1. For Caregivers

Aging is a part of life. Many of us are taking care of parents and grandparents as well as preparing for our own future. If you are helping a spouse, relative or friend with basic activities-like driving them to the doctor, shopping, cooking, paying bills, bathing, housekeeping, managing medications and even arranging for others to provide services-you are a caregiver.

Caring for someone else can be rewarding and exhausting. Many people are balancing their responsibilities as parents, employees and caregivers. Our goal is to help you understand the challenges facing the older adult in your life and how best to address these issues.

Talking with Your Loved One

It is never too early to talk to the older adults you love about their future. Listen to their thoughts and bring up tough, important issues like their health, medical care, housing, transportation, finances and happiness. Support them as they identify the areas in their life where they could use extra help.

These discussions can be complex. Sometimes, you may disagree about what's in their best interest - financially, physically or emotionally. But don't get discouraged. Compromise takes time. The more prepared and supported you are, the more productive your conversation will be. It may help to reach out to a professional counselor, who can guide the family through these hard issues and reach a solution everyone can support.

You may notice that your older friend or family member is behaving "out of character." It's extremely important to dig deeper and discover why they are acting differently. They may be having trouble with their daily routine because of their health, eyesight, hearing or even side effects from medications. Perhaps he or she is feeling depressed and embarrassed to admit it. Or you could be witnessing the onset of dementia or Alzheimer's Disease. It's critical to understand the root cause of their behavior; some problems can be easily fixed, while others may require a family discussion or medical help.

Express your concern to your loved one if you notice:

• Mail and bills piling up
• Food being forgotten and spoiled in the refrigerator
• Scorched pots and pans, which may mean they forgot them on the stove (both a sign of short-term memory loss and a dangerous fire hazard)
• Wearing the same clothing for days in a row
• Missing doctor's appointments
• Not taking medication as prescribed
• Repeated phone calls to you or others

You should consult with your loved one's physician about any of these behaviors. That way, if treatment is appropriate, it can begin as early as possible and have the best chance for success.

Is Driving Unsafe?

Sometimes caregivers have to address very sensitive, difficult subjects. Many decisions will affect both of you and it is important to maintain an open relationship with your family member or friend. Driving, for example, can be a difficult topic to discuss. There is no "right" age when someone should stop driving. Many older adults continue to drive well into their 70's and 80's. But if you notice erratic driving or if their doctor tells you that certain medications or their condition will impair their driving, it is time to talk about finding new ways to get around.

Seniors often equate driving with independence, and they may not be willing to admit they're having trouble on the road. They might even be offended that you broached the subject. Tact is key. Emphasize that they will still be able to get where they need to go. Explore transportation alternatives and plan together how they will get around.

• Family members and friends
• Public transportation http://www.haywoodtransit.com  
• Volunteer drivers  http://www.1-800-volunteer.org/1800Vol/haywood-county/vcindex.do

Remind them that driving is a public responsibility-if something goes wrong, they're not only endangering themselves, but putting others at risk as well. As backup, have a note from their doctor recommending they retire from driving. But keep in mind that, to them, driving means freedom and independence.

Caregiver Tips

More than half of all caregivers also work full or part time. Many are simultaneously caring for their own children. Being a caregiver means learning how to balance responsibilities to your family, your job, your older loved one and yourself. Below are some guidelines to make the balancing act easier.

• Take Care of Yourself.
  Odds are you are a busy person. Being healthy, eating well, getting rest and making time for exercise are vital if you are going to accomplish all you have got on your plate. It is equally important to keep yourself emotionally balanced by making time for yourself, laughing with friends and enjoying your hobbies. Being able to care for others means being strong and healthy yourself.
• Ask for Help.
  No one person can do everything without support. Every caregiver needs the informal support of family, friends, neighbors or faith communities. If you feel stressed or lonely in your caregiving role, share your thoughts with others or join a caregiver support group. If you find you need more formal support, you may want to consider respite care, having your loved one attend an adult day care program or hiring a professional geriatric care manager. If you would like to discuss these options with someone and you live in Haywood County, there are Elder Care Experts listed in the Senior Service Directory section of this web site under “Home and Community Care Services.” They can provide information about these services and caregiver support.

