Caregiver’s Toolbox Ep. 47 “4 Common Reasons Seniors Need Private Care”
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Caregiver’s Toolbox Ep. 47 “4 Common Reasons Seniors Need Private Care”
Announcer:
Welcome to The Caregiver’s Toolbox, tools for everyday caregiving. We provide education and information on senior care topics. Here’s your host, Ryan McEniff.
Ryan McEniff:
Hello, everybody. My name is Ryan McEniff, and I’m here with Janet, and welcome to The Caregiver’s Toolbox, tools for everyday caregiving. Today, we’re getting into it with four common reasons seniors need private home care. I mean, Janet, there are maybe 5 million different reasons why seniors need private home care, but these are kind of the four that we find come through the door more often than not, maybe.
Janet:
Yeah, I think that’s a fair statement.
Ryan McEniff:
We could add a fifth on there. We’ll add one fifth one, a bonus one, at the end of it.
Janet:
Okay.
Ryan McEniff:
The first one we wanted to talk about was fall prevention. And Janet, you have plenty of experience with dealing with fall prevention and seniors. What are your thoughts on that?
Janet:
Well, with fall prevention, people get unsteady for a variety of reasons. Can and be a certain health condition, medications, they’ve had an injury, losing balance, whatever, and they still want to stay in their home, and they can’t be watched 24/7 by family, so they oftentimes need a caregiver in there to help them safely do their personal care, help them with their meals, take them out on errands, things like that.
Ryan McEniff:
Yeah. I mean, fall prevention is such a huge one. I mean, we were just dealing with it with a client that’s still using us right now, where… Falls happen all the time. I would say the most likely time that is is nighttime, where somebody’s just a little disoriented getting up, they fall.
Ryan McEniff:
But falls happen, and we just got a call today where somebody had a fall where they… They were not receiving care from us, but they had a fall one way or another. And they happen anytime. And where I feel for families, and I’m sure you empathize with them as well, is that private home care, as we’ve talked about, gets expensive. When falls can happen any time of the day, any time of the night, 24 hours a day, how do you weigh the amount of money you can spend, or you can budget for spending towards this, to dealing with making sure the most at-risk hours are covered. And I think that’s a problem a lot of families deal with in America, of “I don’t have the money to pay 24/7 care.”
Janet:
Yeah. And I think people will look into things where… Just like for anybody, you and I, the most dangerous place usually is a bathroom, and that’s either getting up at night, and if there’s someone at home or someone has a monitor or an alarm on the bed, they deal with that. If you have mom living or dad living with you, or something like that. But a lot of times it’s that getting up in the morning, it’s the personal care. The majority wear glasses, and you don’t usually wear your glasses in bed, so you haven’t put them on yet-
Ryan McEniff:
Yep.
Janet:
… and getting started for the day. And a lot of times, if people are trying to manage their finances and figure out how to ease into some of this, some people do very well if a caregiver’s in there in the morning for a period of time, and maybe the client goes to daycare, elder daycare, for the day.
Ryan McEniff:
Sure.
Janet:
Or a certain type of program or-
Ryan McEniff:
A pooled care where at least eyes are on them, where-
Janet:
Exactly.
Ryan McEniff:
… it doesn’t guarantee that somebody won’t fall, but if they happen to, maybe it’s a slow fall where they can be there and pick them up, or catch them, or they’re not on the ground for six hours waiting for somebody to realize that they’ve fallen because they haven’t answered the phone for a while.
Janet:
Yeah. And some people that are unsteady, but they’re cognitive, and their thought process is clear, will often, if they live alone, they will try and stay in bed until the caregiver comes. So, it’s that first thing in the morning that probably is the time when most people feel the need for someone to be there.
Ryan McEniff:
And that’s more the reason why seniors need to know about how to use smartphones. Because I can tell you, on a Saturday morning, I can waste a good hour laying in bed viewing my smartphone, whether it’s Netflix or YouTube or social media. Before I know it, I’ve spent an hour, and I’ve already been up, and haven’t even gotten out of bed. So, that’s what we need to do is make sure the seniors know how to waste their time on the smartphone for when the caregiver’s gone.
