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When then-83-year-old Cinnaminson
resident Beatrice Fassett broke her hip in 1999, it was a life-changing
moment for her and her daughter, Nancy.
“I didn't know if she would be
mentally alert or if she would be physically able to manage after several
hospitalization and rehab sessions over the years,” says Nancy.
Nancy, who lives in Moorestown,
found herself in a fast and unexpectedly steep learning curve as a home
caregiver.
She helped her mother for years
single-handedly, but eventually realized that she needed assistance.
Her mother, now 97, now receives
round-the-clock care in the comfort of her Cinnaminson home, thanks to a
live-in caregiver with Senior Wise Care Management.
In Laurel Springs, Robert
Dambrowski, 71, is coping with chronic obstructive pulmonary disease (COPD),
an incurable progressive lung disease that makes it extremely hard to
breathe.
“My husband has his good days and
his bad days, but when his condition flares up, he needs immediate care and
attention,” says his wife, Cheryl, adding that it wasn’t always easy to get to
a hospital emergency room.
Rather than admit her husband to
a life-care facility, Cheryl opted to have periodic at-home visits from a
palliative care nurse from Marlton-based Samaritan Healthcare and Hospice.
Changing landscape
These scenarios represent mere
snapshots of a rapidly changing health-care landscape and in particular, a
trend toward home health care nationwide.
Recent statistics from The
National Association for Home Care and Hospice indicate home health care has
exploded into a $70 billion-plus annual industry, with more than 30,000
providers serving an estimated 12 million people with disabilities, long-term
health conditions and other ailments.
Contributing factors fueling this
growth include shorter hospital stays, the aging of the baby-boom generation
(born 1946 to 1964) and increased life expectancy.
“I think home health care is
growing in popularity largely because it’s typically more affordable, but
also because a home environment tends to be cleaner, more comfortable and is
more familiar,” says Mark Baiada, founder and CEO of Moorestown-based Bayada
Home Health Care.
Baiada, whose company employs
some 20,000 aides and nursing professionals in 26 states, points out that
high-acuity care needs for both adults and children, once relegated to
hospital settings, are now routinely performed at home.
But, when faced with medical
emergencies, especially with elders, many family members find themselves in
unfamiliar territory, asking “What do we do now?’’
Shifting roles
The sandwich generation, those
with dependent children and parents over the age of 70, feel the brunt of
this phenomenon.
These concerns and all the
related stress can negatively impact workplace performance. That’s why
companies such as ENI, which provide employee training and wellness programs,
have expanded their services to include specific counselling and other
resources for child and elder care support.
“When people have significant
life events occur, such as dealing with the many decisions and emotions
connected with families and elderly parent care, it’s important to offer
ongoing support and to look at how an employer's complete benefit package can
be leveraged to maximize assistance opportunities at all levels,’’ says ENI’s
CEO Gene Raymondi.
Raymondi estimates his firm has
seen a 15 percent to 20 percent increase in home care and related family
issues over the last six years.
“Evaluating each individual
circumstance is key, to determine whether an at-home, hospital, rehab center,
skilled nursing or assisted living setting is best,’’ says Nancy Carman,
director of geriatric care management at SeniorWise, a division of Samaritan
Healthcare and Hospice.
Carman says a comprehensive needs
assessment helps to not only establish the extent of physical and cognitive
capabilities, but also to provide important insights into what structural
modifications might be needed to maintain safety and independence, especially
at home.
When home is best
Take the case of Annabel Arena.
Now in her mid-80s, she was
always active in the family’s Hammonton produce business until a stroke
nearly three years ago left her partly paralyzed.
Annabel's son, Joe Arena Jr., a
married father of two in his 50s, says the family is fortunate to have its
own support network, which includes his brother, David; sister, Judy; and
Annabel’s husband, Joe Sr. The back-up helps everyone cope with emotional
issues that arise.
“Initially accepting mom’s
condition was tough,” says Joe Jr., “but we decided home was the best place
for her and we've all since settled into regular visitation routines that fit
in with our respective lifestyles.”
Annabel has a live-in caregiver
and also receives regular “house calls” from UMDNJ- SOM family practice
physician Dr. John Bertagnolli, who also happens to be Judy’s neighbor in
Mount Laurel.
“Annabel has a strong
constitution” says Bertagnolli, “but since her stroke, it’s clearly been a
big adjustment for her as well as for her entire family, too.”
Ask questions
Before making any decisions on
home health-care providers, Nancy Alterman, a clinical instructor and
geriatric social worker for The New Jersey Institute for Successful Aging,
advises families to ask lots of questions.
For example: What are an
agencies’ qualifications and credentials? Are they licensed and insured and
by whom? What scope of services do they offer? Will you receive a written
care plan in advance?
Are agency employees screened and
are references available? What insurance plans, if any, are accepted? What
other costs might be incurred, over and above what insurance plans pay? How
much could those costs be?
Alterman says insurance-based
home care applies mostly to those who have been discharged from the hospital
and will be doing rehabilitation at home.
“This kind of care is usually short
term. For extended care, families need to evaluate what fee-for-service
options are available,” Alterman explains, adding that rates in South Jersey
range $20 to $30 per hour.
Enrolling in supplemental
long-term-care insurance plans can be a good way to offset some
fee-for-service costs.
Care-related visits can vary from
an hour or two to a live-in arrangement and anywhere in between.
In some instances, companion care
is all that’s needed. These trained, non-medical professionals provide
assistance with daily living needs such as personal hygiene and grooming,
plus shopping and related household support activities.
Assess your needs
Lisa Grim works with Comfort
Keepers of Haddonfield, one of many agencies that offer such care.
“We prefer to think of what we do
is assist our clients, rather than do things for them,’’ says Grim. “By
getting our clients actively engaged with activities they can do, it keeps
them moving and also stimulates their minds, which is equally important,’’
she continues.
There are other scenarios where
more extensive home health-care services are needed.
In these situations, a licensed
practical nurse or registered nurse is required to administer medication,
provide injections and tend to other more complex medical needs.
Palliative care offers pain and
symptom management, through physicians, nurse practitioners and social
workers, to people at any stage of illness. It typically focuses on advanced
illnesses such as cancer, cardiac disease, chronic obstructive pulmonary
disease, kidney failure, Parkinson’s disease and Alzheimer’s, where curative
treatment is still being done.
Considering hospice
Yet another option, hospice care
focuses on treatment for either seriously ill or terminally ill patients,
where a cure is not likely. In addition to attending to medical needs, this
care emphasizes ongoing emotional support for patients and their families.
Sandra Bennis, assistant vice
president of Virtua Home Health Care says including family members in the
entire home-care process is pivotal.
“With advanced and often more
complex medical technology, it's now more important than ever that both the
patient and the family fully understand all aspects of home-care
procedures,’’ such as catheter or wound care.
“The end goal is to ultimately
have our patients be as safe and independent as possible, which in turn gives
everyone more confidence,’’ she continues.
Family choice
With an estimated 10,000 boomers
turning 65 every day for the next 20 years, the impact on an already stressed
health-care and benefit system is inevitable.
Experts agree that home health care is indeed an effective
choice in many cases, but also say it's ultimately up to everyone to do the
necessary homework, ask questions, know what short-and long-term health-care
options are available and speak openly with all family members about what
actions to take should a medical emergency occur.
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