Most families make the decision to bring in support when they start to see physical or mental changes in their aging parent. It’s rarely a pre-emptive play, but reacting when something happens can lead to oversights. for example, Kevin’s mom loved to cook. So when he hired a caregiver to help around the house, he had the best intentions in mind, more time for her to do what she loved. It didn’t occur to him that inviting a stranger in to help with dinner planning might be met with resistance. Kevin and the caregiver spent weeks working through the hurt feelings that had grown from good intentions.
1. Conduct a Real Safety Audit Before Anyone Steps Through the Door
Falls lead seniors to need institutionalized care faster than anything else. Yet, the place they’re most likely to fall is in the familiar comfort of home. Before you do anything else, walk through every room with a fresh eye and an urgent sense of purpose. Safety bars in the shower, non-slip mats, stair lighting, and cleared hallways are not nice-to-have details. They are the scaffolding that holds up life. If you feel more comfortable getting an expert opinion, hire an occupational therapist or geriatric care manager for this same evaluation. It’s money well spent to prevent one fall. These modifications don’t have to be fancy or expensive. They do have to happen before care starts.
2. Know Exactly What Your Coverage Will and Won’t Pay For
Almost every family gets stuck on this distinction: medical necessity vs. custodial care. Your health insurance, and typically Medicare, will pay for skilled nursing services, things like wound care, medication management, post-surgical monitoring, if a physician states that it’s medically necessary. Your health insurance and Medicare won’t pay for a personal care assistant helping your parent with bathing and meal preparation, even if it’s every bit as necessary for their health.
Medicaid waivers can cover some of that care for qualifying seniors, but the paperwork and application process require time and proof. Start researching this before you need the care, if possible, a sudden, acute need leads desperate families to make concessions they otherwise wouldn’t.
When you’re weighing providers, consider what is and isn’t included in each model. Families researching available home health care options in PA will see real distinctions between outfits in how they structure their services, what they expect their personal care assistants to do, and how they collaborate with your family doctor.
3. Build a Communication Infrastructure, Not Just a Care Schedule
Having a care plan on paper is one thing, but if that information remains isolated, it really doesn’t do anyone much good. Home-based care creates at least three stakeholders who should ideally have real-time access to similar sets of information: the family caregivers, the agency, and the patient’s physician(s). What’s more, it’s inevitable that with in-home care the family is going to be closer to the patient than ever in healthcare history.
Then you get to “med management.” This is where errors of omission can literally be fatal.
Establish clear protocols before week one. Changes to medication are common, especially for clients with progressive conditions. And compliance is always an issue with this population, compliance and often competence. You have to spell out expectations regarding who updates the meds list and how often they confirm the list with the family or the patient. Who contacts the MD when the patient starts having more frequent or severe symptoms? Who’s got the current POC?
4. Vet the Agency on Specifics, Not Just Credentials
While most agencies certainly conduct background checks, a differentiating factor to focus on is the level of training they provide.
What prior experience do their caregivers have working with dementia patients? For patients with cognitive issues, caregiving, routines, and communication all differ and require specific training. Also, how much do the caregivers know about dementia itself and its progression?
What about prevention of falls, assistance with transferring, or mobility support for patients in recovery from surgery? What level of training in those areas can they provide, and what experience do the caregivers have?
Also, question how they go about finding the right caregiver for you or your family member. If you’re going to be using the service long-term, the same points raised about fall prevention apply.
5. Schedule Respite Care Before You Need it
The burden on caregivers is real and it builds over time. The family member who steps in to become the primary coordinator, managing all the schedules, attending most or all of the appointments, filling all the gaps in coverage, just slowly takes on the toll until they hit crisis mode.
It’s incredibly important for people to understand that this is a long-term game. And that means that this “respite care is a luxury you can consider from time to time” is the biggest mistake that families make. It is easier to build it into the schedule for that first time and then make adjustments as you move the schedule forward. But if you wait until things are a mess and then try to change it, the primary family caregiver is functionally out in many cases. Then the whole system is in crisis.
If the person who needs care is the seed at the center of the family system, then the primary family caregiver is the water that nourishes that seed. And the person who coordinates that care has to understand that protecting their ability to provide that nourishment is not a selfish thing. It’s a sustainable thing.
