Finding the best care for a family member

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When a family realizes that a parent or loved one needs additional care, often the first thought in peoples’ minds is to find someone to come into the home to provide care.

Up until the mid-1970s, when someone was frail of body or mind, it was common for them to go live with a family member or they were placed in a nursing home. Caring for a family member with physical needs or with memory loss is not as easy as it may sound.

As a caregiver, our bodies are also aging and changing; we lose some of our mobility, strength and most importantly — we lose our patience. Giving someone else a shower or changing protective undergarments, or lifting a person from a bed to a wheelchair can be physically challenging for the caregiver. Living with a family member with dementia, their unpredictability can wreak havoc on a caregiver and the entire family.

Ask anyone who has been a caregiver for a family member if they felt their work was rewarding. A small percentage will tell you what an honor it was to care for someone else, but the majority will tell you stories of unbridled family stress. It will encourage you to find a paid caregiver to provide care so you can continue to maintain cohesiveness in the family.

The thought occurs to many people to undertake the task of finding a caregiver they can hire on their own. The main lure to becoming a care employer is that the hourly rate may be less than that charged by an agency. What comes to light later is the amount of stress involved in managing that person and dealing with the typical absenteeism issues, can end up costing much more in the long run. 

When someone needs care, they need consistency, and they need to know they can rely upon those giving them care. Attempting to hire, train, and ensure the person you hire is capable and conscientious about their caregiving, unfortunately, this scenario almost never works out.

In the 1980s, private-duty in-home care agencies began offering the services of screening, hiring, and managing the care delivered in a person’s home. At first, the industry boomed, but the reality of finding enough quality staff and paying them a sustainable wage became difficult. Also, as our communities grew, so did the traffic congestion. Agencies that once offered to visit a home for a single hour began moving to two, then three and even four or more hours as a minimum visit.

At the same time, in-home care agencies developed, and so did assisted living and residential assisted living (homes that care for a small number of residents). Both Oregon and Washington put forth plans to change the face of nursing homes. Families were no longer willing to accept placing three or four residents in a small nursing home room. 

The nursing home industry has been morphing ever since, and a growing number of nursing homes are not intended to be places where people live out their entire lives; instead, they have become short-term rehabilitation facilities where people stay for ten days to several weeks in order to receive intensive physical, occupational and speech therapy.

In the Vancouver and Portland Metro area, we have an abundance of options available for receiving care. We have around 75 in-home care, home health and hospice care agencies offering care in your home. There are just over 1,500 private homes offering care for three to eight residents in family-like setting. And we have just under 200 retirement living, assisted living and specialty memory care communities.

Having all these options makes the task of knowing which options best meet the needs of someone needing care a very difficult task. Also, because the costs associated with each care option are significant, it’s important not to make mistakes when selecting a care provider.

As the number of available options grew to the point that families realistically could no longer visit all the options on their own, senior care referral agencies came into being to help families sift through the mountains of information they found and to understand how it affected their options. There are now over 50 such agencies in our geographic area. To find a quality agency, visit the Oregon Senior Referral Agency Association (which includes agencies in Vancouver, Washington) at www.osraa.com.

In-home care is best for a person who requires a specific number of tasks within a given time period. As an example, someone may need help getting up in the morning, showering, having breakfast and getting set up for the day. Unless someone has the funds to pay for care for extended periods, in-home care is not likely to be a good match for someone who needs short amounts of help at varying times of the day, evening or at night.

For some people with dementia, in-home care is a good option at certain stages in the memory loss process. At other times, the person suffering from memory loss may find it unsettling to have a stranger in their home, or they may even refuse to allow anyone in their home that they don’t know.

When considering the options, here are just a few things to consider: 

• What setting would best work for the older adult(s)?

• If you want in-home care, do finances allow for an approximate hourly cost of $45+/hour?

• What specific geographic locations are best?

• What has changed that is causing a need for care or a change of living environment?

• If a retirement or assisted living community is preferred, for what period of time can the older adult(s) be left alone without being checked on?

• What are the specific health concerns and diagnoses?

• What type of care is needed and at what times of the day, evening or nighttime? 

• What is the personality of the person who needs care?

• What sight, hearing or speaking impairments exist that may need special attention?

• What inspires the person, what are their joys, what upsets the person?

• Is the person at risk for falling?

• Is there a spouse or significant other that will be making the move as well?

• Is the person a veteran or a spouse of a veteran?

• Does the person qualify for any discounts on monthly base rent based on income?

• What income and assets are available to pay for care; if finances are limited, how long before the person will need to transition to state assistance?

• Is there a pet that also needs care? Can the person care for the pet, or will they need the caregiver’s assistance?

When you enlist the help of a referral agency, they will likely ask you well over 100 questions before defining your options.

Whether a person is staying at home or moving to a community-type or home-like setting, it’s always critical to think about the actual and specific needs of the older adult(s). As family members, we often are guilty of seeking out options we would like to see them in, yet their wellness in life depends upon making the best decisions and making those decisions after fully understanding your options.

Les Ostermeier, Housing & Care Advisor/Owner, 1st CHOICE Advisory Services, Inc.

Serving Washington and Oregon seniors since 1993.