What are your thoughts about home care?

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When I spoke with various home care agencies during my search for a caregiver at home, they all said that home care is now a trend in dementia care, because everyone wants to be at home, not in a strange place. I was aware that I was talking to the people in the business to provide home care for money, but it did make sense. I for one would not want to be in a facility. What are your thoughts about home care? Is this a trend that people in the medical field start to recognize?


Home care IS a trend (at least where I live), and not just in dementia care. The problem is it is a two edged sword; a lot of lip service is given to "allowing" people to remain in their own homes but the resources to to let them do it are lacking. Even here where there is government sponsored home care the maximum you can get is 60 hours a month (and nobody gets that except those actively dying), so either folks are left to cope in unsafe conditions or friends and family need to fill the gaps.
cwillie is so right. I liken this (in some small way) to the push decades past to get the mentally ill out of institutions and into community care. That community care was (and is) so woefully inadequate.

24/7 home care is prohibitively expensive for most people. I don't understand what good someone coming in for a few hours every day or every other day really is. If they are doing specific tasks, that's one thing. But what about all the elders who really need someone there all the time? Someone there for a few hours/day -- that's just a little bit of help. The elder isn't magically competent the rest of the time.

Yes, the expectation is that family will pick up the slack. And that expectation is unrealistic, unless there is family that is willing to do it. And how many family members really are willing to do it?
My mom is on Medicaid and she has caregivers come in from 9am to 8pm Monday through Saturday. So that's 66 hours a week! And she's approved for up to 80 some hours per week.
Of course this works for us now because she sleep through the night and may change as the disease progresses. She is in late stage 6 Alzheimer's. She can assist with getting up, but just barely and can only walk a few steps without being weak.

Not sure what government sponsored care you are talking about cwillie, but Medicaid where I live funds far more than that. I'm happy to pick up the slack because I don't want to put her in a nursing home which is my only other option. Actually, she was turned down by 2 nursing homes because in the past she had been violent and had fallen. None of which she has been lately, but oh well.

So I am able to go to my own appointments, take naps, whatever I need to during the day, as long as I can try to schedule around moving mom around. And even then, the caregivers can usually manage without me if mom helps bear some weight.
Nomad, count yourself lucky. In Texas, Medicaid waiver does not grant nearly that amount of care at home. The governor here didn't opt for expanded Medicaid. Many caregivers are trying to balance the sandwich generation, still working to fund their own retirement, increasing needs of elders and lack of training, and just burnout and own medical needs.
I'm in Canada Nomad - where we supposedly have equal access to care regardless of income - many people here do pay for extra care, but for those who can not the only choice is to accept the inadequate level of funded home care or go into the nursing home, where those with low income are subsidized. The ridiculous part of that is that it costs much more to keep people in a nursing home than it would to fund decent care in the home.
I would much rather have mom at home than in a facility but it takes a village and is expensive and even agency caregivers are not dependable - they cancel at last minute and agency can't replace the shift

Now that mom is immobile it would be near impossible to have her home - who could use a hoyer lift - Wheelchairs wouldn't fit in bathroom - there'd be no way to transport her to appointments

The whole thing is very frustrating for everyone
NomadSE: Where do you live?

I am worried about costs of home care too, but in my situation, facility is also expensive.
Home care or facility care, it all depends on what is the right choice for the person and if they can budget the cost.

My Dad had 24 hour care at home [3 shifts of caregivers from a professional Agency] he was a fall risk, with very mild dementia. Thank goodness my parents were very fugal their whole lives as it was costing my Dad $20k per month, yes per month. Yes, YIKES!!

The caregivers were a godsend as they didn't mind getting meals for my Dad [I hated to cook], doing the laundry, and doing light housekeeping. They also took Dad to his doctor appointments and for his haircuts.

Then Dad decided he no longer wanted to be home, the house maintenance was too much for him (he was in his 90's) even with the caregivers helping him, and Dad wasn't one to call for outside help. They also kept Dad away from the snow shovel any time it snowed. A neighbor would use the snow blower on his driveway.

Dad picked out a place he really liked and was happy as a clam being there around people from his own generation. The cost was around $5k per month... and Dad was able to budget for his favorite caregiver to come help him in the mornings... it gave him a sense of routine.

So there are pros and cons to each decision.

We tried to keep my mom in her home with Visiting Angels. It did not work; mom couldn't figure out what she wanted them to do and felt as though she needed to entertain them.

We tried giving her lists of tasks, but she didn't want them using her washing machine or other appliances. It was a very frustration and expensive week.

We eventually found an Independent Living facility. The geriatrics doctor who was on-site a couple of days a week simplified mom's medications and gave her his cell phone number. Rather than giving her complicated instructions about her bp meds, he said " if it goes above x, call me. If it goes below Y, call me".

He sent in the geriatric psychiatrist, who better managed mom's anxiety, and who insisted mom go for cognitive texting. THAT'S how we discovered that mom had MCI, which was driving her anxiety.

A village indeed!

I am currently watching a friend whose mom has dementia try to manage her mom's care at home. The woman has 24/7 aides. The fires them, is suspicious of them, has very limited medical oversight because she has to be gotten to doctor appointments. When she feels unwell, she insisted she's dying and has the aide take her to the ER.  She is getting substandard care in the name of maintaining her " independence"  
I agree with everyone about the cost of homecare, but I also wonder if cost in a facility is cheaper. My experience is that it is MORE expensive in a facility. Anyone else thinks so too?

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