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From what I've observed, the people who are willing to do food provision and actual cooking of a nightly supper can be different from the people who will do bathing, help in the bathroom, helping out or into bed, incontinence help, dressing, etc.
Sometimes the people who do the bathing, helping into bed etc will do some light cleaning, but that is not a given. Heavier cleaning? Laundry?
And people who do errands and grocery shopping may not be the same people who do bathing, bathroom assistance, etc. (grocery delivery & household items delivery are good as a separate service where available)
Interested in what others have experienced about the separation of duties among employees.
This is why agencies exist to provide home care. They can send a variety of people on whatever schedule you need. I see this with a neighbor - she has different people who come throughout the day.
But you are right, if you look for a live-in helper, you would be expecting that person to to all of the various tasks.
Some of the coming and going to a person's private home is also a nurse who takes vital signs on a schedule, and checks medications, but that is all the nurse does, as stipulated by Medicare.
Do the math on 24x7 home care. Around me, a CNA is about $20.00 to $25.00/hour through a home care agency that handles employment taxes, health insurance, workmans comp, unemployment insurance, and the rest of the list of expenses when you have an employee. 365 24-hour days at $20/hour is $175,200. You still have to pay all the ownership costs on the house. Taxes. Insurance. Utilities. Mowing the lawn. Building maintenance. In my state, the average cost of a private room in a nursing home is $140,000.
If the CNA agency charges $20-$25 per hour, my guess is the actual Certified Nursing Assistant only makes $12 to $17 per hour.
The thing is you could also need full time personal/medical care. We are doing something similar but with family. we bought a large 5 bedroom house in WV to retire to because of the cost, we also got One of my children and his family to move in with us.
The purpose of this is for them to take care of us. We both have health and disability issues.
I think in some ways it would be harder with strangers, and you would want ones with training at some point, so you are probably talking about several different care givers over time and finding ones you can trust or that have the right stuff can be very hard indeed.
Yes it is hard to find good home care and if you are considering having family move in with you please don't forget about their needs and is it beneficial to them. Too many times when people make these kind of plans they think of their own needs and never consider how it effects their kids, their own families and their jobs. Also consider the spouse too, they have parents too.
Yeah, but I'm not so sure a nursing home gives you "higher quality" care.
For the most part the workers don't care about you. You're a number. I've seen their reactions while I was visiting relatives. The workers get pihssed when you ring the call bell. When don't what to eat they get snippy. When they think you can't hear they talk about patients. If you want "better care" in a facility -- you still have to pay for your own aide, or companion.
I'd take one-on-one care at home over a facility any day of the week. Period.
12 years ago a relative was in a nursing home, that looking back on it, I wouldn't put anyone in.
(She was private pay and it's where the hospital found a bed for her near family. Again looking back, and now today more familiar with what to ask and look for, and how to research nursing homes, I'd bet she was the only private pay person in there, given the demographics of the other residents (and that's all I'll say about that.) But looks and stereotypes can be deceiving of course.)
And within the past two years, a friend who fell and was paralyzed from the neck down was in a so-called nursing and "rehab" facility. And again, the care wasn't the best.
And I know it's a tangent -- but I'll also add, as an aside....
I HATE that facilities have now started adding "rehab" to their name. When many times it's no more a true rehab center, than I am 5'10 and a size 2! When I say rehab I mean, enough therapy sessions in number and length of sessions to actually accomplish something, improve something, get the person back on their feet (so to speak). Not, 2 sessions each of occupational or physical therapy for a 1/2 hour. What the heck is that? How is anyone really supposed to improve -- and bounce back from possibly both a surgery -- AND and injury, with a lousy 2 hours a week of "rehab." When I say rehab -- I mean -- rehab like athletes get. They're pushed they're challenged. The goal is recovery. I know depending on the patient in rehab -- especially elderly or frail ones -- some people will never totally recover. But darn it, from what I've seen they're not getting enough rehab to even recover as much as they could if they had more and better rehabilitation.
Yeah, but I'm not so sure a nursing home gives you "higher quality" care.
For the most part the workers don't care about you. You're a number. I've seen their reactions while I was visiting relatives. The workers get pihssed when you ring the call bell. When don't what to eat they get snippy. When they think you can't hear they talk about patients. If you want "better care" in a facility -- you still have to pay for your own aide, or companion.
I'd take one-on-one care at home over a facility any day of the week. Period.
12 years ago a relative was in a nursing home, that looking back on it, I wouldn't put anyone in.
(She was private pay and it's where the hospital found a bed for her near family. Again looking back, and now today more familiar with what to ask and look for, and how to research nursing homes, I'd bet she was the only private pay person in there, given the demographics of the other residents (and that's all I'll say about that.) But looks and stereotypes can be deceiving of course.)
