Live Free Home Health Care, LLC. - Bristol, New Hampshire

Monday, January 22, 2007

Understanding Challenging Behavior

By Sharon Roth Maguire MS, APRN-BC, GNP, APNP

While being a caregiver to unusual or so-called “difficult” behaviors, it is quite common for persons with dementia to display these types of behaviors and while many of these behaviors are predictable, like repetitive questioning, pacing, forgetting how to use common objects, etc., there are others that are more upsetting to both the caregiver and the individual with dementia. Agitation in the form of shouting, pushing, resisting care; spitting out food; urinating in inappropriate places, disrobing; wandering, etc., are the kinds of behaviors that are truly unsettling and should prompt investigation. Special note should be made of the fact that medication in the form of sedatives, tranquilizers, and other “behavior” medications like antipsychotics need not be the first step. Many of the medications given to help control these behaviors can cause more harm than good. It is true that in certain instances these types of medications are warranted, but far too often these medications are prescribed as a knee-jerk response when no or few other strategies have been attempted to reduce the problem or are continued for far too long without attempts to reduce the dosage or discontinue the drug.

Current thought on best practices with regard to understanding difficult behaviors in persons with dementia focuses on the concept of unmet need. As human beings, we all have certain, basic physical and emotional needs: air, food, water, sleep, comfort, love, safety, security, belonging, etc. Individuals with dementia continue to have these needs despite their disease; their disease, however, may make it more difficult for them to express or satisfy these needs. For example, if I no longer am capable of explaining an abstract concept like insecurity due to the cognitive impairment I have related to Alzheimer’s disease, yet I feel that way, how can I express it? If I have physical discomfort due to arthritis pain in my hips and lower back but cannot articulate the words to describe it due to the language impairment I have related to Alzheimer’s disease, how can I tell you that I am in pain when you try to get me out of my chair? I may “show” you by resisting, or withdrawing, shouting, striking out or any number of other ways that seem like difficult behavior. When in fact, I am trying to “tell” you that I have an unmet need: I am in pain; I need comfort.

As caregivers, you know your loved one well. You may be surprised when he or she does something out of character or behaves unusually. You may be tempted to respond abruptly or seek strong medication to curb the problem. Better strategies would include an analysis of the potential causes of the behavior focusing on unmet need. Some common themes related to physical need: Is your loved one in pain? Many older adults have chronic pain that research tells us is inadequately or even un-treated. The addition of a regularly scheduled mild analgesic may be of tremendous benefit. Could your loved one have an infection? The most common infections that we see in older adults with dementia are urinary tract infection, pneumonia, and skin infections from scratches or open wounds. This can be very uncomfortable for the individual and definitely contribute to exaggerated behaviors. You would need to see a physician for treatment of these. Could your loved one be dehydrated? As we get older, we have a diminished thirst response and coupled with common medications that older adults take, like diuretics (“water pills”) that further dehydrate them, you could see increased confusion. Is your loved one uncomfortable due to constipation? Again related to poor fluid intake and certain medications (add calcium supplements to the list), lack of exercise, and limited dietary fiber, older adults are at risk for constipation which can be very uncomfortable. Simple strategies like providing regular liquids throughout the day, adding fiber to the diet and a daily walk can help.

Some common themes related to emotional need: Is your loved one bored? Are they wandering or trying to leave your home to find something more interesting to do? Conversely, is the day too busy or too overwhelming and they are looking for more quiet time? The best days for persons with dementia are when they have balance between sensory stimulating and sensory calming activities. Is your loved one frightened of being left at home alone? Are they feeling sad or depressed? The research tells us that the rate of un or under-treated depression is quite high in older adults with dementia. Providing social times and opportunities for continued belonging are important; consider a pet, plant or an indoor garden to offer care responsibilities and purpose to the individual with dementia.

It may take some time before you are able to identify the potential causes of the challenging behavior, but understanding that it may be the result of an unmet need is an important first step. Unfortunately, there are behaviors that we may never be able to understand as they are part of the mystery of this challenging illness. Finally, it is very important to have a care team that accepts this approach to behaviors as well. Understanding challenging behaviors is key to meeting your needs as a caregiver!