Respite care is designed to give you a break. You can get help for a few hours or even a few weeks. Relief comes in many forms, from temporary in-home caregivers to short stays at assisted living communities. Respite grants are available through the Jackson County Family Resource Center which serves the seven western counties including Haywood.  If you are overwhelmed with your caregiver duties or just need a break, please call Wanda Temple Messer at (828) 586-2845 to sign up for the program.   For further information on respite care, you may call the Area Agency on Aging at (828) 586-1962. 

Maple Leaf Adult Day Care is located in Hazelwood. The center opens at 7:30 a.m. and stays open until 5:30 p.m. during the week to help working caregivers. Transportation is available.  There is a range of services offered at the center such as nursing care, meals, personal care, and recreational activities.  The cost of adult day care is less than most in-home care, and there's greater opportunity for therapeutic activity and connecting with others.  Call (828) 456-9488 for additional information. 

Geriatric care managers are professionals who specialize in assisting older adults and their families with long-term care arrangements. They work with you to evaluate your needs and develop a care plan before the situation becomes urgent. Private care managers remain independent from the resources they recommend to maintain integrity and provide unbiased information.

Avoid Burnout.

Caring for someone else and managing all your other responsibilities can take a toll on your health and well-being. Avoid burnout so you can be happier and care for your loved one longer. When you're wrapped up in your routine, it can be difficult to notice your own fatigue. So take the time to see if you are:

• Feeling sad, moody or resentful
• Feeling exhausted or lethargic
• Feeling helpless or hopeless
• Overreacting to minor annoyances
• Losing interest in work
• Losing interest in your hobbies or things you normally enjoy doing
• Withdrawing from friends
• Eating differently
• Having difficulty sleeping or relaxing

If you think you are nearing burnout, take time for yourself, talk with people you trust or seek help from trained professionals or counselors.

Alzheimer Caregiver Support Group
452-4876
Silver Bluff Nursing Home
Third Thursday at 2:30 p.m.

Alzheimer Caregiver Support Group
(828) 254-7363
First United Methodist Church (Haywood Street)
Fourth Tuesday at 5:30 p.m.

2. ADULT CARE HOMES / ASSISTED LIVING

In North Carolina, an assisted living residence is defined as “…any group housing and services program for two or more unrelated adults, by whatever name it is called, that makes available at a minimum, one meal and house-keeping services and provides personal care services directly or through a formal written agreement with one or more home care agencies.”  Included under the umbrella term of “assisted living” are licensed adult care homes.  The homes listed in this section are all licensed adult care homes.  It is important to know that there are different types of assisted living residences.

Adult Care may be the answer for the older person who is not able to live independently, but who does not need nursing home care. Commonly referred to as "Rest Homes" or Assisted Living, Adult Care Homes are licensed by the North Carolina Department of Human Resources to provide assistance with activities of daily living (ADL).

Two types of Adult Care Homes serve older adults. Family Care Homes (FCH) are small homes that provide care for up to six people in a family-like setting.  These homes are often found in residential communities and have around-the-clock or live-in staff that prepare meals, supervise medications and provide help with dressing and other needs.  Homes for the Aged (HA) are larger facilities, serving seven or more people.  They, too, provide assistance with meeting the residents' daily needs, and they have staff on duty 24 hours a day.  Some nursing homes have Home for the Aged beds on site for those who do not need nursing care.  Often, these HA residents have priority for the nursing home beds if the need arises.

Adult Care Homes have an administrator who is responsible for managing the facility and a supervisor-in-charge (SIC) who oversees resident care.  Aides provide assistance to the resident.  The number of aides on duty is determined by the number of residents.  Nurses are not required in adult care homes, although some have nurses on duty.

