Driving: Skills and Significance
Driving: Skills and Significance
What
are your four or five most prized possessions? If you are like many
people
you will probably answer your house, car, cell phone, computer, flatscreen
TV
or maybe your iPod. What if you had to give something up? What would you give
up
first,
second, etc.? While this is hopefully a hypothetical question for most of us,
it is a reality
people
often face as a result of aging, illness or injury.
All belongings have meaning and significance; however, the thought of
giving up the privilege and freedom to drive can be daunting. To help older
adults and family members discuss driving and potential concerns, a new tool
was released last month by Liberty Mutual insurance company. The Driver Seat Game is available online at http://libertymutual.com/driverseat and is specifically designed to simulate situations many drivers
confront. In short, it highlights potential cognitive and physical limitations.
While the game may be a better test of video gaming skills than driving skills,
it is clearly a new and innovative approach that addresses a common concern.
Any time there is a
series of serious traffic accidents in which older adults are involved, it is
typically not long before someone suggests the elderly be subject to some sort
of road test in order to renew a driver license. Even though older adults as a
group have the second worst driving record behind people ages 16-25, age should
not be the determining factor.
According to Tibi
Ellis, president of Home Helpers, “Any type of age-based legislation would be
ageism and would unfairly discriminate against older adults.” For the safety of
drivers, passengers and pedestrians, driving requires good vision and hearing,
quick reflexes, upper body strength and flexibility and confidence behind the
wheel. Regardless of age, any sort of cognitive or physical limitations can
impact a person’s ability to safely operate a motor vehicle.
Ellis continued, “Just
because certain older adults may face challenges and be considered unsafe
drivers, does not mean all older adults are unsafe.” In fact, many older adults
tend to impose their own restrictions such as not driving during rush hour or
bad weather conditions, and limiting their driving to familiar side roads and
certain times of the day.
“At Home Helpers, many of our clients have given up the
privilege to drive, either by choice or due to medical problems that limit
their ability. If driving is a concern for you or your family, maybe Home
Helpers can help. Many of our clients enjoy the care, companionship and
assistance with transportation that we offer,” Ellis added.
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Aging & Diversity
“It seems like all too often our
diversity highlights our differences as a negative when in fact we have so much
to learn from people of different ages and cultures,” said Tibi Ellis,
president of Home Helpers. “Our
diversity adds to the rich tapestry of America that may be best reflected in
art, music, poetry, politics and more,” she added. The diversity in America
also tends to be quite visible in health care as it influences how people age,
their health and wellness practices, and how younger generations revere and
support older adults.
It
is important not to classify groups of people in categories that are too broad,
as doing so may fail to reflect variations specific to each culture. For
example, the term Hispanic or Latino represents populations from over 20 countries
including people who are Mexican-American, and those from
As
professionals in the home health care industry, we recognize the need to
promote cultural sensitivity and provide culturally sensitive care. We
recognize that in many cultures, family members tend to be quite involved in
health care decisions. In addition, spiritual and religious practices are often
a source of strength for people dealing with life events, illness and other
stressors.
With
many different cultures in the
·
Perceptions
and practices specific to health and illnesses, including acceptable treatments
and therapies, the roles of medicines, foods, prayer, etc.
·
Views
of health care providers (e.g., due to a history of discrimination, many
African-American elders are reluctant to trust organizations and professionals).
·
Preferences
and boundaries specific to gender, physical touch, privacy, trust, power, etc.
·
Communication
style (e.g., eye contact, direct questions, who is involved in the decision-making
process, body language, use of formal names, hand shaking, health literacy).
·
Preferences
for people whose primary language is not English (e.g., use of an interpreter,
family as interpreter, seek out providers who speak native language).
Another
way to help ensure the preservation of one’s cultural values and beliefs is to
ask open-ended questions to discover individual perceptions and preferences. For
more information on Cultural Competency, visit the U.S. Department of Health
& Human Services Office of Minority Health’s website at http://www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=3.
Reflecting with Purpose
As the New Year begins, many people find themselves reflecting on the past year to help identify things they may want to do, or do differently, in 2009. The changes people tend to focus on reflect alternatives for which they are familiar. For example, we may see someone who is physically fit and choose to pursue an exercise regimen. But, what can we do when we lack awareness of issues or alternatives? Why not turn to the big screen?