If you need assistance in caring for a loved one with dementia or would like to consult with someone for more information or for suggestions feel free to contact Live Free Home Health Care in New Hampton, NH. Live Free Home Health Care provides medical in home elder care in Central New Hampshire. We have registered nurses and licensed nursing aides who are experienced in providing care to people with dementia. Call us today at 603-346-4214 or visit our website at http://www.livefreehomehealthcare.com/.

Tags:   Alzheimer's Disease, caregiver, dementia

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Tuesday, October 17, 2006

Should You Use a Licensed Home Health Care Agency?

New Hampshire Home Health Care

The case for using an agency as opposed to hiring someone directly

As anyone who has had to look for home care for a parent, child, or loved one may have discovered, home care rates can be less if you hire help (sometimes referred to as a “private duty nurse”) on your own rather than using an agency like Live Free Home Health Care. This is could be one of the most important decisions you make in regards to looking for in-home care, and if you are contemplating hiring on your own to save a few dollars, it’s important to know what your responsibilities will be. Here are some things you should ask yourself:

1. Are you prepared to place ads, screen responses, conduct interviews, check references, do criminal background checks, and drug screening? Also will you know whether a potential candidate has the right training and skills?

2. Have you calculated the cost of required taxes? You will be responsible for paying social security taxes, unemployment taxes, and workers’ compensation.

3. Do you want the responsibility of supervising workers and resolving misunderstandings when they (and they will) happen?

4. What are you going to do when your caregiver calls in sick? Are you always going to be available to provide back-up? If so, doesn’t that mean you will be on-call around the clock?

5. What about insurance? Does the person you are considering hiring have professional liability insurance?

A quality agency that directly employs its home care associates will assume each of these responsibilities for you. That’s what we do at Live Free Home Health Care. We have carefully screened our caregivers, done criminal background checks and drug screening. We have made sure they have the right training and licenses. We are responsible for paying our caregivers and making sure the appropriate payroll taxes are paid. If one of our caregivers has to miss work at the last minute, we are responsible for finding a replacement. Live Free Home Health Care has the appropriate insurance and we are licensed by the State of New Hampshire as a Home Health Care Provider.

You will have the comfort of knowing we have a Registered Nurse on-call 24 hours a day and are here to handle the unexpected for you. We will anticipate your needs and respond to changes before a potential problem may arise. Let us take the job of employer and care case manager from your shoulders so you can concentrate on relating with your parent, child, or loved one how it matters most: as family.

Jason M. Harvey

Owner, Business and Finance Manager

Live Free Home Health Care, LLC

603.346.4214

Tags:   caregiver, in-home care providers, insurance, Jason Harvey, Live Free Home Health Care

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Monday, October 02, 2006

How To Care For An Aging Parent Without Sibling Rivalry

Tips on how to help and stay on speaking terms with other family members

As a New Hampshire based home health care agency, we know how difficult it can be to watch mom or dad’s health decline and not know what services are available to help them maintain independence and dignity and stay in the comfort of their own home. It can make it even more difficult when multiple siblings are trying to coordinate care; it’s hard enough when everyone concerned lives in close proximity. Imagine how difficult it is when mom and dad live towns or even states away. Here at Live Free Home Health Care, we have heard stories on more than one occasion of siblings squabbling over how best to help; this can make an already difficult situation a nightmare. Maybe one sibling isn’t doing his fair share of the hands-on work or there is another sibling who perhaps is better situated financially, yet hasn’t contributed a penny. This can cause hostility to build and create grudges that can last a lifetime, to develop. Everyone has mom and dad’s best interest at heart but without anyone to coordinate how best to help, it can not only place more stress on the siblings but also cause more stress for your aging loved one. Imagine how hard it is for them to see their kids bicker over them! Live Free Home Health Care can help; this is one of the many areas we excel. Coordinating care between family members and physicians, acting as the quarterback if you will. We can provide home health aides in the home to assist with daily living activities or a registered nurse to provide case management and to ensure everyone concerned is on the same page and understands what is going on. We can even accompany your parent or aging loved one to his or her doctor appointments to help relay what can be at times complicated information and act as a patient advocate. These are just some of the services we can provide, check out our website at http://www.livefreehomehealthcare.com/ to learn more or call us at 603-346-4214 to discuss your needs. Here are four tips to help ease the tension and get your parent or aging loved one the best possible help.

