Home Care Services for Seniors

Respite care basics
Seeking support and maintaining one’s own health are key to managing the caregiving years. Using respite care before you become exhausted, isolated, or overwhelmed is ideal, but just anticipating regular relief can become a lifesaver.

Respite can take many forms, but boils down to two basic ideas: sharing the responsibility for caregiving and getting support for yourself. Finding the right balance requires persistence, patience, and preparation.

Planning your relief
Planning starts with analyzing needs…both yours and your loved one’s. As a caregiver, is support what you need most? Some free time? Help with transportation? Keep track of your daily activities then make a list of the areas and times when you most need help. Identifying your loved one’s requirements, abilities, and preferences will also help you find the right match. Are social activities primary? Assistance with walking, eating or medications? Mental stimulation? Exercise? Answering these questions will help you determine which respite options to pursue.


Types of respite care services
Respite Services
In-home respite

Informal family support and relief
Online caregiver communities and video workshops
Volunteer or paid companionship
Personal care or skilled health assistance
Out-of-home respite

Adult day programs
Residential respite care
Caregiver support groups


Engaging family members in respite care
Family members and friends may be able to help out while you run an errand, take a break or even go on vacation. However, just as the burden of caregiving is often more than one person can handle – it can also be a tough process for families to share.

Even the healthiest families can be severely stressed by ongoing care, and the division of labor is frequently lopsided. You can encourage support and participation by:

Talking openly and regularly. Keep everyone up to date on your loved one’s needs and condition. Family members who don’t share the day-to-day caretaking experience may not fully appreciate the situation.

Encouraging family members to evaluate what they can reasonably and honestly do. Changing roles and varying resource levels can impact family involvement. Welcome different viewpoints, accept limitations, and be willing to try alternate strategies. Share your list of needs and take advantage of all offers to help.
Recognizing your own feelings and discussing disproportionate tasks. Harboring resentment when you need more help can lead to your burnout and impaired health. Ask directly for concrete support and specific time commitments. Consider establishing an online calendar to organize relief and reconfirm schedules.

Using technology to bridge distances. Try free video conferencing services to hold family meetings at times that work for everyone. Create a web-based community to share updates and explore options.

Exploring a family respite cooperative. Consider trading respite services with other caregivers and their families. Pooling resources can encourage involvement, reduce costs, and increase flexibility.

Participating in support groups. Learning how other families cope can suggest new options and provide reassurance. When siblings are unable or unwilling to share the load, peer support can be invaluable.

In-home respite care

In-home services can be provided by volunteer or paid help, occasionally or on a regular basis. Services may last from a few hours to overnight, and may be arranged directly or through an agency. This popular respite choice enables individuals to remain in their own environments, and can be invaluable for caregivers. Consider which of these options might meet your needs:

Stimulation, recreation, and companionship can be provided by family members, friends, or neighbors while you take a break. Faith-based, community, and other non-profit organizations recruit volunteers, while home-care businesses provide trained staff to cover short in-home intervals.

Personal care providers assist with daily living skills such as bathing, dressing, feeding, or toileting. Homemaker services support meal preparation, shopping, and housekeeping. Skilled health care, which requires more specialized training and experience, addresses medical needs.

The key to successful home respite is matching needs to services, selecting qualified providers, providing meaningful information, and evaluating results.

Out-of-home respite care programs

As our aging population grows, this range of private and non-profit respite programs continues to expand:

Adult day centers are designed for older adults who can no longer manage independently, or who are isolated and lonely. Planned activities promote well-being though social and health services. Adult day care centers operate during daytime hours, Monday through Friday, in a safe, supportive, and cheerful environment. Nutritious meals and afternoon snacks that accommodate special diets are typically included.

Residential programs offer temporary care for varying lengths of time. Group homes, hospitals, nursing homes, and other specialized facilities provide emergency and planned overnight services, allowing caretakers 24-hour relief. Although medical insurance generally does not cover overnight respite, long term care policies and veterans programs may subsidize care.

Caregiver retreats and respite camps are available in some areas, combining respite with education and peer support. Availability varies from state to state and may be disability specific.

When you devote so much love and energy to caregiving, it may be difficult to entrust your family member to strangers. Whether you engage a provider directly or work through an agency, you can allay your fears by conducting some basic research.

Using independent providers
Although you are anxious for relief, taking time to find the right person is essential for your peace of mind and your loved one’s safety. Make sure you:

Conduct an in-depth interview with each candidate. Screening applicants on the phone should always be followed with a personal interview.

Be specific about all of the tasks, skills, and schedules involved.

Discuss compensation and payment schedules. Do not pay for services in advance.
Request several work and personal references, then check them carefully. Verify t
he information provided, and ask all references about reliability, trustworthiness, punctuality and the care provider's ability to handle stress.

If possible, consider a background check. Professional services cost between $100-$150 and can alert you to potentially serious problems. Check with your local police department, legal aid service or attorney for referrals to reputable investigators or search for "background checks" on the Internet.

Always include the potential care recipient in the screening process if he or she is able to participate, to ensure that both parties are comfortable and that your loved one's needs are respected.