Janet:
Well, there you go. That’s what you need to do. Or you could be like in my house, where you use the cell phone, you take it off the handle, and you try and change the TV channel on it. So, technology’s a challenge.
Ryan McEniff:
Our home lives are a little different. I grant you that.
Janet:
Yeah.
Ryan McEniff:
So, the next one up, and granted, there’s a bit of a particular order for this, for fall prevention, I think, being number one. But dementia, it can be 1B, or fall prevention could be 1B and dementia’s 1A. I mean, they’re tied. They’re thoroughbreds racing down to the wire on the Belmont. So, dementia’s obviously a huge one where there are obviously multiple different kinds of dementia, but Alzheimer’s is number one.
Ryan McEniff:
And in that, it’s just kind of even just general forgetfulness, where they become a safety risk for themselves. And almost, dementia can be a one-two punch with you have dementia, and you’re wandering, and your brain’s telling you to just keep walking, keep walking, and you’re also a fall risk at the same time.
Janet:
That’s right.
Ryan McEniff:
And way to put the perfect ingredients for a catastrophe to occur. Hey, I just decided to start walking down the road, and I’m going to keep going until my legs give out.
Ryan McEniff:
And all the cracks and crevices and traffic. So, dementia is obviously a big reason why people call private home care agencies. And kind of, what are your feelings on that?
Janet:
Well, and with dementia, a lot of people think that dementia and Alzheimer’s are the same thing. And Alzheimer’s is a form of dementia, but there’s so many dementias that are undiagnosed, especially early stages, and there are also dementias that are reversible.
Janet:
One that people are getting more comfortable with, because usually you think, “Dementia? Oh my gosh. We’re going off the cliff.” But you can have dementia because you had anesthesia at the hospital. So, someone could break a hip or break something, have a surgery, and now they’re saying they’ve got symptoms of dementia. It doesn’t mean it’s forever, but they need to have some observation. They need to have some assistance to make sure that they’re not a safety risk to themselves, because their reasoning is just not what it ought to be.
Ryan McEniff:
Absolutely.
Janet:
So, depending upon what the nature is, and some people, they’re determined to live alone, and it’s not safe to do so. Some people, they live with family, but family needs a break, and they need someone to be there for them. So, there’s such a variety, and there’s so many different ways to deal with the dementia, that that oftentimes is the first call that we get. “I’m not sure where we’re at with mom, but we’re starting down that road. What do we do?”
Ryan McEniff:
Yeah. And so often when we get those calls, one of the questions we always ask is, “How’s mom’s or dad’s memory?” And inevitably, I would say, well, maybe seven out of 10 times, maybe six out of 10 times, there’s always an issue with memory impairment of some level. It might be at a one, it might be at a 10, somewhere in the middle, but there’s always some forgetfulness in there.
Ryan McEniff:
Like, “Oh, well there’s this one time they left the gas stove on, the gas burners on for three hours, and realized three hours later that it was going.” So, we could spend all day talking about all the different scenarios and intricacies of different dementia cases that we’ve dealt with over the years.
Ryan McEniff:
But it definitely is always… If it’s not the primary reason people are calling us up, it’s definitely a secondary or a “third-ary” reason, if I can use that made-up word. It’s always lurking in the shadows at some point in time. It’s just how big that monster is under the bed. So, it is part of the aging process and part of being in private home care.
Ryan McEniff:
The next one that we thought was a good one, number three was just kind of maybe more of a vague title, but general wellness and kind of personal care. We get this lot where family members just want somebody to come in, a caregiver to be more clear, to come in three or four times a week for anywhere from three to six hours a day, just to make sure that the house is being kept up with, making sure that mom’s okay, that there are some eyes and ears. Maybe there’s a neighbor that doesn’t mind stopping in every once in a while, or every day. Maybe there’s an event that happens on the weekends, or maybe the family gets there on the weekends, but they need some eyes and ears for most of the day on the weekdays. Whatever that is, it’s just making sure that there’s a general wellness there.
