March 22, 2011
MMS Physician Focus: March 2011
By Robert Schreiber, M.D. and Pat Kelleher
Our population is rapidly aging. By 2030, nearly 72 million
people in the U.S. will be 65 or older. And not only are we aging
faster, we're also living longer: A report just released by the
Centers for Disease Control charted U.S. life expectancy in excess
of 78 years, the highest it's ever been.
Additionally, chronic diseases, such as diabetes, arthritis, and
Alzheimer's, are affecting more and more people. Whatever the
medical condition, whatever one's age, however frail one may be,
the desire remains strong to stay in one's home, living as
independently as possible. Home care may provide some
help.
Currently, about eight million Americans require some kind of
medical care in the home, a number that will jump dramatically as
people live longer, want to stay at home avoiding nursing homes or
other living arrangements, and pressure mounts to control soaring
health care costs. If you've thought of home care for yourself or a
loved one, here are some things to consider.
Start by observing Sometimes people don't
realize that their parents or elderly family members can't do the
things they once did. Look for warning signs. Is mom or dad having
memory or vision problems, trouble walking, or taking many
medications? Is the person having difficulty with the normal
activities of daily life? If the answer to any of those is yes, it
may be time to proceed.
Speak up When you've identified the need for
help, let someone know. Talk to the individual's physician about
your concerns. Schedule a visit with all present and have an honest
conversation. Many referrals to home care services first come from
geriatricians or primary care doctors.
Get ready for objections Mom or dad may object
at first to admitting a need for help or to having "a stranger"
come into the home. Remember that family members caring for someone
also need help, to get the things done that they need done while at
the same time caring for a loved one.
Identify what you'll need Home health care
services are more complex and numerous than ever before. Will you
need skilled assistance such as nursing or physical therapy? Help
with meals and hygiene? Or just housekeeping activities? This is a
critical step, as it determines not only what kinds of care the
individual needs but also the cost of care.
Consult an Expert. You needn't face these
decisions alone. Professional home care agencies can assess needs,
identify resources, and develop individual care plans for a
person's specific situation.
Allow care for the caregiver Most home care -
up to 80 percent by some estimates - is provided by family members,
juggling work, the care of their own families, and that of their
parents or other family members. Caregivers often become burned out
and don't realize it. If the primary care giver gets sick, and
there's no back-up plan, the system of care collapses. One of the
key things to remember about home care is that it's not only taking
care of the patient, it's also taking care of the caregiver.
A team effort is best To do the best job for
the patient, everyone involved must play key roles. It takes a team
approach, with health professionals, home care aides, the family,
and the patient, so that when something goes wrong, everyone can be
alerted. Think of the patient and the family as the captains of the
health care ship, and the providers as the crew.
Oversee and advocate Family members must
remember to oversee the care that's given and to advocate for the
patient. You want your family member to get the right care, and
that comes from constant oversight and advocacy. If you see
something you don't think is right, speak up and get it corrected.
Remember: the patient and the family are the captains of the
ship!
Many good sources of information on home health care are
available online. To review Medicare-certified agencies, visit www.medicare.gov/homehealthcompare.
To connect to services for older adults and their families, visit
Eldercare Locator at www.eldercare.gov. And to
learn more about the details of home care, available services, or
find an agency in Massachusetts, see www.thinkhomecare.org
Robert Schreiber, M.D., is a geriatrician and
Physician-in-Chief of Hebrew Senior Life in Boston; Pat Kelleher is
executive director of the Home Care Alliance of Massachusetts.
Physician Focus is a public service of the Massachusetts Medical
Society. Readers should use their own judgment when seeking medical
care and consult with their physician for treatment. Send comments
to PhysicianFocus@mms.org
