nursing home following hospitalization in critical condition with malnutrition and dehydration.

Care for You® was given the following additional information about Mr. B:

Client has dementia and paranoia; is fearful, but pleasant and non-combative.
Depression is suspected, as client sleeps about 18 hours per day. He is mobile, has good hearing and vision.
Client was a college English professor. His condo contains thousands of books, LPs, and CDs.
Client’s verbal responses are monosyllabic and infrequent.
Client no longer receives messages of hunger and thirst, so is unaware of being hungry or thirsty. With short-term memory loss, client also doesn’t remember if he’s eaten or drunk.
When presented with food and drink, client will readily eat and drink.
With this mental area impaired, client also eats compulsively when presented with food. He will continue to put food into his mouth without ceasing, leading to inability to chew or swallow. This presents a serious choking problem. Without support—both by providing nutritious food regularly, and monitoring his eating of it—client is in a potentially fatal situation.
Client also does not respond to temperature or weather cues. He was wearing heavy sweaters, coats, or stocking caps on summer days, contributing to dehydration.

During the initial assessment, Care for You® noted that Mr. B’s condo was dirty and cluttered, with soiled clothes and linens strewn throughout. But Mr. B is familiar with his condo, the building, and his neighborhood. He desires to continue living in his home.

Upon starting services, Care for You® safety proofed Mr. B’s condo, removing throw rugs and junk furniture. The home was thoroughly cleaned, including discarding spoiled food in the refrigerator and cabinets and ridding his home of old, insect-infested bedding and clothes under the bed. His living space continues to be maintained, his medications monitored, and his laundry kept clean and put away.

The Care for You® Companion attends to his personal hygiene, setting up his shower and laying out clean clothing. Mr. B’s safety razor was replaced with an electric razor. The Care for You® Companion immediately formed a strong bond with Mr. B, and within a few months companion hours were increased to eight hours per day, five days per week. With evidence of progress—Mr. B was no longer as fearful and depressed.

Companion hours were further increased to ten hours per day, seven days per week. The male Companion initially assigned now leads a coordinated effort involving three Care for You® Companions to cover the expanded hours of service.

In May 2005, Mr. B’s Care for You® Companion hours increased to 24/7/365. To achieve this, Care for You® construction divided his living room to accommodate a partial live-in arrangement. Care for You® assisted Mr. B in the purchase and delivery of a futon for overnight and weekend Companions.

To assist with Mr. B’s ongoing support, Care for You® created a log for use by Companions and all others concerned with Mr. B, which includes:

1. Medication Chart
2. Personal Care List
3. Daily Cleaning List
4. Weekly Cleaning List (Companions initial on the day the chore is completed)
5. Log notes

In the time Care for You® has been with Mr. B, Care for You® has become part of the management team, working cooperatively with Mr. B’s niece, a social worker, a nutritionist, a psychologist, his primary care physician, and his bill-paying service. He has gained weight, and eats the regular, nutritious meals and snacks provided. His eating continues to be monitored to prevent choking.

The lead Care for You® Companion, researching on his own and under the direction of the nutritionist
and executive director of Care for You®, developed a cookbook specific to Mr. B. Per direction from the physician, Mr. B now consumes five meals per day, focusing on nutrition and caloric intake.

Mr. B’s daily physical activity has increased; he now sleeps about 12 hours per day, down from 18 hours per day. He receives daily mental stimulation, including outings to the library, museums, zoo, etc. He looks at picture books and listens to music. Care for You® Companions ensure his regular weekly church attendance, very important to Mr. B.

Mr. B has been taught the LifeLink™ system, and he has procured a non-driving ID card. On another important measure of progress, Mr. B now communicates with short sentences and participates in limited, directed conversations.

Conclusion
Mr. B’s case is not unique. For example, Care for You® was requested to increase services to another client in her mid-90s after she had been discharged from the hospital to a hospice following a broken hip. Although some felt she would never fully recover from the hip fracture, Care for You® worked closely with her and her daughter, and the woman was able to return to her assisted living facility.

It is unfortunate that in many cases, Care for You® is not called until after an expensive hospitalization, and this is often because the hospital cannot discharge the person unless there is someone in the home to provide support and assistance in activities of daily living. Yet the experience with Mr. B is ample demonstration of the medical benefits of nonmedical care. He gained much-needed weight, he began speaking again, and his fear and paranoia decreased.

Some long-term-care insurance companies have now begun authorizing payment for these “low-tech,” nonmedical support services. They recognize and support the fact that nonmedical support services will delay or avoid more intensive, expensive institutional care.

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