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

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Wednesday, January 27, 2010

Looking for a Home Care Bargain?

Beware: Some types of care hide expensive implications

As the economy struggles, it’s hard to avoid the sordid stories of scammers and criminals preying on the weak and vulnerable. When it comes to the frail elderly, the stories of exploitation are doubly unsettling. For those whose loved ones are cared for in their own homes, some dark questions may linger: Are you inadvertently putting your loved ones at risk? Who are you inviting into your loved ones’ homes to care for them? How do you ensure their safety and wellbeing in home care situations that are mostly unsupervised care settings?

Live Free Home Health Care is raising awareness and educating the local community about various home care options as well as potential risks and liabilities associated with hiring an independent contractor or using a registry for home care. While everyone likes a bargain, especially in tough financial times, when it comes to home care, selecting the cheapest price for care can result in some very expensive implications.

There are several models of in-home care providers, and their similarities and differences can be confusing. We believe it is important for people to be armed with information on the different types of home care. Registries, also known as referral services or nursing registries, match independent contractors to clients and patients. In these cases, the registry serves as the middle man to match independent workers to clients seeking home care but these workers are not actually employed by the registry. Private duty agencies, like Live Free Home Health Care, provide caregivers who are employed, bonded, insured and licensed. Such agencies do the accounting, background checks, provide training, supervision and discipline, carry insurance and ensure shifts are covered.

Though at first glance, the hourly rate for an independent provider or a registry caregiver may seem substantially lower than an agency-employed caregiver, it is good to note that there are a number of unexpected or hidden issues that consumers and workers face when dealing with workers who are not already employed. One major issue is that there is an employer-employee relationship that is created in most of the care situations – between the worker and the consumer, the frail elderly person receiving the care. Unfortunately, in most cases, the frail elderly person and/or their family are not aware of this. Referring registries and independent contractors often don’t communicate to the consumer that this arrangement could result in the creation of an employee-employer relationship. Because of this, both the worker and consumer can suffer significant financial liabilities.

A Taxing Complication

When the consumer is considered the employer of the home care worker, the consumer is responsible for the appropriate employer-paid Social Security, Medicare, federal and state unemployment, and state and federal payroll taxes for the worker. If these taxes are left unpaid, the government has the option to assess the consumer or their estate for back taxes, interest and penalties as well as potential civil fines and criminal penalties, should the situation be severe.

Hurt on the Job

Workers’ compensation protection is required by law in nearly every state, and it may be surprising to learn that homeowner’s insurance does not typically cover an employee in the home. If a worker sustains an on-the-job accident, such as a back injury from lifting or transferring a frail person, the medical costs and disability payments for that worker could cause financial hardship for even a very wealthy client. Then if the consumer is unable to pay, the worker could be left with no help for a devastating injury.

Beware of Abuse and Exploitation

Most workers who enter the home care industry are caring, giving people. Unfortunately, there are also those who know that it is very easy to take advantage of frail, functionally limited, often cognitively impaired clients. Registries usually do not perform background investigations on the caregivers they place, and by law, they are not allowed to monitor or supervise them since the worker is not an employee of the registry. In hiring an independent contractor, the background check process would fall on the family or the frail elderly person receiving the care. This lack of thorough screening could subject clients to physical, psychological or financial abuse. A good home care agency does perform a variety of background screenings, as well as ongoing supervision, scheduling and worker training to their caregivers. Plus, the agency provides ongoing monitoring in the home as an additional safety measure.

No Guarantees

What would happen if a consumer’s registry caregiver or independent contractor did not show up for work, or wanted to take a vacation, or was sick? With an agency, consumers do not need to worry, because the agency will provide a replacement caregiver for the consumer.

In short, it is very important to understand the risks and liabilities associated with hiring an independent contractor or a registry before making a decision for care. This knowledge may well save a frail elderly person from an unfortunate, and preventable, experience.

