What are Home Modifications for Older Adults & How do they Help?

Home modifications are changes made to adapt living spaces to meet the needs of people with physical limitations so that they can continue to live independently and safely. These modifications may include adding assistive technology (see the fact sheet on Assistive Technology for details) or making structural changes to a home. Modifications can range from something as simple as replacing cabinet doorknobs with pull handles to full-scale construction projects that require installing wheelchair ramps and widening doorways.

What is the benefit?

The main benefit of making home modifications is that they promote independence and prevent accidents. According to a recent AARP housing survey, “83% of older Americans want to stay in their current homes for the rest of their lives,” but other studies show that most homes are not designed to accommodate the needs of people over age 65.

Most older people live in homes that are more than 20 years old. As these buildings get older along with their residents, they may become harder to live in or maintain. A house that was perfectly suitable for a senior at age 55, for example, may have too many stairs or slippery surfaces for a person who is 70 or 80. Research by the national Centers for Disease Control and Prevention shows that home modifications and repairs may prevent 30% to 50% of all home accidents among seniors, including falls that take place in these older homes.

Will they be right?

The best way to begin planning for home modifications is by defining the basic terms used and asking some simple questions. According to the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), home modifications should improve the following features of a home:

• Accessibility. Improving accessibility means making doorways wider, clearing spaces to make sure a wheelchair can pass through, lowering countertop heights for sinks and kitchen cabinets, installing grab bars, and placing light switches and electrical outlets at heights that can be reached easily. This remodeling must comply with the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act accessibility guidelines, and American National Standards Institute regulations for accessibility. The work must also conform to state and local building codes.

• Adaptability. Adaptability features are changes that can be made quickly to accommodate the needs of seniors or disabled individuals without having to completely redesign the home or use different materials for essential fixtures. Examples include installing grab bars in bathroom walls and movable cabinets under the sink so that someone in a wheelchair can use the space.

• Universal Design. Universal design features are usually built into a home when the first blueprints or architectural plans are drawn. These features include appliances, fixtures, and floor plans that are easy for all people to use, flexible enough so that they can be adapted for special needs, sturdy and reliable, and functional with a minimum of effort and understanding of the mechanisms involved.

• Visability. Visability features include home modifications for seniors who may want to entertain disabled guests or who wish to plan ahead for the day when they may require some extra help in getting around their own homes. For example, installing a ramp to the front door of a house and remodeling the hallways and rooms to allow wheelchair access would make a home easier to visit for disabled family members or friends. Such changes may also give seniors a head start on home modifications they may need later in their lives.

Where do you begin?

Before you make home modifications, you should evaluate your current and future needs by going through your home room by room and answering a series of questions to highlight where changes might be made. Several checklists are available to help you conduct this review. The National Resource Center on Supportive Housing and Home Modifications is a good place to start. Go to the center’s website at http://www.homemods.org/ and click on the link to the “Safety Checklist and Assessment Instrument.”

In addition, Rebuilding Together, Inc., has an excellent home modification checklist:

Modification Checklist
http://www.rebuildingtogether.org/home_modifications/house_assessment_checklist_content.htm

You can begin your survey by examining each area of your home and asking the following questions:

Appliances, Kitchen, Bathroom

* Are cabinet doorknobs easy to use?
* Are stove controls easy to use and clearly marked?
* Are faucets easy to use?
* Are there grab bars where needed?
* Are all appliances and utensils conveniently and safely located?
* Can the oven and refrigerator be opened easily?
* Can you sit down while working?
* Can you get into and out of the bathtub or shower easily?
* Is the kitchen counter height and depth comfortable for you?
* Is the water temperature regulated to prevent scalding or burning?
* Would you benefit from having convenience items, such as a handheld showerhead, a garbage disposal, or a trash compactor?

Closets, Storage Spaces

* Are your closets and storage areas conveniently located?
* Are your closet shelves too high?
* Can you reach items in the closet easily?
* Do you have enough storage space?
* Have you gotten the maximum use out of the storage space you have, including saving space with special closet shelf systems and other products?

