Learning How to Navigate the Landscape of In-Home Care

By: HCO

It’s about getting the resources and support you need

The U.S. Census Bureau projects that Americans age 65 and older will reach about 73 million in 2030. That’s up from 46.2 million in 2014. And government data estimates 70 percent will need to use long-term care. However, a 2011 survey by the National Conference of State Legislatures found that about 80 percent of older adults intend to age in place, using only in-home services.

Unfortunately, the costs — both financially and personally for caregivers and families — can be daunting, especially when you consider that 45 percent spend 20 hours or more a week on caregiving, and 62 percent pay out of pocket or use personal savings to cover the costs. At an average of $47,934 per year, it’s a heavy financial lift for most families. To further complicate matters, caregivers often need to cut back on work hours or even take a leave of absence from their jobs.

So how do you manage it? You remember that you aren’t alone. Leaning on your loved ones, on skilled professionals and on the many resources available to you is crucial.

Grow your confidence as a caregiver

If you’re a caregiver providing in-home for someone you love, you don’t have to go it alone. There are many great resources available for help: You just have to know how to access them and make them work for your family. Getting the support you need will:

• Alleviate much of the financial and emotional stress of caregiving.
• Empower you to make informed decisions by helping you understand your options.
• Help you, help them live life on their terms.

And the earlier you ask for support, the quicker your confidence as a caregiver will grow. That’s why we’ve put together these suggestions to set you on a path for success.

Include the whole family

If you have a parent who needs caregiving, reach out to your other family members. Work as a team, with different people owning different tasks like housework, paying bills and monitoring medications. Including everyone in the conversation, and fairly delegating, will help minimize hard feelings and disagreements. It can also get everyone on the same page when difficult discussions and decisions happen.

Talking to your parents may be more difficult. They might resist the help of a caregiver — whether that person is a family member or paid professional — because it makes them feel like they’re losing their independence. And, with a paid caregiver, they might have reservations about letting a stranger into their home to help with personal tasks. So, start small, like hiring someone to help with just one chore, like laundry or meals, to help your parent warm up to the idea.

Tap into support systems

Some people need a caregiver because they live with medical conditions that limit their ability to care for themselves. These are often common conditions — like arthritis, respiratory diseases, and mental health issues — that affect many people. And there are condition-specific support groups for both patients and caregivers who are dealing with these conditions. Joining one can give you and your parent a much-needed support system.

You can also connect to community-based initiatives that are helping seniors remain in their own homes. Senior villages, cohousing and naturally occurring retirement communities are becoming more common and they provide a much-needed sense of camaraderie and belonging for people who’ve chosen in-home care.

Talk to your employer

Filling the dual role of employee and caregiver can be a big challenge. If you work for a large company or organization (one with 50+ people within a 75-mile radius), the Family and Medical Leave Act protects your employment status. If you’ve worked at least 1,250 hours in the 12 months prior, your employer must provide you up to 12 weeks of unpaid leave to care for a seriously ill family member.

But even more than getting excused time, open conversation builds a strong relationship with your employer and helps them understand what you’re dealing with outside of the office. You may be surprised by the many additional resources available to you through your company — so, stay open to hearing what they have to offer.

Protect your family’s finances

As a caregiver, you must have a complete understanding of your parents’ finances. Having a full picture of their insurance coverage, savings and retirement funds will help you determine what kind of care they can afford.

You should also make sure your parents have taken care of all the necessary estate planning documents, including a durable power of attorney to give a trusted relative (like you or another sibling) the authority to make financial decisions on their behalf when they cannot do so themselves.

They should also have documented healthcare proxies, so someone can make medical decisions when they can’t, and complete a HIPPA form so their medical providers know who they can talk to about their care.

Understand Medicare and Medicaid Eligibility

Traditional Medicare pays the total cost of nursing home care for up to 20 days after a three-day hospital stay. Then the patient must pay $185.50 a day for the next 100 days unless they have supplemental insurance. After 100 days, the patient must pay all costs. But the terms of Medicare Advantage plans may be different.

To use Medicaid to pay for nursing home care, patients need to have their doctor confirm their health eligibility requirements and prove that their assets are below their state’s guidelines. However, Medicaid can be used to pay for in-home care expenses, including payments to family caregivers for their work. Medicaid coverage varies from state to state, and Medicaid’s resources for states [AO3]provide details on each state’s guidelines.

Get basic medical training

Once you and your parents have decided to move forward with in-home care, you’ll need to get some basic training. For example, you may have to learn how to:

• Attend to their personal hygiene (like bathing)
• Care for wounds
• Get them in and out of a wheelchair
• Give them injections

If you know that you’ll need to tend to medical needs, get help from your parents’ doctors and the hospital. Ask about what services you’ll need to provide, and if you can get support doing them. These activities can be physically and emotionally challenging. The Caregiver Advise, Record, Enable (CARE) Act ensures training for family members who need to provide complex medical care. And some hospitals already have these types of programs in place.

Take advantage of technology

You may be able to use apps and devices to cover times when you cannot provide in-person care yourself. For example, you could:

• Get your family set up with Skype, Zoom or FaceTime for virtual check-ins.
• Use digital reminders to track medications.
• Install smart-home devices to help control room lighting and appliances, answer simple questions, and even call 911 in an emergency.

Caregiving can be a long and unpredictable journey, but you can make plans and get support that will help you navigate it. As a HealthCONNECT member, you can access resources and tools designed for families in situations just like yours, so you can make informed choices you feel good about.