For further information on the risks and liabilities associated with hiring home care, please call us at 603-217-0149 or visit http://www.livefreehomehealthcare.com.

About Live Free Home Health Care, LLC:

Serving the Lakes Region and central New Hampshire, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home as an alternative to assisted living facilities or nursing homes. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing, and all care is supervised and updated by a registered nurse. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise. Whether the need is for short or long term care, Live Free Home Health Care’s compassionate staff promises to treat each client respectfully and like a cherished family member. For further information, contact (603) 217-0149 or visit http://www.LiveFreeHomeHealthCare.com.

Tags:   caregiver, exploitation, home care, in-home care providers

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Friday, November 13, 2009

Alzheimer’s: The Rising Epidemic

Activities and Communication Tips for a Better Quality of Life

(Central New Hampshire – November 4, 2009) – Alzheimer’s Disease has been a hot topic in recent headlines, and for good reason. The progressive, degenerative neurological disease for which there is presently no cure affects an estimated 35 million people worldwide – a 10 percent increase over 2005. According to the 2009 World Alzheimer Report, the number of people with Alzheimer’s is projected to double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. Worldwide, the estimated annual economic cost of dementia is $315 billion. Every 70 seconds, someone in the US develops Alzheimer’s, according to the Alzheimer’s Association. As the more than 77 million American baby boomers begin reaching the age of greater risk, this disease and its effects simply cannot be ignored.

Because many in our local community are affected in some way by Alzheimer’s or dementia, Live Free Home Health Care is helping raise awareness of the enormous impact of this increasing epidemic. The disease can take a physical, emotional and mental toll on patients, families and caregivers. As communication skills fade for a person with Alzheimer’s, caregivers often find it frustrating to support the person’s sense of self while trying to minimize skills that may be compromised due to the disease.

“With Alzheimer’s, a daily routine is essential,” said Jennifer Harvey RN, BSN, Owner, Clinical Director of Live Free Home Health Care. “Activities that are done regularly, even at the same time every day if possible, may help establish routine and increase the person's sense of stability. Following structured activity ideas that involve and interest the person w/ Alzheimer’s will help minimize the disturbing behaviors associated with the disease,” such as agitation, anger, frustration, depression, wandering or rummaging.

Harvey offers the following structured activity ideas for helping Alzheimer’s patients experience a better quality of life:

• Motor: Take a walk, do chair exercises, stretch, or even do a dance using just the hands – the important thing is to encourage some sort of movement.
• Sensory: Listening to music on tapes or CDs (not the radio, as commercials can be confusing) while looking at old photographs, watching TV or movies, looking at picture books, sniffing perfume, soap and spices, or working on basic art projects are beneficial to the patient. Be careful to avoid sensory overload by eliminating competing noises.
• Interactive: Invite friends or relatives over for tea or coffee, reminisce, asking basic questions while looking at old photos, play simple card or board games, or try pet therapy (be sure to match the animal’s activity and energy level with that of the individual).
• Cognitive: Practice computerized memory exercises, do simple crossword puzzles or word finds, play games such as “Simon Says” or “I Spy”.

Because Alzheimer’s gradually diminishes a person’s ability to communicate, it is important to help people with dementia express their thoughts and emotions, as well as help them understand others. Here are some tips to help in communication and understanding:

• Create a ‘kind voice,’ talking slower, lower and clearly, smiling in the process.
• To orient the person and obtain his or her attention, call the person by name, identify yourself, and be sure to approach from the front so there are no surprises.
• Ask one question at a time, using short simple words and sentences.
• Avoid using logic and reason, as well as quizzing.
• Avoid criticizing, correcting or arguing, and do not take any negative communication personally.
• Let the person know you are listening and trying to understand what is being said by maintaining eye contact, being careful not to interrupt.
• Patiently wait for a response as extra time may be required to process your request; repeat information and questions. If there is no response, wait a moment before asking again.
• Focus on the feelings, not the facts, as sometimes the emotions being expressed are more important than what is being said.
• Let the person think about and describe whatever he or she wants.