And within the past two years, a friend who fell and was paralyzed from the neck down was in a so-called nursing and "rehab" facility. And again, the care wasn't the best.
And I know it's a tangent -- but I'll also add, as an aside....
I HATE that facilities have now started adding "rehab" to their name. When many times it's no more a true rehab center, than I am 5'10 and a size 2! When I say rehab I mean, enough therapy sessions in number and length of sessions to actually accomplish something, improve something, get the person back on their feet (so to speak). Not, 2 sessions each of occupational or physical therapy for a 1/2 hour. What the heck is that? How is anyone really supposed to improve -- and bounce back from possibly both a surgery -- AND and injury, with a lousy 2 hours a week of "rehab." When I say rehab -- I mean -- rehab like athletes get. They're pushed they're challenged. The goal is recovery. I know depending on the patient in rehab -- especially elderly or frail ones -- some people will never totally recover. But darn it, from what I've seen they're not getting enough rehab to even recover as much as they could if they had more and better rehabilitation.
Off soap box now. Thanks.
Your soap box needs some scrubbing.
You want "The Best"? Then pay for it.
"Nursing homes" don't just randomly add "rehab" to their name, for goodness sakes. They DO rehab or do you think the government just pays for naming conventions?
Are you an OT or PT? You're totally wrong about the length of time and ratio of the capabilities to the patient or the regimen they may need for various things.
They even get an allocation on Medicare or other insurance for the entire year and the doctor will write the order for what is needed or depending on if they feel they need to save up some of those hours/visits OR do it at home instead of in-house, then that's to HELP the patient not ....whatever it is you're suggesting. For example if someone falls or has a rehab need in January, there may be a consensus that they are high risk to repeat later in the year and it's wiser to do the rehab at home in some instances.
Furthermore, if the patient can't keep up to the RIGORS of the rehab and the scheduled plan, they have to leave. Especially the "good" ones. My client's family had her walking with her walker with her eyes closed (lol dementia) because they were fighting so hard to keep her going in the rehab instead of getting kicked out for inability or unwillingness to work.
And it made a world of difference.
I don't think you've really "seen" much.
And I know for SURE you haven't seen the caregivers' secret activities when able to hide in a patients home with no supervision, like they get in a facility.
I have.
Only the most forward, and with-it patients can be trusted with in-home care, and even at that it's very easy to fall, get dropped, crack a knee-cap or skull and end up in SNF or worse. Not to mention other idiocy like the aide who kept bringing my 96 year old client fresh pineapple juice and giving him a 16 oz glass and causing diarrhea for 3 days all over the condo. Even AFTER I told her to STOP because he NEVER eats fruits, fiber, juice, has a very regimented diet and is easily dehydrated.
She also tried to scam a trip for her and her husbs up to his former summer house in New England (that his family still uses) and he almost agreed!
And YES, she was from an agency, in fact, the very same agency run out of the upscale CCRC he lives in. WHICH, BTW assigns the bad aides to the home health agency division - especially like him who pays for 24 hour care - and keeps the GOOD ONES for the SNF they have because nobody wants to work with the bad ones. Albeit they can overlap at times. Some of them don't even know how to operate the HVAC properly and you walk in and your client is sitting in 95 degree heat in FL summers with their face beet red sweating profusely.
Shall I tell you that 99% of the time, the home health aides don't even bother with the gait belt?
That being said, I'm sure at THIS POINT, you'd have no problem expressing your standards to an in-home care giver.
BTW, it's not anyone's choice to "put anyone in". It's often and most times unavoidable. Well, unless you're independently wealthy and able to pay for MULTIPLE caregivers concurrently to the tune of about 50K per month and have NO MEDICAL issues requiring a registered nurse level of care. Since it's virtually impossible to transfer one dead weight body with one person and without a lot of equipment like a lift. I'm not even going there about hygiene!
We won't even discuss the no-shows and personality conflicts and how many times the patient may fire someone or vice versa.
Real life.
Visit the caregiving forum.
Last edited by runswithscissors; 01-18-2018 at 02:25 PM..
I did. Quite often over the years when dealing with my mom's dementia issues. Not so much since she passed away. Although I did just today as a matter of fact.
Fortunately, my brother was able to handle the brunt of her care early on. When that got to be too much (and I do think he was burdened for too long) -- my mom had 24/7 live in at home care, supplied by an agency which was personally recommended by someone I trust implicitly, whose parents had also been served by that agency.