Doors, Windows

* Are your doors and windows easy to open and close?
* Are your door locks sturdy and easy to operate?
* Are your doors wide enough to accommodate a walker or wheelchair?
* Do your doors have peepholes or viewing panels? If so, are they set at the correct height for you to use?
* Is there a step up or down at the entrance to your home? If so, is the door threshold too high or low for you to get in or out easily?
* Is there enough space for you to move around while opening or closing your doors?

Driveway, Garage

* Does your garage door have an automatic opener?
* Is your parking space always available?
* Is your parking space close to the entrance of your home?

Electrical Outlets, Switches, Safety Devices

* Are light or power switches easy to turn on and off?
* Are electrical outlets easy to reach?
* Are the electrical outlets properly grounded to prevent shocks?
* Are your extension cords in good condition?
* Can you hear the doorbell in every part of the house?
* Do you have smoke detectors throughout your home?
* Do you have an alarm system?
* Is the telephone readily available for emergencies?
* Would you benefit from having an assistive device to make it easier to hear and talk on the telephone?

Floors

* Are all of the floors in your home on the same level?
* Are steps up and down marked in some way?
* Are all floor surfaces safe and covered with non-slip or non-skid materials?
* Do you have scatter rugs or doormats that could be hazardous?

Hallways, Steps, Stairways

* Are hallways and stairs in good condition?
* Do all of your hallways and stairs have smooth, safe surfaces?
* Do your stairs have steps that are big enough for your whole foot?
* Do you have handrails on both sides of the stairway?
* Are your stair rails wide enough for you to grasp them securely?
* Would you benefit from building a ramp to replace the stairs or steps inside or outside of your home?

Lighting, Ventilation

* Do you have night-lights where they are needed?
* Is the lighting in each room sufficient for the use of the room?
* Is the lighting bright enough to ensure safety?
* Is each room well ventilated with good air circulation?
* Once you have explored all the areas of your home that could benefit from remodeling, you might make a list of potential problems and possible solutions.

Source: US Dept of Health and Human Services, Administration on Aging, www.AoA.com
Provided by: The Staff at www.RetirementConnection.com
For more information: www.aoa.gov

Copyright © 2008 RetirementConnection.com. All rights reserved.

How do I Hire a Home Care Employee?

Today, many families care for an older relative, friend, or neighbor. An estimated 25 to 40 percent of women care for both their older relatives and their children. Half of all caregivers also work outside the home. It is no wonder then that caregivers often need help. Depending on your work, living, and family arrangements, there are a number of things you can do to make caregiving easier.

Ways to Make Caregiving Easier

* Work Options and On-the-Job Training Programs. If you are a working caregiver, it is important to discuss your needs with your employer. Telecommuting, flextime, job sharing or rearranging your schedule can help to minimize stress. Increasingly, companies are offering resource materials, counseling, and training programs to help caregivers.
* Involving Older Children. Older children living at home may be able to assist you and/or your older family member. Such responsibility, provided it is not overly burdensome, can help young people become more empathic, responsible, and self-confident and give you needed support.
* Asking Other Family Members to Help. You can and should ask other family members to share in caregiving. A family conference can help sort out everyone’s tasks and schedules. Friends and neighbors also may be willing to provide transportation, respite care, and help with shopping, household chores or repairs.

Sources of Information

If you need additional information and assistance in caring for your older relative or friend, you can contact:

* The National Eldercare Locator, funded by the Administration on Aging. Eldercare Locator advisors can direct you to agencies and organizations that can assist you. When calling the Eldercare Locator at 1-800-677-1116, please provide the older person’s address and ZIP code.
* The Area Agency on Aging serving your older relative or friend’s community can provide information about in-home and community services. Information also is available about benefit and assistance programs for older persons with limited incomes. These include:

o Subsidized housing

o Food stamps

o Supplemental Security Income

o Medicaid

o The Qualified Medicare Beneficiary program, which covers the cost of the Part A and B insurance premiums, deductibles, and coinsurance for low-income older persons.