Movies are remarkably accurate in the experiences, hopes, and fears they depict. They are often able to share perspectives and get people thinking about topics they might otherwise overlook or avoid. Two examples are The Curious Case of Benjamin Button (2008), which debuted on Christmas Day, and the Bucket List (2007).
The Curious Case of Benjamin Button is a story about of a man who ages backwards, while the Bucket List is the story of two men, both dying of cancer, and the adventures they have as they complete their to-do lists before they die. Both movies are powerful and will cause you to stop and reflect about life.
In an interview with the Today Show’s Ann Curry on December 19, Brad Pitt, who stars as Benjamin Button, commented that one of the things people tend to avoid most is accepting life as finite. During the interview, he mentioned a friend who worked at a hospice and who said of his patients, “In their last days they never focus on accomplishments…, but rather they spoke about family and regrets.”
“Regardless of age or health status, we encourage people to give consideration to their bucket list and the things they would most regret if life was cut short,” said Tibi Ellis, president of Home Helpers. It may be a list of adventures, sharing heartfelt words of appreciation and love, or something else.
The point is if you do not know where you are going, it is guaranteed that you will never get there. Likewise, if you are not purposeful about the things you want to do, or do differently, chances are few things will change.
“At Home Helpers, we find people who need assistance with daily living activities are often the ones who most appreciate the gift of life,” said Tibi. She added, “They are often the ones who focus more on what they have, instead of what they do not have.”
The story of Alfred Noble demonstrates the point about being purposeful. As historians recount it, when his brother Ludwig died, the newspaper mistakenly ran Alfred’s obituary instead. When he read what was said about him, he was filled with regret and, as a result, made sudden and significant changes in his life.
Albert is now best known for the Noble Peace Prize. While few may have the chance to make such a significant mark on history, we all have the chance to be the person we might have been. If you have not already seen it, you might start the New Year off by watching the Curious Case of Benjamin Button, reflecting on life, and making purposeful choices to minimize your regrets. Happy New Year.
The Importance of Affordability and Flexibility
With
the economy being on the mind of most every American, our feature story for
this newsletter
is
about the importance of affordability and flexibility. As Americans have quickly
come to realize,
gas
not only fuels our cars, it also fuels the American economy. On July 17, former
Vice President Al Gore said, “I don’t remember a time in our country when so
many things seemed to be going wrong simultaneously.” Due to the uncertainty in
our economy, most people are forced to reconsider many of their leisure
activities, lifestyle choices and long-term plans.
“Regardless
of the economic climate, people continue to face health-related challenges,
experience functional limitations, and need assistance with daily living
activities,” said Tibi Ellis, president of Home Helpers. According to A Profile of Older Americans: 2007
published by the Administration on Aging, “Most older persons have at least one
chronic condition and many have multiple conditions.” Whether a person is
younger or older, one thing is for certain, chronic conditions often lead to
functional limitations – physical and/or cognitive.
As
people are becoming increasingly aware of the cost of products and services, it
seems that people want to get the maximum value for each dollar they spend.
That same level of scrutiny also applies to finding affordable and flexible
options for loved ones who need assistance with daily living activities and
desire companionship.
“Frankly,
assisted living and nursing care facilities are not feasible for many people
who need assistance. Also, few people want to commit to making such a drastic
and often irreversible change,” said Tibi Ellis. Earlier this year, the results
released from an AARP survey indicated 90% of people ages 64 to 74 want to live
out their lives in their current homes. “That’s no surprise to us as there’s no
place like home. Our clients tell us that their homes provide comfort, enhance
quality of life, and signify independence,” Ellis added.
Homecare
provides tremendous flexibility and tends to be affordable as clients pay an
hourly rate for care services. According to a report released by the Federal
Interagency Forum on Aging Related Statistics and the Family Caregiver Alliance,
“Limited (not 24/7) but regular care at home costs less than 50% of care
provided in a ‘facility.’”
Home
Helpers provides the care and support people need and deserve, regardless of their age. It’s all about Making
Life Easier SM. “An advantage of home health care that many people
are finding to be increasingly important is our affordability and flexibility,”
added Tibi. Offering services on an hourly basis for a minimum of two hours per
visit, Home Helpers tailors its homecare services around an individual’s needs
and budget. If you or someone you know may be interested in learning more about
home health care, we offer a no obligation, free in home consultation. We also
offer a helpful educational series covering a variety of topics and can direct
you to other resources within our community that might be appropriate.