Working with agencies
Although independent providers are generally the least expensive, home care agencies and referral services are often easier to use. Use your planning lists to help these professionals better serve you.

An agency finds and places providers, handles payroll, and usually provides substitutes for sick or absent personnel. If problems occur, you also have specific avenues of recourse (complaints, mediation, or arbitration) that are not available when working with individuals.

Referral services work to match your needs with local program options. Use online registries, check newspaper ads or the yellow pages to find specialists who know local programs and can help you navigate their systems.
Choosing off site programs for respite care
When you have identified potential out-of-home programs, plan to visit at least three. Observe the care participants and their interactions with the staff. Try to picture your loved one there, and check your instincts to see if you’re on the right track.

Be sure to ask the following questions:

How are care providers screened?

What is the training and level of experience of the care providers?

Will care providers need additional training to meet specific family needs?

How, and by whom, are the care providers supervised?

What procedures does the program have for emergencies?

Are families limited to a certain number of hours of services?

Does the program provide transportation and meals?

What is the cost of services? How is payment arranged?



Paying for respite care

In today’s challenging economy, you may think respite services are unattainable. However, thinking creatively can uncover valuable resources:

Ask local retirement groups for volunteers to sit with your loved one while you take a walk, watch a movie, or complete an internet workshop.

Trade services with other caregivers. When a loved one is able to change locations for an afternoon, alternate weeks caring for both recipients at once.
Contact area high school counselors. College-bound students often need community service experience and are available afternoons and evenings.
Traditional funding sources for respite care

Insurance: Although medical insurance generally does not include respite coverage unless licensed medical professionals are involved, long term care policies usually fund services up to specific time or dollar limits.

SSI: Patients with disability coverage may be eligible for home health care benefits. Check your local Social Security office or call the toll free number to verify eligibility.

Medicaid: Medicaid does not fund respite directly, but some states use waivers to apply federal funds to offset respite costs for residents with specific conditions and disabilities. Consult your state’s Administration on Aging website.

Veterans’ Benefits: The VA provides inpatient respite coverage for up to 30 days per year for qualified veterans. In addition, when war-time vets care for their spouses, funding for in-home services are available on a state-by-state basis.

Foundation Grants: Private foundations, such as The Robert Wood Johnson Foundation and the Brookdale Foundation make grants to organizations that provide direct respite. These funds are usually awarded annually and posted on foundation websites.

Nonprofit and Disability Organizations: The United Way, the Alzheimer’s Association, and other disability-specific organizations may offer respite money in your area. Agency care specialists can assist you in researching these funds.

State Agencies: Over half of all states allow family members to receive payment for providing respite care. Eligibility, delivery modes and funding vary from state to state.

Strategies for successful respite care

Finding and implementing respite care sounds like a lot of work! Relief and revitalization is not just important for you, it benefits all involved in the caregiving process.

Remembering the benefits and following these six tips can ease the process:

Plan and schedule frequent breaks. Respite is not just a service-it is an outcome that requires regular relief.

Use checklists to teach providers about your care recipient’s schedules, likes and dislikes. Offer suggestions for handling behaviors.

Make back-up plans. Always keep a list of alternate providers and resources. Unplanned emergencies should not prevent you from taking care of yourself.

Evaluate often. Observe your care recipient before and after respite sessions. Ask for brief updates and more detailed reports regularly.

Expect changes. Respite care is a process that often requires fine-tuning, Anticipating and accepting changes in personnel or programs can keep you from becoming discouraged.

Attend your support group regularly. Structured and informal groups allow you to meet others in situations much like yours. You can talk, vent, laugh, and exchange tips with people who understand. If you can’t easily leave home, online communities, message boards and forums can provide much-needed support.

Depression is Not a Normal Part of Growing Older

Depression is a true and treatable medical condition, not a normal part of aging. However older adults are at an increased risk for experiencing depression. If you are concerned about a loved one, offer to go with him or her to see a health care provider to be diagnosed and treated.

Depression is not just having "the blues" or the emotions we feel when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension.

How Do I Know If It's Depression?

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. He or she may also experience–

•Feelings of hopelessness and/or pessimism

•Feelings of guilt, worthlessness and/or helplessness

•Irritability, restlessness

•Loss of interest in activities or hobbies once pleasurable

•Fatigue and decreased energy

•Difficulty concentrating, remembering details and making decisions

•Insomnia, early–morning wakefulness, or excessive sleeping

•Overeating or appetite loss

•Thoughts of suicide, suicide attempts

•Persistent aches or pains, headaches, cramps, or digestive problems that do not get better, even with treatment

How is Depression Different for Older Adults?

•Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses (such as heart disease or cancer) or whose function becomes limited.

•Older adults are often misdiagnosed and undertreated. Healthcare providers may mistake an older adult's symptoms of depression as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don't understand that they could feel better with appropriate treatment.

How Many Older Adults Are Depressed?

The good news is that the majority of older adults are not depressed. Some estimates of major depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospital patients.

How Do I Find Help?

