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placeholder February 18, 2013   •   VOL. 51, NO. 4   •   Oakland, CA
Start the conversation about adult home care

The tipping point for some seniors may be to let them know that by accepting help, "they are giving their family peace of mind."
Courtesy photo

You may think Mom and Dad need help around the house. But they don't think so.

You might think you are helping them maintain their independence. But Sash Nagle, co-owner of Irish Help at Home, said the elders see it differently.

"The day I have somebody in, I've given up," said Nagle, who in addition to her 26 years of experience in elder care, is helping coordinate the care for her "very stubborn mother" in Ireland.

It's a conversation no one wants to have.

"It's tough getting old, for the elderly and their kids," said Jeffery Johnson, co-founder of Visiting Angels, which provides in-home care. As for that conversation, sometimes "you just have to plunge in."

Talking points

• Not something you do in a half-hour discussion. (Unless the elder is ready to have somebody in.)

• Have a lot of patience. (But you can't always wait for elders to bring it up.)

• Consider the options: home care vs. nursing home or assisted living.

• If this doesn't work, you can try, "Mom, I worry about you. I'd like to bring someone in to help. (A very powerful approach. People don't want to be a burden.)

• Call in a geriatric care case manager to assess the needs.

Source: Jeffrey Johnson,
Visiting Angels
"The discussion can't be rushed," he said.

Before he started the company, Johnson was director of social work at a care facility. As part of his job, he needed to walk around to "get a pulse for what was happening."

"It was always bad," he said. "Nobody wanted to be there," he said. Residents and staff didn't want to be there. "Families despised that they had to put their loved ones there."

There had to be a better way, he reasoned. "There's home."

"Home care has been around forever," he said. Still, he said, "nobody wants to discuss this subject."

Not even Johnson. He's 61. "I hate the thought of thinking of my kids having to deal with me," he said.

What's important from the care provider's perspective, he said, is "When you go into someone's home, understand what they're going through."

In the Visiting Angels model, which provides non-medical care such as shopping, companionship, cooking, laundry, driving, light-housekeeping and personal care, a director goes to the home for the assessment with the potential client and members of his or her family.

The director will return with a caregiver for the client to meet. If that proves to be successful, the caregiver can begin work as scheduled. If they don't click, the director will return with another caregiver for an interview.

"We're not here to take away independence, or things you do successfully," he said. "We are here to support. Think of it as an extra pair of hands. It's about having more control over their lives."

The tipping point for some clients, he said, is to let them know that by accepting help, "they are giving their family peace of mind."

He does the assessment, and finds a caregiver who he thinks meets those needs. The agency brings the caregiver to the home for an interview although some may not want that.

For Nagle, the assessment gives her an opportunity "to try to get a sense of the dynamics of the house and what kind of person would work for this person."

Making that match is crucial. "Half the battle is having somebody open to us," she said.

Irish Help at Home requires a two-week minimum for a placement and a minimum of 12 hours a week of care.

Visiting Angels' care can vary from a minimum three-hour visit to every day care. In doing, so, "My caregivers help people stay home every day," Johnson said.

Accepting that care can mean the difference between being able to stay in their own homes, or making a bigger change, such as moving to assisted-living care.

At a companionship level, there might be assistance with transportation to appointments, running errands, and some meal preparation.

Higher-level care would include assisting with personal care, light housekeeping and transfer from bed to wheelchair, for example.

As the non-medical side of the team, Visiting Angels can play a role in hospice care, helping with the activities of daily living.

Johnson said there is no weekly minimum and Visiting Angels has clients who use their services twice a year for medical appointments. A minimum visit is three hours.

He has some caregiver-client relationships that are eight and nine years long.

With his service, caregivers are pre-approved drivers; they can use the client's vehicle, or are driving a vehicle approved by the agency. Clients are billed mileage for use of those vehicles.

Transportation and meal preparation are the most-requested services.

While some people might start with minimal care, others might start with more help, after, for example, discharge from a hospital or rehabilitation facility.

So while a companionship arrangement may work up to more hours, others might start with more hours and taper off.

The hourly rate stays the same, Johnson said.

"We are an employee-based agency," he said. He requires two years of industry experience for caregiver applicants. Once hired, there are ongoing educational opportunities.

Chris Wheaton opened his Visiting Angels offices in Sunnyvale and Fremont in 2003. His wife's grandmother had been in hospice care in Oregon, where Visiting Angels provided some of the day to day care. "It opened our eyes to the opportunity and need for quality care," he said.

While it might be difficult for some clients to accept care, it's "amazing what a difference that can make," he said.

One of the areas that show up is meal preparation. Some clients don't realize they haven't been eating healthy meals. "Or they've skipped meals," he said.

"It's important to allow elderly people to feel independent as long as they can," Johnson said. "Home care allows you to do that," he said, at least for a while. "Our bodies and minds give up."

When he started the company, live-in care was a major portion of the home-care industry. "Economics have changed," Johnson said.

"Recession for the last five years hurt people" he said, paving the way for more short-term, part-time care. But that may be all some people need.

Irish Help at Home has seen finances become a bigger issue for people. "People are living longer and want to stay home," Nagle said.

With 70 million Baby Boomers on the brink of old age, the needs for in-home care are expected to grow. Funding it is a matter many are planning for — or say they are planning to plan for.

"People are saving for that rainy day," Nagle said. "And it's pouring."

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