Janet:
Yeah. It’s like a wellness check. I can remember when my grandmother was alive, and she was living alone, and the neighbors knew that my grandmother was one of these people that ran a timetable like a train station would. And they always looked to see that the kitchen window shade was up. So, if they didn’t see it, you’d get a call. That kind of thing.
Janet:
But for a lot of people… And we get more and more of these calls. That people want mom or dad to maybe get used to care, because they don’t think they need it, or they’re reluctant. We always hear, “Well, they’re reluctant. They’re not sure they need this.” So, they want someone to come in to kind of get them to realize it’s not the bogey man under the bed. Or, very, very common is, their personal care, to your point, is such that they’ll do the little… We call them bird baths, a little surface cleaning here and there. And nobody I know of died from not getting a bath. But the chances are, needing an honest-to-goodness shower or a real good cleaning, you probably need that a couple times a week.
Janet:
And the last thing most men want to do is drop by to give their mother a bath.
Ryan McEniff:
Gosh, sure [crosstalk 00:10:31].
Janet:
So, often check on things like that. So, a lot of times things will work that way. Or maybe it’s some personal care in the morning, and take them shopping once a week, because it gets them out, and they still have a purpose or whatever. But we have taken mom’s keys, fortunately, and now she’s not on the road trying to do this herself.
Ryan McEniff:
Yeah. And the reason why it’s kind of vague is because there’s no one task. It’s just a variety. Making sure that the linens get changed every week. Making sure the laundry gets folded and put away. It’s just the beginning stages of maybe being unsteady on their feet, or the beginning stages of dementia, where they haven’t lost complete independence, but they just need a helping hand X amount of hours per week.
Ryan McEniff:
And one of those helping hands that you didn’t mention, and I’m sure you’ll agree with, is meal preparation.
Janet:
Absolutely.
Ryan McEniff:
It doesn’t matter… Generally, I think when you think of Hungry Man or Stouffer’s, you think of a guy that’s just gotten back from work and just wants something quick, and certainly that’s a demographic they cater to.
Ryan McEniff:
But seniors use a lot of pre-made meals where it’s microwave ready, and those aren’t bad every once in a while. I’m guilty, just as anybody who’s eaten them before. But when they become your primary source of food every single night, or maybe even lunch and dinner, we get a lot of calls about that where they’re worried about their parent’s nutrition, their nutrients that they’re getting on a daily basis. And those foods have just mega sodium. And I know we’ve even talked about this before in the past, but it is a cause of concern, and that’s why I kind of list it under that just general wellness, making sure everything’s okay.
Janet:
Yeah. And even in terms of, we’ve talked about people’s vision, or their sense of smell or whatever, can be off. It can be hard to read the instructions on some of these things, so you may have to help them. And as we’ve talked about, too, with sense of smell, to have part of that wellness check for a caregiver to kind of do a little quickie check of the refrigerator, because a lot of people can’t determine when something’s expired. And especially dairy, and I mean, we all know what bad chicken smells like, especially in the summertime. Elderly people can’t always sense that smell, and they can be at risk for that. And that’s something that doesn’t eat every day.
Ryan McEniff:
Did we talk about that recently? I can’t remember. Was that something-
Janet:
Exactly. What is that smell in the fridge?
Ryan McEniff:
Yeah. And so, if you think about it, if you have a mom or a dad, they don’t say these things, but we hear it all the time where they’re a little unsteady on their feet. Maybe they’ve had a minor fall, and they say, “Listen, I’m not reaching up high to grab things out of the cabinets. I’m not reaching down low to get a bunch of pots and pans. Then I got to clean it all up.” My dad is able bodied, and I was a single guy. I didn’t want to have to clean up five pans just to make myself one meal, when I could order from Domino’s and just have it delivered and throw it out.
Ryan McEniff:
So, there’s the convenience part of it as well, but it’s good where… Just to summarize, what happens is an aide will come in, will make a nutritious meal, and make a large portion of it so that they can have it for lunch and dinner for the next two days. And then when the home health aide comes in two days later, they do the same thing. So, they’re still getting the microwave meal, it’s ready, it’s in the Tupperware, but at least it’s nutritious and it’s not 5 million calories and 5 million grams or milligrams of sodium that’s in there. And it’s more balanced nutrition, rather than the same thing over and over again.