The County Department of Social Services monitors Adult Care Homes at least bi-monthly and may be contacted if a resident or family member has a concern or complaint about the care being provided.  Under North Carolina's Adult Care Home Bill of Rights, all residents are to be treated with respect, consideration and full recognition of their personal dignity and individuality.  The Regional Long-Term Care Ombudsman (an advocate for the residents) and the local Adult Care Home Community Advisory Committee work to see that these rights are respected.

The Cost
The cost of adult care varies from facility to facility, ranging from $1400- $4000 a month.  This includes three meals daily, activities, transportation, laundry, personal care and the supervision of medications.  A few facilities require an additional entry fee.  For those on limited incomes, Special Assistance (SA) may help cover the cost of adult care.  Residents receiving Special Assistance receive a small Personal Needs Allowance ($66) monthly to cover the cost of personal items.  Contact your local Department of Social Services to find out if you are eligible.

Some Adult Care Homes only accept "private pay" residents who are able to cover the cost of care themselves.  Others accept those who are private pay as well as those who receive Special Assistance.  All services provided in the monthly rate should be included in the contract.

How to Apply
All people applying for Adult Care are required to have an FL-2 form; a physician authorized medical form, describing residents’ care requirements.  This form may be obtained from the facility administrator or the County Department of Social Services.  If public assistance is needed, the person seeking assistance applies at the Department of Social Services in the county where he/she lives.  Otherwise, the resident and the facility simply enter into a contractual agreement. Some facilities require a deposit.

A guardian must sign the contract for residents who have been declared legally incompetent. 

Life in an Adult Care Home
The daily routine in adult care homes should resemble, as much as possible, routines followed when living independently.  Activities are offered and residents are encouraged to participate.  Some residents are able to leave the home on their own to go on walks.  Most are able to participate in organized activities outside of the home such as occasional shopping trips.

Upon admission, the home will provide the resident with a copy of its policies on smoking, visitation and other matters.  Private paying residents may leave the facility to visit with their families as they wish.  Those who receive Special Assistance may leave for up to 30 days at a time.

3. NURSING HOMES

Nursing homes provide care to persons who are chronically ill or recuperating from an illness or injury and need 24 hour nursing care and other health services but not hospitalization.  They usually provide rehabilitation programs, social activities, supervision, and basic room and food services.  Nursing homes are licensed by the North Carolina Division of Facility Services and most are certified for Medicare or Medicaid reimbursement.

Nursing homes have an administrator who has the responsibility of managing the facility.  A licensed nurse serves as Director of Nursing (DON) and supervises the residents' personal care.  Certified nursing assistants provide routine care.  The number of assistants on duty depends on the number of residents.  Social workers, activity coordinators, physical therapists and dietary staff provide specific services in the facility.  

The Division of Facility Services (DFS) is a facet or component of the Department of Health & Human Resources.  DFS Inspections are conducted annually and complaints are investigated when reported.  Facilities that accept residents receiving Medicaid and Medicare are certified by the Division of Medical Assistance (DMA) and must post their inspection reports. 

Under North Carolina's Nursing Home Bill of Rights, all residents are to be treated with respect, consideration, and full recognition of personal dignity and individuality.  The Regional Long-Term Ombudsman (an advocate for the residents) works to see that these rights are respected.

The Cost
The cost of nursing home care often seems overwhelming to the resident and her/his family.  Facilities typically charge $3700 - $6000 per month.  This cost covers 24 hour nursing care and meals.  Most facilities charge additional monthly fees for personal laundry, and some therapies require additional charges.  Residents receiving Medicaid do not pay an additional fee for laundry services. Ask the appropriate facility personnel about these costs and charges.

Over 70 percent of the residents in nursing homes receive Medicaid – an entitlement program for those with limited incomes and resources.  Often residents enter a facility with their own resources and then convert to Medicaid when their personal funds are used.  A private pay resident may not be discharged from a facility certified to serve Medicaid residents only because he or she needs Medicaid to reimburse the facility.  Medicaid reimburses facilities for the "cost of care" (which includes wheelchairs, medical transportation, bandages, etc.).  Residents should inquire about the costs already associated with their care before they pay for additional services from their own funds. Call the Medicaid worker at the Department of Social Services if you have questions about what Medicaid covers and to see if you are eligible.