In addition, the AAA can direct you to senior center and adult day programs. These programs are particularly helpful to working caregivers who want a safe environment with planned activities for their older relative.

* Senior centers serve active older persons and those who have minor problems with mobility and activities of daily living.
* Adult day programs serve older persons with serious mobility limitations, dementia, or medical conditions that require daily attention.
* Many AAA’s have a registry of home care workers from which you can recruit directly as well as information on home care agencies and volunteer groups that provide help.
* Hospital or Nursing Home Discharge Planners also can refer you to home care agencies and home care workers.

Determining the Type of Care You Need

If you decide to hire a home care employee, you need to determine how much and what type of help your older relative needs. Following are descriptions of some of the types of home care personnel:

* Housekeepers or Chore Workers may be supervised by the person hiring them and perform basic household tasks and light cleaning. Chore Workers often do heavier types of cleaning such as washing windows and other heavy cleaning.
* A Homemaker may be supervised by an agency or you and provides meal preparation, household management, personal care, and medication reminders.
* A Home Health Aide, Certified Nurse Assistant, or Nurses Aide, often referred to as home health care workers, are supervised by a home care agency’s registered nurse and provides personal care, help with bathing, transfers, walking, and exercise; household services that are essential to health care; and assistance with medications. They report changes in the patient’s condition to the RN or therapist, and complete appropriate records.

Sometimes, home care employees take on several of the roles described above.

General Eligibility Requirements for Home Care Benefits

Medicare may pay for home health care services through a certified home health care agency, if a physician orders these services. Home health care agencies focus on the medical aspects of care and provide trained health care personnel, including nurses and physical therapists. For a patient to be eligible for services paid for under Medicare, she must need skilled nursing assistance, or physical, speech, and/or occupational therapy. Home health care workers are a supplement to this care and usually help the older person for three hours a day, several days a week.

If your older family member or friend needs additional hours of care or requires custodial care, she may be eligible for services under Medicaid. The state where she resides determines if her income and assets qualify her for Medicaid covered services. Otherwise, you or your older relative must cover the cost of having a home care worker.

Home care agencies, which can be nonprofit or for-profit, recruit, train, and pay the worker. You pay the agency. Social Service agencies, in addition to home care services, may provide an assessment of the client’s needs by a nurse or social worker, and help with the coordination of the care plan. If services are being covered under Medicare, your doctor, care manager, or discharge planner will probably make arrangements for a home health care agency.

Selecting an Agency

If you select an agency, ask the following questions. Those questions starred with an asterisk should also be asked, if you are hiring the home care employee.

1. What type of employee screening is done?
2. Who supervises the employee?
3. What types of general and specialized training have the employees received?*
4. Who do you call if the employee does not come?
5. What are the fees and what do they cover?*
6. Is there a sliding fee scale?
7. What are the minimum and maximum hours of service?*
8. Are there limitations in terms of tasks performed or times of the day when services are furnished?*

Unless your older friend or relative needs care for a limited number of hours each day, the rates charged by home care agencies for homemaker, home health aide services and van services for transportation are often beyond the means of middle income families. If this is the case, you may want to explore the option of hiring a home care employee directly.

Hiring a Home Care Employee

Avenues for hiring home care aides include:

* Asking other caregivers for referrals
* Going to senior or other employment services
* Contacting agencies that assist displaced homemakers and others entering the job market
* Advertising in the newspapers

Screen home care employees carefully to ensure that they have the necessary qualifications, training, and or temperament.

Interviewing Applicants

Your interview with a prospective home care employee should include a full discussion of the client’s needs and limitations, with a written copy of the job description; the home care worker’s experience in caregiving and his or her expectations.

Special Points to Consider

* If the older person needs to be transferred from a wheelchair, make sure that the aide knows how to do this safely. If the aide does not know how to bathe a person in bed or transfer, but is otherwise qualified, it may be possible to provide the necessary training, but make sure she can do it before hiring her.

