How to choose a home health worker-Call 972-346-2013 in Dallas Area

Tips for families

■ Assess your needs to determine type of care needed.
■ Consult with medical professionals for recommendations.
■ Ask lots of questions and consult with all family members before making decisions.
■ Work through an accredited agency and analyze insurance coverage and budget.
■ Consider extended-care insurance.
■ Never choose a health-care worker without doing a background check and requiring references, especially if you are not working through a large organization.
■ Be sure all job parameters and expectations are spelled out clearly from the outset, everything from weekly schedules to specific duties to household privileges.
■ Be flexible as the patient’s needs change to determine if home care is the best option going forward. Reassess with patient, family and health professionals periodically.
Sources: Senior Wise; Samaritan Hospice; Virtual Home Health Care; AARP; Paloma Home Health Agency

On the Web

■ Paloma Home Health Agency : www.palomahomehealth.com

■ Virtua Home HealthCare: www.virtua.org/health/home-care.aspx

■ Samaritan Healthcare and Hospice: www.samaritanhealthcarenj.org

■ SeniorWise Care Management: www.seniorwisecare.org

■ New Jersey Institute for Successful Aging: www.njisa.umdnj.edu

■ Comfort Keepers of Haddonfield: www.comfortkeepers.com/

■ ENI - The Employee Benefits Company: www.eniweb.com 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.