Few people in nursing homes (less than 5 percent) are covered by Medicare - a federal health insurance program.  Medicare only pays for specific needs and procedures and for a limited period of time.  A physician must certify the resident's medical care needs.  The resident is evaluated on admission and a determination is made then about Medicare coverage.  Currently, Medicare may cover up to 100 days of nursing home care; however, the resident is responsible to pay a co-payment of 20% after the 20th day of Medicare coverage.  A secondary insurance will pay the 20%.

Some older adults have insurance policies that will cover some, if not all, of the costs of nursing home care.  These policies should be read carefully to determine what level of care is covered.  Veterans may also be eligible for assistance from the Veteran's Administration.  Ask if the facility handles insurance billing. Residents eligible for Medicaid will receive a small Personal Needs Allowance to purchase personal items.  Most facilities charge the private pay daily rate to "hold the bed" should the resident have to be hospitalized.

How to Apply
The Admission Coordinator of the nursing home will assess the applicant's medical and social needs and will provide the necessary forms.  A contract will include the cost of care and other services. All residents entering a nursing home are required to have an FL-2 form completed by their physician.  This FL-2 form may be obtained from the County Department of Social Services or from the nursing home itself.

An individual care plan will be developed to meet the resident's medical and social needs.  The resident and family members should be involved in the care planning at the time of admission and thereafter at the resident’s quarterly care planning meetings.

Life in the Nursing Home
Residents in facilities should be allowed and encouraged to participate in the activities of day-to-day life as much as they are able.  A Resident's Council provides the opportunity for residents to have input into the activities of the facility.  Family, friends, colleagues, and church members should be encouraged to visit the resident and continue the relationships that they have had in the past.  If the resident or the family has a concern, he/she should feel free to discuss the issue with the Administrator.

Many facilities encourage family involvement with family nights and Family Council meetings.  Residents who are private pay my leave the nursing home to visit their families as long as the daily rate is paid at the nursing home.  Those receiving Medicaid are allowed to take 60 days of therapeutic leave per year to visit their families if they are medically approved to do so.

