Clients and their family members often ask us about the different caregiving options available. To address these frequently asked questions, we contacted Lifeline Smart Home Care Solutions, of San Diego, California (619-346-3096), which offers a comprehensive approach to senior care management. The following are just a few questions and answers.
If a client requires 24-hour care, do your employees spend the night? What are the options available to clients in terms of a caregiver’s shifts? Lifeline’s answer: We have two options when a person needs 24-hour care. One is choosing three (3) eight (8) hour shifts. This is needed when someone requires care support by a person who is awake for the full 24 hours. The second option is a Live-In caregiver. In this situation, one caregiver is there for a 24-hour period, but will sleep at night while the person sleeps. The law requires at least five (5) hours of uninterrupted sleep for the caregiver in order for this to be a viable and safe option. If a Live-In shift is appropriate, there must be a private, designated area suitable for the caregiver to sleep.
What are the lowest levels of care plans to the most extreme care plans available? Lifeline’s answer: Companion Care for errands and driving for an able-bodied healthy person is one of the lowest care options. The most complex clients we work with are on hospice or have several medical conditions that require us to partner with home health to ensure stability and/or recovery. This is where Registered Nurse Care Management is so helpful in assuring healing and quality of life.
Can any of your services be covered by Medicare or private insurance? Lifeline’s answer: Some private insurance will pay for services, particularly long term care insurance. Home Health, Palliative Care and Hospice are services generally covered by medical plans.
What services do you provide when a spouse is worried that he or she can no longer take care of his or her spouse within their home? Lifeline’s answer: We can provide care for the spouse who needs the care and support the spouse who is the main caregiver.
What are other considerations for aging couples who are trying to take care of each other or where one is the main caregiver for the other? Lifeline’s answer: The spouse that is the caregiver needs to be sure to take care of their own health as well. Medical studies show that the physical health of a family caregiver declines after just a few months. Ensure you are there for your loved one by securing enough respite care so that you can take care of yourself too. Respite can be found through a private company, trusted friends or other family members.
If more aid is needed, can a couple be placed in a facility together where only one spouse needs 24-hour care, but they don’t want to be apart? Lifeline’s answer: Yes, couples can be placed in the same facility, but within facility legal guidelines. The spouse who needs long term 24-hour care often goes to a different area within the facility for skilled nursing or memory care. The other spouse would likely be in the Independent Living or assisted living part of the facility. They can, of course, spend their entire days together. Most, but not all, communities offer Independent, Assisted and Skilled Nursing.
Please briefly define the following terms for our clients:
- Caregiver: Caregivers do more than provide basic daily living care. They go the extra mile to enhance quality of life and ensure independent living to its fullest. Lifeline Caregivers provide: Facilitated Customized Leisure Activity Programs, Initiate Social Engagement, Enforcement of In-Home Safety Program, Mobility Assistance, Medication Reminders, Bathing, Grooming, Hygiene, Toileting, Incontinence Care, Errands, Transportation, Light Housekeeping, Laundry, Grocery Shopping, Meal Preparation, Special Diet Support, Companionship & Conversation.
- Care Manager: Educated, trustworthy specialists who assist people in navigating the wide range of care-related decision making process and in implementing customized care solution. Lifeline Care Managers provide: Care Planning; assessments in-home or in-facility to identify problems, eligibility for assistance, and need for services; In-Home Safety Assessment and implementation of changes; personalized activity program development; Define and manage customized cognitive stimulation programs; Supervise and train Lifeline caregivers specifically to your loved ones health conditions and needs; Coordinate Appointments with Physicians, Physician Specialists, Occupational Therapy, Physical Therapy or wound care; Coordinate home health and hospice services; Medical and Medication monitoring and management; Collaborate with physicians on medical and medication concerns; Manage behavioral concerns to prevent putting your loved one in danger or stopping them from enjoying life; Provide crises intervention; Hospital Discharge and transition to home; coordination Assistance with Equipment purchases; coordination of home maintenance and vendors; Clear and Regular Communication with families, physicians, Durable Powers of Attorneys, or other designated professionals; Ensure trusted advisors are in place for financial, legal, or medical decisions; Provide assistance in finding and moving your loved one to a facility; Provide education and advocacy; Offer counseling and support.
- CNA: A certified nursing assistant – often this is the first step in becoming a nurse.
- Assisted Living: Assisted Living is defined as, “housing for the elderly or disabled that provides nursing, meals, and/or housekeeping as needed.” For those who are able to care for themselves independent living facilities are an option that can provide help with activities of daily living (ADLs) like laundry, bathing, and help with errands or temporary care in the home setting at-home nursing care can be an option.
- Senior Living: Communities designed with the senior in mind, often offering activities and social events tailored to the community. Senior Living should be as comfortable and wonderful as possible!