1. Understand the situation – conflicts often arise because of misunderstandings about your loved ones condition. After all, if your out-of-state sibling isn’t around to witness it, he may not know that dad sometimes forgets to turn off the stove or that mom has difficulty remembering to take her medication (medication management is another service Live Free Home Health Care offers). Fill siblings in so they’ll know why it is imperative to spend the money for in-home help. If they’re still in denial, ask the doctor to discuss your parent’s care needs with the whole clan (maybe a conference call) or hire a registered nurse to help everyone understand the situation.

2. Share the load – We all know the saying of why you should never assume anything. Just because one sibling lives closer to mom and dad doesn’t mean they will or can do most of the care giving. Have a family meeting to create a list of tasks and divide them fairly, says Linda Fodrini-Johnson of Eldercare Services. Ask for volunteers first, but make sure everyone has a suitable job. For instance the sibling that lives the furthest away may pay dad’s bills online, while one who lives closer takes on more of the day-to-day care.

3. Talk frankly about money – Money does strange things to people unfortunately. The best approach is just to be straightforward. Just because you suspect your sibling opposes a pricey nursing home or paying for in-home care because she wants an inheritance, she really could just be worried that mom will go broke by 85. If discussing the cost of care and how the family is going to pay for it is done openly, it can clear the air and prevent misunderstandings.

4. Seek out a middleman – still bickering? Get objective advice from a professional. If you have a tax problem, you call your CPA, if you have a legal problem, you call your attorney, and if your tooth hurts, you call your dentist (hopefully). The same should be true with something as important as helping your parents or loved one age with dignity while getting the care they need. If an agreement can’t be reached, perhaps you should seek out an impartial third party, like Live Free Home Health Care, to help with a care plan.

You can always count on Live Free Home Health Care to provide objective and caring advice to assist you with caring for an aging parent or loved one.

Jason Harvey

Owner, Business and Finance Manager

Jennifer L. Harvey RN BSN

Owner, Director of Patient Services

Home care is what we do; Dignity and Independence is what we provide.

Source: Money Magazine, Oct. 2006

Tags:   home care, home health care

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Monday, October 02, 2006

Who Pays for Home Care Services?

Home care services can be paid for directly by the patient and his or her family members or through a variety of public and private sources. Hospice care generally is provided regardless of the patient's and/or family's ability to pay. Public third-party payors include Medicare, Medicaid, the Older Americans Act, the Veterans Administration, and Social Services block grant programs. Some community organizations, such as local chapters of the American Cancer Society, the Alzheimer's Association, and the National Easter Seal Society, also provide funding to help pay for home care services. Private third-party payors include commercial health insurance companies, managed care organizations, CHAMPUS, and workers' compensation.

Self-pay:

Home care services that fail to meet the criteria of third-party payors must be paid for "out of pocket" by the patient or other party. The patient and home care provider negotiate the fees.

Public Third-party Payors Medicare:

Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency. Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational, and speech therapies; medical social work; HCA services; and medical equipment and supplies. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be intermittent or part time and provided through a Medicare-certified home health agency for reimbursement.

Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit. The physician also must re-certify the individual at the beginning of each six-month benefit period. In turn, the patient is required to sign a statement indicating that he or she understands the nature of the illness and of hospice care. By signing this statement, the patient surrenders his or her rights to other Medicare benefits related to terminal illness.