If you fear someone you love may be showing signs of dementia or early stages of Alzheimer’s disease, Live Free Home Health Care recommends a memory screening. Though a memory screening is not used to diagnose any particular illness and does not replace consultation with a qualified physician or other healthcare professional, it is a good first step towards diagnosis and treatment. For more information about memory screenings in the local community or dementia and depression in older adults, please contact Live Free Home Health Care.

About Live Free Home Health Care, LLC:

Serving central and northern New Hampshire, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home as an alternative to assisted living facilities or nursing homes. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing, and all care is supervised and updated by a registered nurse. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise. Whether the need is for short or long term care, Live Free Home Health Care’s compassionate staff promises to treat each client respectfully and like a cherished family member. For further information, contact (603) 217-0149 or visit www.LiveFreeHomeHealthCare.com.

Tags:   Alzheimer's Disease, better quality of life, caregiver, communication, dementia, depression, Jennifer Harvey

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Thursday, October 29, 2009

Holiday Blues - Depression in the Elderly

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?

It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attending to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death
• Talk about suicide

How do you know if it is depression or dementia?

Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm or visit our website at www.livefreehomehealthcare.com.

Treating depression in older people.

Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

Tags:   caregiver, dementia, depression, holiday blues

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Thursday, October 22, 2009

Communicating Effectively With Someone With Alzheimer’s

Caring for an individual with Alzheimer’s disease isn’t always a walk in the park; in fact, it can be downright stressful. Between memory loss, repetitive questions, false thinking or aggressive behaviors, each day often brings new challenges.

A person’s understanding of the disease as well as their attitude about the illness can have a large impact on the way day-to-day caregiving responsibilities are managed. Just because this illness has taken over someone close to you, it doesn’t have to conquer you as well.

So what do you do when your loved one blames you for something you didn’t do or becomes paranoid that you are plotting against him or her? How about when someone sees objects that aren’t there or says things that simply don’t make any sense?

If your first instinct is to try to orient the person back to reality, you are not alone. Many caregivers spend endless hours trying to prove who they are, where they are and what they are doing, but to no avail. They mistakenly believe that just by showing family photos or having other family members confirm information that the person with Alzheimer’s disease will catch on and it will become clear for them. Even though the caregiver’s heart is in the right place, these efforts most often do not succeed. Their loved ones may continue to press the issue, and even become angry or hostile at the “evidence” presented to them.

Fortunately, there are ways to manage daily challenges in order to minimize a caregiver’s stressful feelings and improve the odds that an individual with dementia will respond positively.

One of the best approaches to use with people with dementia is Validation - a technique that confirms their right to feel a certain way and express their emotions regardless of the situation. The validation theory, developed by Naomi Feil, suggests that an individual could be revisiting past events or trying to solve unfinished business. This helps explain why some people feel the need to go to work years after they retire or pay off a debt from decades ago. By validating their experience, you are meeting them where they are and sending a message that you still accept them no matter what.

Another powerful approach to utilize is redirection-a behavioral intervention that shifts the individual’s focus, by distracting the person or moving away from an undesired topic or behavior to something more pleasant. Here are some examples:

When your mother says, “I want to go home!” Instead of saying “This is your home! Don’t’ you remember? You’ve only lived here for 30 years!” Try Saying “Of course you want to go home! Your house was the prettiest on the block. Why don’t you tell me about those tulips you planted in your front yard?” Why? Memory impairments and disorientation can cause people to forget where they are. When they want to go “home,” it really signals a desire for a sense of safety and familiarity. Bring mom “home” by reuniting her with her favorite memories of what home represents.