* Do not try to hire someone on a 7-day-a-week basis. No employee can remain a good employee for long, if she does not have time for her personal needs and interests. Additionally, aides who live in or sleep over cannot be expected to be on call 24-hours a day. If your older relative needs frequent help or supervision during the night, you should hire a second home care aide, or have a family member fill in.

* If your older relative needs a considerable amount of help, live-in help may be available, which can be less expensive than hourly or per day employees. However, keep in mind that you will be providing food and lodging and that it may be more difficult to dismiss live-in aides, especially if they do not have alternative housing available. It also is important to ensure that the aide has her own living quarters, and that she has some free time during the day, sufficient time to sleep, and days off.

References

Have applicants fill out an employment form that includes their:

* full name
* address
* phone number
* date of birth
* social security number
* educational background
* work history
* references

Ask to see their licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.

Thoroughly check their references. Ask for the names, addresses, phone numbers, and dates of employment for previous employers, and be certain to contact them. If there are substantial time gaps in their employer references, it could indicate that they have worked for people who were not satisfied with their performance. It is best to talk directly to former employers rather than accepting letters of recommendation. With the applicant’s permission, it is also possible to conduct a criminal background check.

Job Expectations

When hiring a home care aide, it is important to list the job tasks and to ask applicants to check those they are willing to perform. You should also discuss:

* vacations
* holidays
* absences
* lateness
* benefits and wages
* the amount of notification time each of you should give if the employment is terminated

If you work and are heavily dependent on the home care assistant, emphasize the importance of being informed as soon as possible if she is going to be late or absent so that you can make alternative arrangements. It is helpful to keep a list of home care agencies, other home care workers, neighbors, or family members who can provide respite care, if needed.

Be clear about:

* the employee’s salary
* when he or she will be paid
* reimbursement for money the aide may spend out of pocket

Needed Information

When hiring a home care assistant, it is helpful to spend a day with him or her, so that you can go through the daily routine together. At the very least you need to inform the home care worker, both verbally and in writing, about the older person’s:

* likes and dislikes
* special diets and restrictions
* problems with mobility
* illnesses and signs of an emergency
* possible behavior problems and how best to deal with them
* therapeutic exercises
* medications, when they are taken, and how to reorder them
* dentures, eye glasses, and any prosthesis

Also provide information, verbally and in writing, about:

* how you can be contacted
* contacts in case of an emergency
* security precautions and keys
* clothing
* medical supplies, where they are kept, and how they are used
* food, cooking utensils, and serving items
* washing and cleaning supplies and how they are used
* light bulbs, flash lights and the location of the fuse box
* the location and use of household appliances

Transportation

If free or low-cost transportation is not available, try to hire someone who drives since this saves you substantial amounts of money in taxi or commercial van ride fares. If the home care employee is going to drive your family car, you must inform your insurance company, and provide a copy of the aide’s driver’s license to your insurance agent. Your insurance company will check to see if the license has been revoked, suspended, or if the aide has an unsatisfactory driving history. If the home care assistant has a car, discuss use of her car on the job and insurance coverage.

Insurance and Payroll

Check with your insurance company about coverage for a home care employee, and contact the appropriate state and federal agencies concerning social security taxes, state and federal withholding taxes, unemployment insurance, and workman’s compensation.

If you do not want to deal with these somewhat complicated withholdings from the employee’s salary, payroll preparation services can issue the employee’s check with the necessary withholdings for a fee.

Some home care aides work as contractors. Even in these cases, you must report their earnings to the Internal Revenue Service. Before employing an aide on a contract basis, consult your financial advisor or tax preparer to make certain that you are following the IRS rules that govern contract workers, since there can be a fine line between who is considered to be an employee versus a contractor.

Ensuring Security

Regardless of who cares for your elderly relative, protect your private papers and valuables by putting them in a locked file cabinet, safe deposit box, or safe.

* Make arrangements to have someone you trust pick up the mail, or have it sent to a post box where you can pick it up.
* Check the phone bill for unauthorized calls, and, if necessary, have a block placed on 900 numbers, collect calls, and long-distance calls. You can always use a prepaid calling card for long distance calls.
* Protect checkbooks and credit cards. Never make them available to anyone you do not thoroughly trust.
* Review bank, credit card statements, and other bills at least once a month, and periodically request credit reports from a credit report company. Your bank can provide you with the names and addresses of these companies.
* If you do leave valuable possessions in the house, it is best to put locks on cabinets and closets and to have an inventory with photographs.

