"Moving to a New Place" - chapter 16 of "Caregiver Helpbook"

A course called “Powerful Tools for Caregivers” was developed by an organization in Portland. You can read general info about the self-care education program for family caregivers at powerfultoolsforcaregivers.org.

As part of the course, class participants receive a copy of a book titled “The Caregiver Helpbook.” Brain Support Network volunteer Denise Dagan is reading the book and will be sharing the highlights, for most chapters. If you’d like far more detail that Denise’s summaries allow as well as access to the book’s terrific worksheets, note that the book is available for purchase in both English and Spanish at powerfultoolsforcaregivers.org.

Chapter 16 focuses on moving to a new place. The necessity of moving into a facility may occur with little or no warning (as with a fall where a bone is broken), but when possible, planning for placement is best done BEFORE the need arises. Often, as care needs increase, family caregivers and in-home services are not be able to keep up with care demands. Learning about different types of facilities and visiting available options eases the stress of decision-making when care in a facility is actually required.

Here’s Denise’s report on chapter 16.

Robin
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Denise’s Notes for

Chapter 16 – Moving to a New Place
The Caregiver Helpbook

Begin with a realistic assessment of the care receiver’s need. Anticipating future needs is wise, so the care receiver doesn’t have to be moved often from one level of care to another. As you’re evaluating options try to maintain as much dignity and independence for the care receiver as possible. Be sure to discuss options with the care receiver, if possible, before making a final decision.

Housing and Care Options:

Shared Housing is for someone who is still very able, but who can no longer care or pay for their own home alone. The arrangement may be two people in like circumstances sharing one home with all expenses and chores divided equally, like typical roommates. Alternately, the homeowner may share their house in exchange for cooking, laundry, home maintenance, etc.. Some faith-based organizations sponsor large homes where several people share space.

Moving to a Family Member’s Home involves much to consider:
– How much of a disruption to the family will this be? Will a spouse, children, or pets feel displaced?
– Does the care receiver have to leave his/her hometown, involving new doctors, dentist, pharmacist, friends, etc.?
– Will the care receiver require 24-hour supervision?
– Will relief be available so the caregiver can have time off?
– What is the comfort level of all concerned in regard to personal care such as bathing and toileting?
– Are there unresolved issues such as strained relationships, past abuse, neglect, alcoholism, or divorce?
– Will the care receiver be able to have some of his/her own furnishings and other familiar items?
Despite the challenges this arrangement can be very rewarding and create closer relationships.

Retirement Living Facilities come in many shapes and sizes. The goal is to maintain independence. The set up may be individual apartments or small homes. Typical services offered include transportation, congregate meals, maid service, and planned social activities. Minimal medical care can often be arranged for acute, temporary issues. Residents purchase their home and the selling price fluctuates with the real estate market.

Residential Care and Assisted Living Facilities are for those who cannot completely care for themselves. They are a blend of retirement living and personal care. There is usually 24-hour supervision, assistance with personal care needs, medication monitoring, congregate meals, housekeeping services, and an emergency call system in each residential unit. Registered nurses and skilled care can be provided on a temporary basis by outside home healthcare agencies. The monthly rent depends on size of the unit and the amount of services needed.

Foster Homes or Board and Care Homes vary from state to state. Typically, they house 5-6 people. Some of these homes have a family that takes in and cares for people; others are staffed by hired, live-in caregivers. Meals, laundry, and personal care are provided. Skilled care can be brought in.

Nursing Home Care typically serves 20+ residents and offers several levels of care.
Two common levels of care are:
Intermediate or Custodial Care for those needing 24-hour care along with room and board, some personal care, medication management and activities.
Skilled Nursing Care is for a person requiring much more complicated care and needing regular registered nurse supervision, injections, IV feedings, catheter care, PT, OT, or speech therapy.
This level of care is where Medicare, some health insurance plans and long-term care insurance will pay (with some limitations.

Alternatives to Nursing Home Care:

The Program of All-Inclusive Care for the Elderly (PACE) is a benefit under both Medicare and Medicaid for people certified to require skilled care, but who wish to remain at home. Participants receive comprehensive medical and social services from teams of health professionals who develop an individualized care plan. PACE receives a fixed monthly payment per enrollee from Medicare and Medicaid, regardless of the services an enrollee may need. Enrollees may also pay a monthly premium, depending on their eligibility for Medicare and Medicaid.

A Social Managed Care Plan provides the full range of Medicare benefits offered by standard managed care plans, along with additional services, including:
– Care coordination
– Prescribed drugs
– Chronic care benefits covering short term nursing home care
– A range of home or community based services, such as:
personal care services, adult care care or respite care, medical transportation, other services like eyeglasses, hearing aids, and dental care.

These plans offer the full range of medical benefits offered by standard managed care plans + chronic care/extended care. Membership offers other health benefits that are not provided through Medicare alone or most other senior health plans. As of late 2005, only four Social Managed Care Plans are participating in Medicare and each Social Managed Care Plan has eligibility criteria with different premiums and co-pays. Contact Medicare’s Personal Plan Finder for details.

Questions to Ask:

Assessing and Choosing Housing Options involves asking the right questions. Page 194 has an extensive list of basic question. Depending on the type of facility and types of services needed, additional specific questions will be necessary.

Transitioning to the New Place:

Feelings run strong in this situation for both the care receiver and caregiver. The care receiver may feel:
– Abandoned and rejected
– A loss of privacy, freedom and space
– Angry at self and others
– Ashamed due to dependency
– A loss of financial security because of impending costs of care
– Depressed
– Confused upon entering new surroundings and routines
These feelings should be acknowledged. The losses are monumental.

The caregiver may feel:
– Failure they cannot continue giving care at home
– Apprehension about care not being given properly or not given in the way the care receiver prefers.
– Resentment that care costs so much, especially if there is no third party reimbursement.
– Relief that the burden of day to day care is lifted.
– Confusion about what to do with the care receiver’s home and possessions.

Settling into the New Place:
– The family are still caregivers
– Get acquainted with staff & volunteers. Visit at different times to become familiar with various shift workers.
– Visit during meal times to observe the food, how it is served and if the care receiver is eating.
– Pay careful attention to the care receiver’s mood and behavior.
– Help the care receiver become involved with activities
– Ask the staff what they need from you. Show appreciation for their work.
– Occasionally take gifts to the care receiver.
– Take old friends to visit.
– Take your loved one on outings, if possible.
– If the facility has a family council, get involved.

There is a list of resources at the end of the chapter including AARP, Family Caregiver Alliance, Area Agencies on Aging, and more.