When a Loved One Is At Home
When a loved one is at home, there is a range of services that are available in the home or community.
Home and Community-Based Services (HCBS)
Home and community-based services consist of a range of services provided to individuals in their homes or communities to help them stay at home and live as independently as possible. Most people who receive long term care at home receive it from unpaid family caregivers. However, when additional help is needed, they can turn to paid providers to supplement services. Because so much of the care needed is personal care—help with activities such as bathing and dressing, help managing medications, or supervision for someone with a condition such as Alzheimer’s disease--having paid providers will allow family caregivers to spend quality time with the care receiver and to do what is necessary to maintain the household and have respite time away from their caregiving duties.
Some of the most common home and community-based services are:
Adult Day Services
Adult Day Services meet the needs of adults who can’t stay at home alone during the day due to cognitive or physical impairments, but who do not require 24-hour residential care. Adult day centers provide supervision, meals, social interaction, and activities. Some centers also provide bathing and some nursing services. Transportation to and from the center may or may not be furnished. Centers typically operate programs during normal business hours five days a week; some have evening and weekend hours.
See personal attendant services below.
Case Managers/Geriatric Care Managers
Case managers are specialists who assist individuals and their families in identifying long term care needs. Case managers can assess your loved one’s needs and discuss with your loved one and you the options that would give your loved one the best care and quality of life. They can also help develop a plan for your loved one’s care and arrange, coordinate, manage, and monitor those services within the limits of their organization's scope. Case managers are often social workers or nurses. Every Indiana Area Agency on Aging provides case management services (refer to Chapter 4 to learn more about Area Agencies on Aging and ways to locate the one in your region). An initial assessment from the Area Agency on Aging is free.
Geriatric Care Managers can be nurses, a social workers, or gerontologists. You hire them privately. These care managers can assess all the care receiver's needs including referral to specialists including lawyers. They also will help evaluate your ability to pay for services. Geriatric care managers usually charge a fee for their services and most will also bill for out-of-pocket expenses (mileage, long-distance calls, etc.). However some managers are certified to bill Medicaid. To learn more about private geriatric care managers and get a list of geriatric care managers in Indiana go to: http://www.caremanager.org/
Chore assistance includes help with heavy household chores, such as washing floors or windows, shoveling snow, and yard work. There are limitations on operating heavy equipment like snowblowers.
Emergency Response Systems
Emergency response systems are devices that provide a signal to a central monitoring location whose employees respond immediately via a special speaker system connected through the phone lines and assess the situation. They confirm that there is a medical or other emergency and will call the appropriate person or emergency service agency on a list preselected by the care receiver or their primary caregiver. To use one of these systems, your loved one wears a “beeper” on the wrist or around the neck. If your loved one falls or has some type of emergency, they simply press a button to alert the 24-hour response system. Some services also include video monitoring. In the past one needed a "land line" to receive these services, but now some companies offer monitoring through cell phones.
Friendly Visitor/Companion Services
Companion services are visits to someone who is frail or living alone. Visits are made by volunteers, paid companions employed by a personal care services agency, or by a private duty companion.
Most home care is non-medical care provided by individuals such as home health aides, personal services attendants, homemakers, and companions. This type of home care may be called “home-based care services” or “personal care services.” However, some home care is of a more medical nature. Usually referred to as skilled care, it is most often needed following an acute event such as a hip fracture, when, after discharge from a hospital, follow-up rehabilitation services are needed at home. Skilled care is ordered by a doctor and must be provided or overseen by licensed health care professionals, such as nurses or physical therapists. This type of home care may be called “home health care” because of the health/medical component that is involved.
Home Health Aide
Home health aides are trained and certified individuals who provide assistance with tasks of daily living, such as bathing, dressing, going to the bathroom, meal preparation, and light housekeeping. Home health aides can provide assistance to people who cannot bear their own weight and pivot. In some cases, home health aides can do treatments such as simple dressing changes under the direction of a licensed health care professional.
Homemakers help with general household activities, such as meal preparation, light housekeeping, laundry, grocery shopping, and shopping assistance.
Home modification involves adapting an existing home to make it more accessible and/or safer and to help make it easier to get around and do daily activities. Examples of modifications include adding ramps, hand rails, grab bars, lever handles on doors, lifts, and wider doors.
Meal programs include prepared meals that are either served in a variety of community settings, such as a senior center, or delivered to a person’s home.
Personal Attendant Services (Also Called Attendant Care)
Personal attendant services help a person with basic self-care tasks and with tasks/functions required in daily living. Personal care services include 1) assistance with bathing, dressing, eating, going to the bathroom and getting around; 2) medication reminders or help giving pre-dosed medications; 3) homemaking (household tasks, cleaning, laundry, shopping, meal planning and preparation); 4)transportation; and 5) companionship. These services are provided by a personal services attendant. They can provide services to people who can bear weight for pivot transfers.
Respite care is a temporary break for families from the responsibility of caring for love ones who are unable to care for themselves. Respite care is provided in a variety of settings including in the home, at an adult day center, in an assisted living residence, or in a nursing home.
A senior center provides a variety of services including nutrition, recreation, health, social and educational services, and comprehensive information and referral to help people find the care and services they might need.
Telephone reassurance are calls made by volunteers to homebound elders on a regular basis to provide contact, support, and companionship.
Transportation services get a person to medical appointments, shopping centers and a variety of community services. Transportation may include curb-to-curb taxicab services, public buses, or vans that are wheelchair accessible. Contact your local Area Agency on Aging or your local public transportation provider to learn more about these options. Transportation services vary by community and may also be provided by the Red Cross or other local non-profit.
When a Loved One Can No Longer Stay At Home
When it is no longer possible for a loved one to be cared for at home, there are several options in Indiana for care in a residential setting.
Adult Foster Care Homes
In Indiana, adult foster care is care provided for up to three adults in a small group setting, often a private home. The host family or provider furnishes room and board, monitoring and supervision, help with medications, and some assistance with personal care. Other services may also be available. Adult foster care homes are not licensed or regulated by the state of Indiana, although homes that receive funding from Medicaid must meet certain requirements.
Assisted living is designed for people who no longer can remain in their own homes and need some assistance and care in their daily lives, yet don’t require 24-hour nursing care or supervision. In general, assisted living residences provide up to three meals a day, assistance with personal care, help with medications, housekeeping, laundry, recreational programs, limited transportation, 24-hour security, and onsite staff for emergencies. Residents usually live in their own apartments. The type of services and level of care vary from one assisted living facility to another.
Nursing homes care for people who need round-the-clock nursing services and/or supervision and who can’t be cared for at home or in the community. Nursing homes provide room and board, a wide range of personal care and health services, social services, activities and transportation. Some nursing homes provide skilled nursing care and rehabilitation therapy after an injury or hospital stay. Some will also have special dementia care or other special care units.
Continuing Care Retirement Communities (CCRCs)
Continuing Care Retirement Communities (CCRCs) are housing communities that offer several levels of care in one location. Where people live depends on the level of care they need. In the same community, there may be individual homes or apartments for residents who live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care. Residents move from one level of care to another based on their needs, but still stay within the CCRC campus or location.
CCRCs generally charge a large payment before a person moves in (called an entry or entrance fee) and then charge monthly fees. The entrance fees can range from $20,000 to over $400,000; monthly fees can range from $400 to $2500 or more. The fees vary according to whether the resident owns or rents the living space, the size and location of the residence, the amenities chosen; whether the living space is for one or two individuals, the type of service contract chosen, and the current risk for needing intensive, long term care.