Protecting Against, Identifying, and Handling Abuse

Although abusive situations are not common, you must be alert to the possibility. They are one of the primary reasons why it is so important to carefully check the references of a prospective home care aide. You can help to prevent abuse situations by:

* Ensuring that the home care assistant thoroughly understands what the position entails, your care receiver’s medical problems and limitations, as well as behavior that could lead to stressful situations.
* Ensuring that the home care aide is not overburdened.
* Keeping the lines of communication fully open so that you can deal with potential problems.

Following are possible signs of abuse or neglect:

* Personality changes in your older relative or friend
* Whimpering, crying, or refusing to talk
* Unexplained or repeated bruises, fractures, burns, or pressure sores
* Weight loss
* An unkempt appearance
* Poor personal hygiene
* Dirty or disorganized living quarters
* Confusion, excessive sleeping, or other signs of inappropriate sedation

If you suspect that an abusive situation exists, don’t wait for it to be tragically confirmed. Find a way to check either by talking to the older person in a safe situation or, if necessary, by installing monitoring devices. If you witness, or are told by a reliable source, about neglect; physical abuse; emotional abuse, including yelling, threatening, or overly controlling, possessive behavior, which often involves isolating the older person from others; seek help, if necessary, and replace the home care aide as quickly as possible.If the situation appears serious, remove your care receiver from the premises and place him or her with another family member or in a facility that offers respite care. Always ensure that your relative is safe before confronting or dismissing the worker, especially if you are concerned about possible retaliation.

Once you have ensured your relative’s safety, report the aide to Adult Protective Services so they can take appropriate actions to prevent the aide from gaining employment with other vulnerable elders. If the abuse is of a serious nature including, serious neglect, physical injury, sexual abuse, or the misuse of the funds of the older person, you should also contact the police.

Supervising a Home Care Worker

Once you have hired a home care worker, make sure that the lines of communication are fully open and that both you and the worker have a clear understanding of the job responsibilities to the older person and to each other. Explain what you want done and how you would like it done, keeping in mind that the home care employee is there to care for the older person and not the rest of the family.

If the home care worker lives in, try to ensure that he or she has living quarters that provide you, the older person and the assistant the maximum amount of privacy possible.

Once the home care aide is on the job, periodic and/or ad hoc meetings can be held to discuss any problems the home care assistant or the older person may have with the arrangement and to find ways to resolve them. It is important to be positive and open in your approach to resolving difficulties. In most cases, they can be corrected.

However, if, after repeated attempts, you find that major problems are not resolved satisfactorily it may be best to terminate the relationship, and seek another home care employee. During this time, it may be necessary for your older relative to reside temporarily in a long-term care facility or for you to hire an aide through an agency. It is best to have reserve funds on hand should such an emergency arise.

While home care may not be less expensive than nursing home care or assisted living, it offers older people the opportunity to remain at home. What is more, it affords a degree of flexibility and choice for the at-risk elderly that few other living arrangements can provide.

Source: www.aoa.gov

Provided by: The Staff at www.RetirementConnection.com
For more information: www.aoa.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

Having Trouble Hearing?

Are you having a little trouble hearing lately? You are in good company. One of every ten Americans in this country experiences hearing loss. In the population group over 65 years of age, over 1/3 has a hearing loss. After age 75, about half experience hearing loss.

It takes an average of five to seven years before someone diagnosed with hearing loss does anything about it. And only 20% of the population that could benefit from hearing aids actually has them. As a long-time wearer of hearing aids, I want to offer some tips you may find useful if you are considering hearing aids.Get your ears examined by an ENT (Ear, Nose, Throat physician). Maybe you have a giant ball of earwax in your ear that is preventing you from hearing like you used to. You will also learn whether or not hearing aids will even help. Obtain a copy of your audiogram, too.