Janet:
Yeah. And because the caregivers do this type of thing day-in and day-out, and someone wants to be pretty independent, to be the sous chef, to be the helper, the caregivers are very good at seeing that Mrs. Smith has to reach way over here for this and way over there for that, and never uses this or that.
Janet:
And, as a project, they will over time move some things around in the kitchen, just like I did for my own mom, because she has back issues. And it was like, “Why are people bending down to get this, or reaching up to get that, when this space is not being used?”
Ryan McEniff:
Sure.
Janet:
So, we do it because we always did. That’s where it always was.
Ryan McEniff:
Absolutely.
Janet:
And that’s something we’re more tuned into because it’s our world. It’s what we live with.
Ryan McEniff:
Yeah. And so another one that we thought was an important one was rehab and hospital discharges. One of the things that occurs is when… And I thought this before I got into the space as well, that when you go into a hospital, you go in injured, they make you feel better, and you walk out of there, and you do a couple jumping jacks, and you skip down the road, and everything’s okay. And that’s about as far away as the experiences that we’ve had with seniors that go into a hospital or a rehab.
Ryan McEniff:
Now, granted, maybe if it’s stitches on your finger that you got, you’ll do that. But usually, when a senior leaves the hospital, the hospital has done a good job treating the acute issue, but hospitals are notorious. And I don’t think it’s a hospital’s fault. I think it’s just the nature of the beast, of they’re confused, disoriented, they’re weak, they’re tired, they’re grumpy, you’ve just gone and completely shaken the Christmas snowball, and the blizzard is going on.
Janet:
That’s a good example. Yeah.
Ryan McEniff:
Versus when it was quiet and nice. And you see that all the time, too, Janet, right?
Janet:
Yeah. It’s one of those things that you… And especially if it’s someone that lives alone, that maybe they came home from rehab for a knee or a hip or whatever, and their mind is sharp as a tack, but they’re home, and they have this walker. And how are they supposed to open the oven, or get at the fridge? Or, like you say, the hospitals are curing and working on the reason that you came to the hospital. Not how you’re going to get around the house.
Janet:
And a wheelchair and a standard walker don’t fit through my bathroom door at home. And these are the kinds of things that people don’t realize. And in some cases, if the condition is such that getting through a doorway, or doing something, is only temporary, you’re not going to go modify the whole house. And you don’t even necessarily need the home care for a long period of time, but you need it for that in-between while the person’s trying to adjust.
Janet:
I mean, I remember when I had shoulder surgery. And, of course, it’s always your dominant hand or leg that you get hurt. And I’m trying to beat an egg in a bowl, and I felt like an idiot because I’m chasing the yolk around trying to beat it with the other hand. And you take someone who was an older person, and maybe they were a little frail to begin with. They can be overwhelmed by, how do they adjust? So, to help them ease back into their own environment, a lot of people will ask for an aide to help them with that transition.
Ryan McEniff:
Absolutely. And this actually kind of segues into our bonus one or fifth one is assisted living, and discharging to an assisted living. We can kind of do 4B or 4A or whatever, where we have a client now, we had a client in the past, where they go to the hospital. They have a fall in assisted living.
Ryan McEniff:
And they come back home, and this gentleman, the difference between him when I saw him and when he moved back into the assisted living, and literally 48 hours later, was totally different.
Janet:
Yep.
Ryan McEniff:
He was back up on his feet. He felt good. He was cognitively okay, for the most part. You would’ve thought it was just getting back home and getting a solid night or two of sleep, and he was feeling great from a nasty fall that he had had a week earlier, or whatever, a few days earlier. And that’s where we get a lot of calls as well with assisted living facilities. Oh, you take it from there.
Janet:
Well, sometimes, to that exact point, people will come home from a hospital or a rehab, and they have been filled with proper nutrition and they’ve had enough fluids, and all of that. And they get back home, and in a few days they look like they’re doing great, but you can also often get a lull that next week, because they don’t have someone that is caring for them the same way they did when they were in the hospital bed.