- Memory Care Facilities: This is a higher level of care than Assisted Living, but is different than skilled nursing in that it specializes in providing secure care for those suffering with dementia or Alzheimer’s. Memory care facilities are locked facilities to ensure safety for residents and provide a higher level or care with specially trained staff.
- Skilled Nursing: Skilled nursing care facilities, commonly referred to asnursing homes, are licensed healthcare facilities that are inspected and regulated by a state’s Department of Health Services. They offer long- and short-term care for individuals who need rehabilitation services or who suffer from serious or persistent health issues, such as Alzheimer’s disease, that are too complicated to be tended to at home or at an assisted living facility.
Are there particular estate planning documents that you wish more clients would have or perhaps have updated more routinely? Lifeline’s answer: We would like to have up-to-date Durable Power of Attorney for Healthcare and Durable Power of Attorney for Finance.
What other documents do you wish more clients would have or perhaps have updated more routinely? Lifeline’s answer: A Care Plan that is reviewed with all involved or responsible parties and POLST (Physician Orders for Life Sustaining Treatment) documents when terminal illness is diagnosed.
What type of information do you want clients to think about? Lifeline’s answer: How they would like to spend their last years? What if something happens, where would you want to live? What are your passions, and which ones do you want to remain in your life? Discuss family history and possible care needs for genetically possible health challenges. What care option is right for you? Do you have a financial plan to support your wishes? Have you reviewed your Power of attorney and Advanced Care Directive? Do all people designated in your plans accept and embrace responsibility for their role in your plan? Are those people fully aware of all of your wishes?
Do you prepare care plans for clients and, if so, how frequently? How and when are the plans reviewed? Lifeline’s answer: If you are healthy, you should do a care plan every 5 years and review it yearly with either your attorney or your care manager to make sure that everything is exactly the way you would like. If you have a medical condition that is currently changing or declining, then we recommend a more frequent review.
How do you typically coordinate with an estate planning attorney? Lifeline’s answer: We meet with Estate Planning Attorneys to see if any part of the Care Plan has already been completed in an existing trust document. Sometimes part of a care plan has already been included. Once a care planning meeting has been completed with a person, we provide guidance and suggest a meeting with the Estate Planning Attorney to make sure legal documents are in sync with their wishes. We offer to attend this meeting to help discuss and facilitate if the person so desires. We also support Estate Planning Attorneys by going in depth with their clients, when asked, to fully flesh out the person’s care needs and desires for when they do need care. We can set up an appointment in the attorney’s office or go to the client’s home to go over the care plan. Often the care plan is part of the estate plan. It is always best to think about this and get it documented ahead of time.
Are there provisions in the trust that you need to see in order to help the elder achieve the goal of remaining in his or her home? Lifeline’s answer: We want to ensure that there is designated responsible party and a successor if the first person listed decides not to take that role when the time comes. That plans are clear and detailed to assist the responsible parties in executing someone’s wishes while minimizing conflict. Sometimes families may react emotionally and intensely toward a responsible party when a crises triggers need to use the document. The more everyone is aware of the detailed wishes and designated financial resources to support those wishes, the more likely things will go smoothly.
How should someone or a family member start the process of working with you? At what point should they start? Lifeline’s answer: The first step is to give us a call. It starts with a conversation to discuss challenges, possibilities, and the options. The time to contact us or any similar organization depends on the situation. Many people wait until there is a crisis. In this situation, the answer is immediately. If a person has been diagnosed with Alzheimer’s or other type of dementia, it is important to start sooner than later to allow the caregiver to develop a relationship with the person before the disease progresses. This helps reduce anxiety for the person with dementia as cognition declines. If there are falls, depression, loss of driver’s license, lack of eating, missed medications, missed doctor appointments, health challenges that are not resolving, or other concern, then make the phone call and we will help figure out what’s going on and help implement solutions.
Is there a point in which it is too late to start the process? Lifeline’s answer: No, we can help in almost every situation, including when someone is in skilled nursing or on hospice. A not too well known piece of information is that hospice does not generally provide 24/7 in home care. We partner with hospice to fill in the gaps, working as a fluid team to help provide everyone with as much comfort and support as possible during the dying process.
What type of education, training and background do the caregivers have? How about the care managers and other members of the support team? Lifeline’s answer: Experience varies as we have different levels of care requested by clients. Some have companion care requests for errands or driving or socialization. Others need more medical condition specific skills. Caregivers range from non-medical backgrounds through to years of Licensed Practical Nurses (LVNs) experience. All caregivers are required to undergo a state mandated 3 hours of safety training, 2 hours of company specific training, and an ongoing 5 hours of training each year. This general training is in addition to the client specific training our Care Managers provide caregivers. Care Managers also have varying backgrounds to meet the varying needs of clients. Currently we have a PhD Geriatric Psych, RNs and LVNs on staff. They have varying backgrounds with varying specialties.