 4. CHECK LIST FOR CHOOSING A NURSING HOME

A.     Using your senses: sight, hearing, smell, touch		STRONG	WEAK
1.	Is there cheerful, respectful, pleasant, warn interaction between staff and residents?	________	_______
2.	Does the administrator seem to know the residents and enjoy being with them?	________	_______
3.	Do staff and administration seem comfortable with each other?	________	_______
4.	Do the rooms appear to reflect the individuality of their occupants? Do all the rooms look alike?	________	_______
5.	Are residents using the common rooms - for example, the front lounge?	________	_______
6.	What is the noise level in the facility?  Is it comfortable and homelike?  Are there quiet places for residents?	________	_______
7.	Do residents look clean and well groomed?	________	_______
8.	Is the home free from unpleasant odors?	________	_______
9.	Do you notice a swift response to call lights?	________	_______
10.	Are there residents crying out?  If so, do they get an appropriate response from staff?	________	_______
11.	Is the dining room atmosphere relaxed and conducive to pleasant meals?	________	_______
12.	Do the meals look appetizing?  Are residents eating most of their food?  Do they have assistance if they need it?	________	_______
13.	Does the home seem clean, cheerful, not crowded?	________	_______
14.	Are there pleasant areas for family visits?	________	_______
15.	Are there residents in physical restraints?	________	_______
16.	Do residents appear to be engaged in meaningful activity by themselves or with others? (as opposed to staring at the wall, blaring TV, slumped over, or in a line)	________	_______
B.	Things you can ask of staff.
1.	What kinds of activities are residents involved in?  Is there access to books, gardening, community activities, and pets, to retain linkages to former interests?  Does the nursing home have a wheelchair accessible van?	________	_______
2.	What kind of activities are there for residents with dementia?  (structured, walking paths, evening activities, music?)	________	_______
3.	Is there permanent assignment of staff to residents?	________	_______
4.	How are the nursing assistants involved in the residents’ care planning process? (They should attend and contribute ideas).	________	_______
5.	How does the staff accommodate the family’s schedule to assure participation in care planning meetings?	________	_______
6.	What happens if a resident refuses to take a medication?	________	_______
7.	What does the facility do for residents who are depressed?  Is counseling available?	________	_______
8.	What is the facility’s policy toward missing clothing and other possessions?	________	_______
9.	What does the facility do to encourage employee retention and continuity?  Does the staff receive health benefits?	________	_______
10.	Does the facility provide transportation to community activities?	________	_______
11.	What kinds of therapies are provided for residents on Medicaid?  (Occupational therapy, speech therapy, physical therapy, mental health services, etc.)	________	_______
12.	Is there a family council?  Are there family members I can speak to?	________	_______
13.	What happens when someone has a problem or complaint?  Are Family / staff conferences available to work out problems?	_      ____	_______
14.	Who is your ombudsman? Does that person visit regularly?	________	_______
15.	What are the extra charges not included in the daily rate?	________	_______
16.	If paying privately:  How often have private pay rates increased?  How much notice is given before an increase?  Are there charges for extra care which are not included in the daily rate?	________	_______
17.	What does staff see as the facility’s main strengths and weakness?	________	_______
18.	Who decides for each resident how she bathes and how often?	________	_______
19.	Who selects roommates?  What do you consider in selecting roommates? How are residents involved in the selection?	________	_______
20.	How are smokers and non-smokers accommodated?	________	_______
C.	Things you can learn from residents and families.
1.	What is your usual routine? Can you get up and go to bed when you wish?	________	_______
2.	Do you have the same nursing assistant most days?  (Does this match the answer to B3?)	________	_______
3.	Are snacks available when you want one?  Are they what you want?	________	_______
4.	Do you participate in care planning meetings?  Is your opinion valued?  (Does this match the answer to B5?)	________	_______
5.	Are care planning conferences held at a time when family members can attend?  Do the conferences last until your questions are answered or all of the issues have been taken care of?	________	______­­_
6.	What happens when you have missing clothing?  (Does this match the answer to B8?)	________	_______
7.	Are residents able to get help for going to the toilet within a short period of time?	________	_______
8.	Whom do you go to with problems? What is the response?  Are you satisfied?	________	_______
9.	How does staff help you with your personal interests like reading and gardening?	________	_______
10.	Do you get outside as often as you wish?	________	_______
11.	Is there a resident council? How does it work?  Who controls the council: residents or staff?	________	_______
12.	Is there a family council?  Is it an effective forum for raising concerns and learning what’s happening at the home?	________	_______
13.	What’s the best thing about living here?	________	_______
14.	What’s the worst thing about living here?	________	_______
15.	What makes a day good for you?	________	_______
D.	Information you can obtain.
1.	Copy of state inspection report - either from the agency which licenses and certifies nursing homes, from the facility itself, or from the ombudsman.	________	_______
2.	Information about the facility from the local ombudsman or state ombudsman.	________	_______
3.	Information from family members or friends of residents.	________	_______

 

Designed and hosted by C-4 The WebStore, Inc. 
 

Search This Site:

 

Haywood Community Connections
Welcome ... we’ve been waiting for you!  We provide
information related to issues involving seniors in Haywood County. Click Here.

The Haywood Community Partnership is supported by the Robert Wood Johnson Foundation®, www.rwjf.org through its Community Partnerships for Older Adults (CPFOA), www.cpfoa.org national initiative. Community Partnerships for Older Adults is a national program funded by the Robert Wood Johnson Foundation to help communities develop leadership, innovative solutions, and options to meet the needs of older adults over the long term