When your wife says, “Get away from me, you’re not my husband!” Instead of saying “But I am your husband! Look at our matching wedding rings. You know, you really upset me when you don’t remember who I am.” Try saying “You must love your husband very much. I can tell by the way you talk about him. Why don’t you tell me about your wedding day?” Why? Memory loss can cause individuals to forget even their closest loved ones. When your wife becomes agitated, respect her space, validate the love she feels for her spouse, and allow her to talk about “him” while you are sitting right beside her. Even though she may have forgotten you today, hearing her talk about you will demonstrate that you are still very close to her heart.

When during meals, your father refuses to eat and says, “You’re trying to poison me.” Instead of saying “That’s ridiculous! Why would I ever do such a thing? Eat your meal and stop making up crazy stories!” Try saying “Dad I understand you are feeling afraid, but I want you to know that I would never let anything bad happen to you. You are safe with me. By the way, this meatloaf is delicious. I am having a big plate of it myself. Let’s have some together and you can tell me all about the fishing trip.” Why? It is difficult, if not impossible to rationalize with people with dementia. Instead of trying to orient Dad back to reality, instill a sense of safety, and demonstrate it by eating the same meal as him or taking a bite from his plate. Once you’ve established trust, you can quickly refocus him by shifting the conversation to something more pleasant, such as a fun day he had by the docks.

When your sister says, “You stole my money! Give it back!” Instead of saying “I’m sick of you accusing me every time you hide your money. You stuffed it in your drawer five minutes ago. I saw you do it, so stop blaming me.” Try saying “Oh no, your money is missing? I can see why you’re upset. Well, don’t you worry because I am going to help you look for it.” Why? It is common for people with dementia to hide items and forget where they are moments later. Since it can be embarrassing to admit this, individuals sometimes accuse others to take the focus off themselves. Rather than trying to deflect blame, simply let your sister know that you understand how she feels and that you understand how she feels and that you want to help her resolve the situation. Then walk her over the drawer and ask her to open it. When your sister finds her money, allow her to take pride in finding it all by herself.

When your grandmother says, “I have to leave now. I need to pick up Jimmy from school.” Instead of saying “Grandma, Jimmy is a grown man. He’s 60 years old. You’re not going anywhere.” Try saying “Oh Grandma, you have always been such a loving mother to Jimmy. Why don’t you come with me to get a drink of water and tell me all about what you love to do with Jimmy after school?” Why? People with Alzheimer’s disease often live in the past by re-creating experiences that happened long ago. Despite the fact that Grandma hasn’t picked Jimmy up from school in decades, her maternal instinct is still very strong, and she feels an urgency to follow the same routine she did while he was growing up. Take this as an opportunity to reunite your grandmother with those happy memories: while you are distracting her from going to the front door, she will tell you all about those wonderful times she had with Jimmy and will forget about wanting to leave.

When your uncle believes he’s still at work. He treats you like an employee and tells you he needs the paperwork finished by the end of the hour. Instead of saying “Are you still starting with that nonsense again? You retired in 1985. How many times do I have to keep reminding you?” Try saying “You really run a tight ship around here! I guess that’s what makes you such a good boss. I’ll make sure to get the paperwork to you, but I could use a little help. Can you assist me with one of the documents?” Why? It’s not uncommon for people with Alzheimer’s disease to strongly affiliate with important roles they have taken on in the past. The fact that your uncle thinks he’s at work suggests that a job is still very meaningful to him. Use this moment to create an activity that can contribute to a sense of purpose. Bring him a phone bill or other document and allow him to “help” you interpret it. Support his efforts and remind him what a great boss he has always been.

Tags:   Alzheimer's Disease, caregiver, communication, dementia

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Tuesday, September 29, 2009

Keeping Mom and Dad Safe at Home

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

• home remodeling services -- making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
• even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer's Disease Grants

Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks
• and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

The caring, friendly staff at Live Free Home Health Care can help you or a loved one remain safe at home. Give us a call at 603-217-0149 or visit our website at www.livefreehomehealthcare.com.

Tags:   caregiver, home safety, long-term care, medical alert, safety alert, telehealth

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