Most older adults see an improvement in their symptoms when treated with antidepression drugs, psychotherapy, or a combination of both. If you are concerned about a loved one being depressed, offer to go with him or her to see a health care provider to be diagnosed and treated.

If you or someone you care about is in crisis, please seek help immediately.

•Call 911

•Visit a nearby emergency department or your health care provider's office

•Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Web Resources

•American Psychological Association’s Depression and Suicide in Older Adults Resource Guide

•CDC’s Prevention Research Centers Healthy Aging Research Network Conference: Effective Programs to Treat Depression in Older Adults

•CDC Prevention Research Centers Healthy Aging Research Network Depression Webinars – hosted by the National Council on Aging

•The Community Guide Mental Health Recommendations

•Geriatric Mental Health Foundation

•National Council on Aging Center for Healthy Aging Mental Health Resources

•National Institute of Mental Health Depression

•SAMHSA Older Adults and Mental Health

•SAMHSA National Registry of Evidence-Based Programs and Practices

Falls in the home

The odds of falling each year after the age 65 in the U.S. are about one in three. Fortunately, most of these falls aren’t serious. Still, falls are the leading cause of injury and injury related death among older adults. As we age, our sight, hearing, muscle strength, coordination and reflexes change, weakening our balance. Also, some health coordination’s, such as diabetes and circulation problems affect balance. Even some medications have been known to make people dizzy.

By 2040 an estimated 500,000 hip fractures per year
(cooper 1992, braensky 1997)

Following hip fracture 17%-32% mortality
(kannis ctal 2003)

87% of all fractures among older adults are due to falls

Approximately 1/3 of older Californians fall each year, with many of the 1.3 million suffering serious injury, particularly hip fractures and head injuries.

More than 40% of those hospitalized for hip fractures never return home or live independently again and 25% will die within one year.

On average, everyday in California, two older adults die from fall related injuries. You’re more likely to fall as you get older because of common age related physical changes and medical conditions. There are medications you can take to treat such conditions.



The majority of falls can be prevented thru proper methods. Such as:

Appropriate risk assessment and follow up by real healthcare practitioners
Exercise strength training and flexibility aimed at reducing falls
Environmental modifications such as removing clutter and installing grab bars



Cause of falls


Internal risk factors

Medical conditions

Decreased vision

Medications

Decreased strength

Foot problems

Decreased balance

External risk factors

Uneven/ slippery surfaces

poor lighting

Activity level

Timing demands (i.e. crossing streets)

Home safety environment



Reducing your risk

Take care of medical problems as needed

Have your vision checked and wear eyeglasses as needed

Check with your doctor regarding possible medication interaction which may affect your balance

Take medication only as prescribed

Exercise daily

Do simple balance exercises balance is just like muscle strength - if you don’t use it you loose it

Try advanced balance exercise Taichi, Yoga, Pilates, balance classes or ball classes
Strength training consider using weights and resistance bands. Strength training helps balance, improves muscle tone, bone strength and fights osteoporosis

Take care of your feet and wear supportive, rubber soled shoes
Install proper lighting thought out your home

use nightlights

Stay on pathways

Let the phone ring- use a portable phone, *69 or answering maching

Use a cane, walker or other device if instructed to do so

Take the home safety check listed below and make repairs or changes as necessary for safety- full proof your living environment

When visiting friends or in any strange environment be alert to possible hazards

Never climb onto a chair to change a light bulb or reach high objects on shelves use a sturdy stool or step ladder or have someone else do it



Preventing Falls At Home

If you want to stay in your own home for as long as possible….

You certainly do not want to fall and risk an injury. Most serious falls occur in and around your home and can be life changing. To help maintain your independence, its important to understand the ways you can protect yourself from falls. Some simple precautions can ensure safety and reduce your risk of falling at home.

Have you done a safety check in your home recently? The attached brochure will help you understand what to do to prevent falls around your home, empowering you to live independently as long as possible.

Questions to ask your doctor

At some point you’ve probably had dozens of questions to ask your doctor. But once you are in the office your mind goes blank. As it turns out, even the best doctors can’t give you the right answers if your not asking the right questions.


Let the doctor know in advance how involved you would like to be in decision-making, and how much detailed information you would like him or her to give you It also is a good idea to bring a notebook with a list of questions for your doctor and a pen to jot down important information.


The benefits of a two way doctor –patient exchange has shown that asking questions has resulted in a more successful treatment. Make the most of your doctor’s visit. Write down everything you would like to ask your doctor. List what your doctor needs to know about you. If you have any symptoms—where and for how long. Bring a list of all medicines that you are currently taking to every visit. Both prescriptions and non prescriptions such as aspirin, vitamins and supplements.


You and your doctor must form a partnership in promoting your health. Only you know how you feel and how you are responding to treatment. Not all medicines or treatments react the same for each patient. Therefore if you do not experience positive results from a medicine or treatment notify your doctor. If you fail to inform your doctor about negative out comes the doctor’s belief will be that you are improving.


Remember your health is not only your doctor’s responsibility but your responsibility to actively participate in the care plan.