Older Adults' Safety When It's Hot Outside
Summer is a
time for fun, relaxation and great times outdoors. But for older adults, the
warm weather can be very dangerous without taking the proper precautions. Thanks
to some of the physical changes that happen as we age, older adults can't cool
down as well as they used to. Sometimes, older people may not even feel hot when
the temperature is dangerously high. They are also less likely to feel thirsty,
even when they are almost dehydrated, which means that their bodies have lost
dangerous amounts of water.
Thanks to
some of the physical changes that happen as we age, older adults can't cool down
as well as they used to. Sometimes, older people may not even feel hot when the
temperature is dangerously high. They are also less likely to feel thirsty, even
when they are almost dehydrated, which means that their bodies have lost
dangerous amounts of water.
Seniors
must take the right steps to stay safe in the summer months. When temperatures
hit between 85-90 degrees Fahrenheit, older adults and their caregivers should:
- Turn on the air conditioner or go where it's air-conditioned a shopping
mall, grocery store, senior center, movie theatre, museum, or library, for
example. (Fans aren't enough.)
- Drink lots of water and other clear drinks
that don't contain alcohol or caffeine. Remember: If your urine is a light
yellow color, you're drinking enough water. If it's darker yellow, you need to
drink more.
- Take cool showers, baths, or sponge baths.
- Wear
lightweight, light-colored, loose-fitting clothing.
- Wear hats.
Avoid:
- Staying in the sun for long
- Walking long distances, lifting heavy
objects, or doing other strenuous things
Warning
Signs of Health Problems Caused by Heat
Dehydration: Weakness, headache, muscle cramps,
dizziness, confusion, and passing out.
Heat
stroke: A body temperature of or above 103 degrees; red, hot and dry skin; a
fast pulse; headache, dizziness, nausea or vomiting, confusion, and passing out.
Heat
exhaustion: Heavy sweating or no sweating, muscle cramps, tiredness, weakness,
paleness, cold or clammy skin, dizziness, headache, nausea or vomiting, and
fainting.
If you or
someone you're caring for start to show these warning signs, call your doctor or
911. Move to a cool, shady place, take off or loosen heavy clothes, drink water
or other clear drinks. If possible, douse yourself with cool water, or use cold,
wet compresses to help lower your body temperature.
How To Choose a Home Care Provider
Home care services can be paid for directly by
the patient and his or her family members or through a variety of
public and private sources. Hospice care generally is provided
regardless of the patient's and/or family's ability to pay. Public
third-party payors include Medicare, Medicaid, the Older Americans Act,
the Veterans Administration, and Social Services block grant programs.
Self-pay
Public Third-party Payors
- Medicare
- Medicaid
- Older Americans Act (OAA)
- Veterans Administration
- Social Services Block Grant Programs
- Community Organizations
- Commercial Health Insurance Companies
Medigap
Long-term care insurance - Managed Care Organizations
- CHAMPUS
- Workers' Compensation
National Association for Home Care
228 Seventh Street, SE
Washington, DC 20003
What is home care?
Home care typically refers to non-medical services that assist individuals with activities of daily living. Home care is an increasingly popular choice for care because it enables individuals to remain in their own environments, and can also be a lifesaver for caregivers.
For example, simple tasks such as housekeeping, shopping, meal preparation, opening a jar, or driving to appointments can become increasingly difficult for many older adults. Personal tasks such as bathing, dressing, grooming, toileting and even transferring from the bed to a chair can became unmanageable alone. Many types of individuals, including those who are trained and supervised by agencies, provide such services. In general, home care providers are available 24 hours a day, seven days a week. They may work by themselves or as a team on a shift, part-time, hourly, live-in, or on an as-needed basis.
While some home care agencies provide health-oriented services, it is important to understand the difference between non-medical home care and home health care. Home health care is more specialized medical care, such as that provided by nurses or physical and respiratory therapists. Care providers are trained medical, health care and psychiatric professionals, or certified nurses' aides. Home health services are usually ordered by a physician and may be covered by insurance.
What types of services are available for seniors living at home?
* Homemaker Services - Can include help with cooking, light cleaning, laundry, grocery shopping, and other household chores.
* Personal Care - Assistance with a variety of daily living activities such as bathing, dressing, toilet use, grooming and eating.
* Companionship - From daily telephone calls from a "buddy," to a daily "friendly" visitor, to round-the-clock paid companions.
* Home Health Care - Skilled care that can include nursing; speech, occupational, physical, or respiratory therapy; home health aides, and social work or psychiatric care.