Medicaid:

Administered by the states, Medicaid is a joint federal-state medical assistance program for low-income individuals. Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals who receive federally assisted income maintenance payments, such as Social Security Income and Aid to Families with Dependent Children (AFDC), and individuals who are "categorically needy." Categorically needy recipients include certain aged, blind, and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels. Individuals younger than 21 who meet income and resources requirements for AFDC, yet otherwise are ineligible for AFDC, also qualify as categorically needy. Under federal Medicaid rules, coverage of home health services must include part-time nursing, HCA services, and medical supplies and equipment. At the state's option, Medicaid also may cover audiology; physical, occupational, and speech therapies; and medical social services. Hospice is a Medicaid-covered benefit in 38 states. The Medicaid hospice benefit covers the same range of services that Medicare does.

Older Americans Act (OAA):

Enacted by Congress in 1965, the OAA provides federal funds for state and local social service programs that enable frail and disabled older individuals to remain independent in their communities. This funding covers HCA, personal care, chore, escort, meal delivery, and shopping services for individuals with the greatest social and financial need who are 60 years of age and older. Increasingly, individuals who can afford to pay for some of these services are being asked to contribute in proportion to their income. Individuals often request the services they need through an Area Agency on Aging, which will provide them directly or in cooperation with local organizations.

Veterans Administration:

Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care coverage provided by the Veterans Administration (VA). A physician must authorize these services, which must be delivered through the VA's network of hospital-based home care units. The VA does not cover nonmedical services provided by HCAs.

Social Services Block Grant Programs:

Each year states receive federal social services block grants for state-identified service needs. The government allocates these funds on the basis of the state's population and within a federal limit. Portions of the funding often are directed into programs providing HCA and homemaker or chore worker services. Individuals should contact their state health departments and local offices on aging for additional information.

Community Organizations:

Some community organizations, along with state and local governments, provide funds for home health and supportive care. Depending on an individual's eligibility and financial circumstances, these organizations may pay for all or a portion of the needed services. Hospital discharge planners, social workers, local offices on aging, and the United Way are excellent sources for information about community resources.

Private Third-party Payors Commercial Health Insurance Companies:

Commercial health insurance policies typically cover some home care services for acute needs, but benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for skilled professional home care services with a cost-sharing provision. Such policies occasionally cover personal care services. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost-sharing varies with individual policies, but often is not required.

Individuals sometimes find it necessary to purchase Medigap insurance or long-term care insurance policies, for additional home care coverage.

Medigap insurance is designed to bridge some of the gaps in Medicare coverage. Some Medigap policies offer at-home recovery benefits, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder's physician must order this personal care in conjunction with the skilled services. Home care coverage in Medigap policies is not designed to cover extended long-term care. This type of coverage is most helpful to individuals recovering from acute illness, injuries, or surgery.

Long-term care insurance primarily was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. However, as the public need and preference for home care has grown, private long-term care insurance policies have expanded their coverage of personal care, companionship, and other in-home services. Considerable care should be taken in selecting a long-term care insurance policy, as home care benefits vary greatly among plans. Consumers should be aware of limitations on coverage, such as prior hospitalization requirements, and pre-existing condition exclusions. Some policies may only pay for services that are already covered by Medicare.

Managed Care Organizations: Managed care organizations (MCOs) and other group health plans sometimes include coverage for home care services. MCOs contracting with Medicare must provide the full range of Medicare-covered home health services available in a particular geographic area. Medicare beneficiaries who are enrolled with an MCO may elect their hospice benefit from the hospice of their choice. These organizations only pay for services that are pre-approved.

CHAMPUS:

On a cost-shared basis the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) covers skilled nursing care and other professional medical home care services for dependents of active military personnel and military retirees and their dependents and survivors. CHAMPUS offers a comprehensive hospice benefit to its terminally ill beneficiaries, which covers nursing, social work and counseling services, therapies, personal care, medications, and medical supplies and equipment.