Ryan McEniff:
Basically, catering to whatever need they have.
Janet:
Exactly. And to one of the cases I think you’re referring to, this person came back, was doing well, kind of backslid a bit. The family was getting a little worried, and he needed some adjustment. He needed to kind of accept where he was at, and that he had had a fall. And after about a week, or two weeks, he’s participating in activities. And the family’s like, “Oh, I’m so relieved. I thought we were going down, down, down.”
Ryan McEniff:
Yep.
Janet:
And it’s one of those things, that it works like the Stock Market or the rolling hills of somewhere, you have your ups and downs. We do.
Ryan McEniff:
Yeah. It’s not a linear movement. It can go up, it can go down. But the idea is over the course of a few days, a few weeks, maybe even a few months, that we’re trending in the right direction to get him back to his baseline, whatever that might be.
Janet:
Yeah. And we’ve had people that are moving to an assisted living, and just the nature of assisted living, we’ve had many families call us because for 48 hours, or through a weekend, they want one-on-one, just so the person can adjust. Because if they’ve lived in a certain home, or out of state, and now they’re in this new place, they got to figure out where their apartment is. The bathroom’s not in the same place. Where’s my toothbrush? And they need that little help for a period of time to help them get settled in.
Ryan McEniff:
And in our recommendation, whether you’re in our service area where we can care for you, wink-wink, nod-nod, or if you’re out in California where we can’t, if your loved one is coming back from a rehab stay or a hospital discharge that isn’t anything more than a mild issue, get 24 hours or 48 hours of care.
Ryan McEniff:
Make sure that that person, that loved one you have, if you can afford it, doesn’t go back into the hospital immediately after being discharged because they’re weak, they’re confused, they’re exhausted, they’re just not in the right frame of mind to make smart safety choice decisions. When you hire a private agency, it doesn’t mean you need to use 24 hours for the rest of your life. And if they say to you, “Well, if you sign on the dotted line, you have to give us three weeks to do 24 hours. And then, if you don’t sign on the dotted line, there’s somebody out there that will do this.”
Ryan McEniff:
So, get that 24 hours for a day or two, or three days, or whatever it might… Even if it’s a week, the amount of stress and pressure and angst that you’ll save the whole family is worth it. And you can lower the amount of hours you get as you don’t need it.
Ryan McEniff:
The gentleman that we’re caring for started out with 24 hours a day. Then he’s down to 16 hours a day, and then they’re going to move down to 12 hours a day. Now, granted, this has been going over for what, two months now?
Janet:
Yeah.
Ryan McEniff:
And so, that is a lot of money. It is costly. There’s no doubt about that. But we’re preventing him from going back into the hospital, which I can all but guarantee would’ve had happened if we weren’t in there providing care for him.
Ryan McEniff:
And so, if you have the ability to do that, and even it just allows… When an assisted living is taking back one of their residents, or if you’re taking in your mom again, it allows you to determine where they’re at after two or three days. And it is a bit of an investment, but I can promise you, it pays its dividends. But you never know that, because the idea is they won’t be going back to the hospital. So, it’s just some food for thought with that.
Ryan McEniff:
But, that’s what ends up happening, where we’d speak with people. They’re getting discharged at the last minute, or they’re getting discharged home, and they’re like, “What should we do?” Use us for 72 hours for home care or 48 hours for 24-hour care. And then let’s reassess on the second or third day. And if you don’t need us at all, then by all means, just cancel services.
Ryan McEniff:
So, it’s just something to think about when you’re listening to this, and you’re like, “Well, if mom ever does go in the hospital, what do we do?” That’s our recommendation.
Janet:
Or, we even do it as just plain respite. You got mom living with you, everything’s working out fine. You want to go to an out of state wedding with the family, and you need someone to come in for a period of time. Or you’re going on a vacation. They’re in a familiar setting and it’s a short term thing. And everybody ends up being a little bit safer, I think.
Ryan McEniff:
Absolutely. Well, excellent. Well, thank you, Janet, very much for the time. And thank you very much to all the listeners for listening, and we hope you have a great day, and we will catch you on the next one. Thank you.
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