* Adult Day Care - Daily, facility-based programs in a community center setting for seniors who need monitoring or companionship during the day. Please refer to Helpguide's Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs for more information.
* Activity Groups - Games, trips, shopping outings, and other stimulating group activities.
* Respite Care - A trained volunteer or para-professional stays with your loved one and takes over your caregiving role, whether for several hours or several days. These brief reprieves from a caregiving situation are healthy for the caregiver and also for the care recipient...a change of daily routine for both. Helpguide's Respite Care includes tips for caregivers' self care.
* Live-in Help - Home care best suited to long-distance caregiving or other situations in which the primary caregiver can't be there in person and the senior needs round-the-clock support. Room, board and, in many cases, a salary, is provided in exchange for meal preparation, light housekeeping, and other non-medical services.
* Hospice Care - Medical, social, and emotional services for the terminally ill and their families. Helpguide's Hospice Care explains how to best utilize this service at home or in a facility.
* Support Groups - Support for issues about aging, peer companionship, illness-based support, groups for caregivers, grief support and many others to help seniors experiencing life changes or specific challenges. Learn more about caregiver support groups available for different needs, and how to locate them in Helpguide's Caregiver Support Groups.
When should I consider using home care services?
For many caregivers, there don't seem to be enough hours in the day. It's difficult to care for all of the needs of a family member and still have enough time and energy left for your own family, a job and yourself. Exhaustion and stress can become overwhelming. If this description fits you, it's time to consider home care services.
Seniors who become home care recipients most often would rather stay in their own homes than move into residential care. And economically, except for round-the-clock nursing care, home care can be less expensive than most board and care homes, skilled nursing homes and assisted living facilities. However, this is not always the case, and prices should be compared.
If you or your loved one has the living space and financial resources (since the cost will most likely be out-of-pocket), you might consider hiring a live-in care provider (see below for more details.) This type of home care is very well suited for long distance caregiving situations in which the primary caregiver can't be there in person and the elder needs full-time assistance or monitoring.
How do I know what types of home care I need?
In addition to consulting with your senior family member and any relevant medical or therapeutic professionals, consider a "needs assessment," which can be conducted by a care manager or home care specialist-or you can do it yourself. FamilyCare America provides a detailed Needs Assessment Worksheet that will help you evaluate every aspect of care, including physical and cognitive functioning, and issues relating to the home environment. The assessment also asks about your needs as a caregiver and the services you use now to help provide care. It will help you ascertain how extensive an informal support network you already have in place.
How can I locate home care providers?
You can research and hire home care providers privately or go through a home care agency. To locate agencies or private providers, check with any or all of the following resources:
* Yellow Page listings for Senior Services, Home Care, Home Health Care and similar subject areas
* Area Agency on Aging (Call 1-800-677-1116 for the AAA in your area)
* Local community and senior organizations
* Religious affiliations including churches and synagogues
* Doctor or hospital referrals from your care recipient's medical affiliations
* Agencies. These agencies may or may not be state licensed, but they select and supervise their own personnel, and are liable for any staff or care problems that arise.
* Registries. These are employment agencies for home health care providers. Typically, you will pay a fee (if not, then the employee will), and you will be responsible for payroll (including tax withholding) and all other employment regulations. You'll also be responsible for selecting and supervising your provider. The registry will not be liable for any problems such as no-shows, tardiness or quality of care.
* Newspaper ads. In addition to word-of-mouth, this is the way you're most likely to find independent home care providers. Hiring an independent provider is like hiring any other employee without going through an agency. You will be responsible for payroll, as well as for selecting and supervising your provider.
* The Internet. The World Wide Web allows you to do vast searches for a number of home care services. Links to helpful web sites are listed in references & resources below.
* Friends and acquaintances. Referrals from people you know who have used an agency or individual for their relative are one of the best sources of trusted help. Ask around.
The Eldercare Locator, a service of the U.S. government, has an online database of senior service agencies. To get more detailed information, call the Eldercare Locator toll-free at 1-800-677-1116 (Monday through Friday, 9:00 a.m. - 8:00 p.m. Eastern time). You will speak to an Information Specialist who can provide more specific and useful help.
What are some tips for hiring agencies and independent home care providers?