My mom had 24/7 live in care and didn't live long after that began (She died unexpectedly of heart failure. That's what the doctor called it. He did not say heart attack.) She slumped over one day, sitting on her porch in the warm October sun, talking with one of my nephews.) We we fortunate enough to give the aides their own room, TV, linens, storage. Set them up very well. As I said, we were all set for the long term. But mom died 2 months later.
As for nursing homes, years ago an aunt was in one as a private pay patient for a year until she died, at 94 from colon cancer. Looking back, I realize that if I had known what I do today, I would have pushed for her to go to some place better than where she was. My mom (her sister) visited at least every other day. And I also let the admin know that we are a very involved family, that would not accept neglect of abuse of any kind. Even being there 3-4 times a week. We still could only see what we could see. But now I know more. I don't believe I ever said I know everything about every nursing home. MY experiences are mine.
Even with all that involvement there were instances we weren't pleased with.
I have a cousin in a nursing home, where another cousin (her niece works). Doctors take better care of their own, Police have their thin blue line. Do I believe she gets "better" care because they know a co-worker's aunt is a resident. I can't say. But, I'm willing to bet they all know, "that's Joanne's aunt." And if that increases the chances she's treated well -- what ever that is -- we'll take that also. Again I didn't say treated "better." I said treated "well."
As for rehab, I've seen what these three people -- and others whose cases I know very well -- were assigned for "rehab" or "therapy," which I know are not necessarily the same -- and I wasn't impressed.
More pertinent to the OPs question....OP, I also am thinking about this....
-- I'm single, no kids, never married. I have siblings who are close in age to me (so when I'm 85, the youngest would be 81 herself). Plenty of nieces and nephews.
-- IF I need it I'd like to have stay at home care as long as I can. But I'm also considering a continuing care retirement community. A friend's parents are in one (bought in about 18 years ago in their 70s), and they've been pleased. They started in their own freestanding apartment unit.....mom died five years ago, dad is now in the nursing care unit.
-- Might I try to do a shared housing with other friends who might be single at that time? Sure. But they all have houses of their own also. And we also have to see who's still around
To be honest I'm not sure what I'll do, or how I'll do it. I'm hoping to have as much money as I can...so whatever I need or want.....I'll be able to afford it.
As with many other things in life -- money talks....and allows for more and better options.
Then you need to dig them up yourself. (They are out there)
In 5 - 6 times doing this for seniors... (finding private help)...
We have always been able to find excellent help;
previous / current nurses
those with skills to do insurance and medical billing
take care of bills (normal household accounts),
call and employ repairmen
Run errands / shopping / cooking / hold garage sales / manage downsizing.. transport clients (Via client's wheelchair van)
Do home repairs / yard work / put up Christmas Lights / clean out attic...
Flexible schedules to meet client needs
Replacement / substitutes for when primary person is busy / unavailable / ill
All this ^^^ for far less than agency costs, and agency workers will / can ONLY do what they are contracted to do. (tho if you can afford and want an agency... please use them)
Gotta DIG and network...
I also have worked to assist Home Healthcare workers to form Worker Co-ops and to become their own 'agency', They have been VERY grateful and had excellent success! HHC workers are often very competent.
Only the most forward, and with-it patients can be trusted with in-home care, and even at that it's very easy to fall, get dropped, crack a knee-cap or skull and end up in SNF or worse. Not to mention other idiocy like the aide who kept bringing my 96 year old client fresh pineapple juice and giving him a 16 oz glass and causing diarrhea for 3 days all over the condo. Even AFTER I told her to STOP because he NEVER eats fruits, fiber, juice, has a very regimented diet and is easily dehydrated.
I just had to respond to the pineapple juice story. This would be me. I cannot eat fruit unless I know I am going to be home by myself (near the bathroom) for most of the next day. It gets really hard sometimes because most of the people around me are always trying to get me to eat lots of fruits and veggies for better health. No matter how many times I tell them, they forget, just can't seem to understand that I cannot do this. And I love fruit, so I do treat myself occasionally, but only if I will be home alone the next day.
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When I say rehab I mean, enough therapy sessions in number and length of sessions to actually accomplish something, improve something, get the person back on their feet (so to speak). Not, 2 sessions each of occupational or physical therapy for a 1/2 hour. What the heck is that? How is anyone really supposed to improve -- and bounce back from possibly both a surgery -- AND and injury, with a lousy 2 hours a week of "rehab." When I say rehab -- I mean -- rehab like athletes get. They're pushed they're challenged. The goal is recovery. I know depending on the patient in rehab -- especially elderly or frail ones -- some people will never totally recover. But darn it, from what I've seen they're not getting enough rehab to even recover as much as they could if they had more and better rehabilitation. 