Workers' Compensation:

Any individual requiring medically necessary home care services as a result of injury on the job is eligible to receive coverage through workers' compensation.

http://www.nahc.org/famcar_whopays.html

Tags:   Alzheimer's Disease, home care, home health care, insurance, long-term care

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Thursday, August 31, 2006

New Hampshire Home Health Care-Live Free Home Health Care

Record Enterprise

Live Free Home Health Care is all about living free with dignity

By KERRY L. NORLIN August 24, 2006

NEW HAMPTON - Live Free Home Health Care, LLC, is a newly established medical home health care agency serving the Bristol Lake and Pemi-Baker Valley Regions, Waterville Valley and parts of the Lakes Region. Jason and Jennifer Harvey, co-administrators and owners of Live Free Home Health Care, are passionate about their work and devoted to providing area residents a diversified and complete home care service that fosters independence and dignity.

"It started with an idea that quality of life and health is best served at home and folks from New Hampshire have a sense of independence ingrained in them," explained Jason. "We are a home health care agency, that is what we do; what we provide is independence and dignity to our patients."

As part of their humanitarian-based endeavor, Live Free Home Health Care and their team of skilled nurses, licensed nursing assistants and homemakers offer IV therapy, home health aides, homemaker services, medication and diabetes management, blood draws, private duty professional nursing, pediatric skilled home care, transportation and errands. They also provide respite care to serve family members and caregivers who need a break, which can be individualized using their half day, full day, bed & breakfast and vacation plans. A registered nurse is on call 24 hours a day, seven days a week.

Case management is another offering. This service arranges for a registered nurse to accompany patients to their doctor's visit to ensure their needs are being met and their questions answered. The RN will also review treatment plans with the patient as well as with family members and the patient's doctor.

Another important service is block staffing, nursing care provided in the home for as little as two hours per day up to 24 hour coverage. Medicare only covers diagnosis-related short term home health care and Medicaid covers block staffing only if a child requires such care, but Live Free Home Health Care is dedicated to providing block staffing, as they believe it as the single most important service that will allow patients to remain at home and out of nursing and assisted living facilities. Family member caregivers cannot always be there to care for their home-bound loved one, but are also unwilling to relinquish their loved one to a nursing home. Block staffing not only makes it possible for the patient to remain at home, but it also allows their caregivers to provide care when they can and still maintain a normal lifestyle. Furthermore, block staffing is a less expensive alternative to a nursing home.

Jennifer and Jason married in 1998 as students at Southern Illinois University. Jennifer graduated in 1999 with a B.S. in nursing and brings over eight years of nursing experience including working in the surgical and cardiac care unit of an Illinois hospital. Since their move to New Hampshire six years ago, she has worked in a physician's practice and most recently for a home care agency in Laconia. Despite completing his degree in political science, Jason pursued a growing interest in finance and investments. He has subsequently worked for Fidelity, Fleet and most recently as assistant vice president with the Global Wealth and Investment Management group at Bank of America, bringing over eight years of experience in business finance.

The pair found a perfect marriage for their unique talents with the new agency - Jennifer, RN and BSN, as director of patient services and Jason as business and finance manager. Perhaps more important than their professional experience is the vitality, enthusiasm and commitment they bring to the enterprise. They are eager to make a difference not only in the lives of their patients but also in the lives of their staff.

"We appreciate and respect our caregivers. Nursing can be a thankless job. We want our caregivers to truly feel they make a difference, because they do," said Jason.

"We are very careful who we hire. We conduct thorough background checks and everyone is required to participate in an orientation program and observation period to insure they have the competency and skill to work with patients in their homes," explained Jennifer. Reconfirming her husband's conviction, she said, "We want our staff to feel just as appreciated as our patients, and we want their ideas and their feedback."Live Free Home Health Care accepts private pay, select Medicaid plans, and will work with private insurance companies and long term care insurance policies for reimbursement. They are fully insured as a home health care agency and licensed by the N.H. Department of Health and Human Services. To find out more about their services or to discuss your needs, call 346-4214 or 888-346-4214 or e-mail at .(JavaScript must be enabled to view this email address). You can also visit their Web site at livefreehomehealthcare.com.

Tags:   home health care, Jason Harvey, Jennifer Harvey, Live Free Home Health Care

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