Agencies will typically be the most expensive; independent providers will be the least expensive. However, home care agencies are also easier to use, since the agency finds and places the provider, handles payroll and any problems that may arise, and usually provides coverage for sick or absent providers. Agencies that are licensed and bonded are generally a good choice, although there are always exceptions. You have avenues of recourse (complaints, legal action) when dealing with agencies that are liable for problems. There is no real recourse (except firing) when dealing with independent providers or ones found through registries.
Before hiring an independent provider:
* Conduct an in-depth interview with each candidate, preferably in person rather than on the phone;
* Be specific about all of the tasks that the provider will be expected to take on;
* Discuss salary and offer to pay wages either weekly or bi-weekly. Do not pay wages in advance;
* Request both work and personal references, and check them carefully. Ask the references about reliability, trustworthiness, and punctuality as well as the care provider's ability to handle stress.
* If possible, consider a background check. For around $100-$150 you can have this done professionally. Check with your local police department, legal aid service or your attorney for referrals to individuals or companies that do this or search for "background checks" on the Internet.
Be sure to include the potential care recipient in the screening process if he or she is able to participate, to ensure that both parties are comfortable, and that your loved one's needs are respected.
Once you've hired a capable home care provider, should a problem develop, discuss it with the care provider first. If that does not resolve matters, talk to the agency (if you've hired the provider through this route). If the provider is independent and you cannot resolve the problem after repeated discussions, you may need to find a new care provider. If you suspect fraud or other criminal behavior, report it to your state's Department of Health and the Better Business Bureau. Remember to read contracts carefully, check all references, and consult with someone you trust before signing on the dotted line.
What does home care cost?
A number of factors affect cost, including location, competition and the general economy. In addition, what you'll pay is based on the skill level of service you need and want. Homemakers, personal care assistants and companions will all cost less (typically $7.50 - $15.00 per hour) than home health aides or skilled nursing care ( typically $16-$25 or more an hour). Live-in care is usually priced by the day or week rather than hourly, and can run as high as $200 per day or more through agencies in some parts of the country.
If you are considering adult day care, know that Medicaid will pay most or all of the costs for a licensed adult day care setting, as well as for Alzheimer's oriented centers, for participants with low income and few assets. Private medical insurance may also cover a portion of adult day care costs when licensed medical professionals are involved in the care. See Helpguide's Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs for more detailed information.
References and resources for home care services
Independent Living: Resources That Can Help Seniors Stay In Their Own Home - Provides a variety of links with resources that can help seniors stay independent in their own homes, including Lifeline Medical Alert systems information and Senior Corps Senior Companions program. (Aging Solutions)
American Association for Home Care - Discusses important questions to ask when choosing a home health agency and presents vital Medicare benefit information. (American Association for Home Care)
Making Your Home Safe for Seniors: A Room-By-Room Assessment - Offers excellent tips for making every room in the house safer for older adults. (Our Senior Years)
Home Care Agency Locator - An extensive home care/hospice agency locator database that you can search by service, payment type, and location. (National Association for Home Care)
Household Employers Tax Instructions (PDF) - What you need to know about employment taxes when you hire household help. (Internal Revenue Service)
Find Homecare Providers - A nationwide non-profit searchable database for all types of private home care services. (National Private Duty Association)
Senior Home Care & Home Healthcare Providers/Agencies - Provides a definition of senior home care, home care agencies and home healthcare agencies with searchable database by state for both home care providers and assisted living facilities. (Senior Magazine)
Additional online resources for home care services
Hiring Home Care On Your Own - Evaluation - Describes how to hire home care providers. (National Organization for Empowering Caregivers)
Caregivers - A detailed explanation of the wide variety of assistance caregivers are available to provide seniors to help them remain at home, from companionship to chores, transportation to moving, and more. (WithALittleHelp.org)
Other resources that we used in writing this article
Needs Assessment Worksheet - A detailed evaluation form of the activities of daily living to help you and other family members determine what types of assistance your loved one needs. (FamilyCare America)
Related Helpguide articles
* Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs
* Daily Money Management
* Respite Care
* Geriatric Care Managers: Helping You Find the Right Elder Care Services
* Geriatric Assessment
* Hospice Care: Full Service Support at Home or in a Facility
* Support for Caregivers of People with Alzheimer's Disease or Other Dementias
* Help and Resources for Caregivers: Caregiving Support and Tips for Preventing Caregiver Burnout
* Caregiver Support Groups
Amara Rose and Monika White, Ph.D. contributed to this article. Last modified on: 7/6/05.