1. If hearing aids can help you, treat your hearing aid purchase like any other big ticket item, and shop around. Be a savvy hearing aid consumer by learning the licensing requirements for selling hearing aids in the state of Oregon (www.egov.oregon.gov/OHLA/HAS).

2. Hearing aid adjustment is a very personal process. You will want to buy hearing aids from a professional who will listen and take the time to make sure that your hearing aids are adjusted to your satisfaction (not just to match the manufacturer’s specifications or even your audiogram).

3. If a hearing aid is “on sale”, be cautious. Don’t fall for pressure tactics.

4. Also, don’t believe that the most expensive hearing aids are the “best”. A recent article in Hearing Loss magazine addressed this issue and concluded that the most expensive hearing aids are not necessarily “best”. Do you really need all those bells and whistles? Choosing manual controls instead of fully automatic controls will usually save a good deal of money. However, directional microphones really do help.

5. Consider purchasing behind the ear (BTE) hearing aids which generally last longer, have fewer problems, and offer the most flexibility. If your hearing loss gets worse, you may have adjustments made without needing to purchase new hearing aids.

6. Join Hearing Loss Association of America (HLA). HLA is the largest non-profit hearing loss advocacy group in the country (www.hearingloss.org).

7. Ask people you know for recommendations. If you don’t know anyone with hearing aids, attend a local HLA chapter meeting and ask members about their hearing aids.

Make sure your hearing aids have T-coils in them. T-coils give you more flexibility for using your hearing aids with telephones and other assistive technology.

8. Have realistic expectations about hearing aids. Hearing aids will not bring your hearing back in the same way that glasses restore vision.

9. Learn your rights as a hearing aid consumer (www.egov.oregon.gov/OHLA/HAS). If they don’t work out, you may receive a refund minus $250 per hearing aid, or 10% of the purchase price (whatever is less). Some professionals are willing to give you more than the state’s minimum requirements for returns.

10. Make sure you participate in hearing aid follow up and adjustments. In many cases, you have only 30 days to decide if you want to keep your hearing aids. But if you are actively seeking adjustments, you may have more time. If you’ve had hearing aid issues that have not been resolved, you can file a complaint with the Hearing Aid Licensing Board online, or at 503-378-8667, ext. 4314.

The state provides telecommunications equipment at no charge for people with hearing loss and other impairments. You may contact the state at 1-800-848-4442 or puc.tdap@state.or.us.

Although hearing aids do not restore hearing, they can greatly improve your quality of life. Hearing aids will help keep you connected to people in your world. Hear hear!

On behalf of the Disability & Business Technical Assistance Center (DBTAC), Andrea Olson, MS, CRC provides presentations on hearing loss, Americans with Disabilities Act (ADA), and other disability-related topics free to employers and groups. She has worn hearing aids for almost 40 years. Andrea may be contacted at hearforears@gmail.com or 503-452-8888.

Source: Disability & Business Technical Assistance Center (DBTAC), Andrea Olson, MS, CRC, Andrea may be contacted at hearforears@gmail.com or 503-452-8888.

Provided by: Andrea Olson, MS, CRC, Disability & Business Technical Assistance Center (DBTAC)
For more information: email hearforears@gmail.com, 503-452-8888

Copyright © 2008 RetirementConnection.com. All rights reserved.

 

 

Handicapped License Plates

Handicapped License Plates are generally administered by the Department of Motor Vehicles within each state. Each state manages their program, application process and renewal requirements. The following is a list of some of the general guidelines for Handicapped License Plates – note that this list will vary state by state:

* Handicapped License Plates provide that certain persons with temporary or permanent disabilities, or individuals and residential facilities that regularly transport individuals with disabilities are eligible for accessible parking placards and/or license plates for motor vehicles.
* Such individuals must obtain a statement or prescription from a physician or podiatrist.
* Provides for the issuance of special parking placards or license plates. This identification, or similar identification issued by another state, province or foreign country entitles parking in spaces reserved for people with disabilities. People with such identification can park for free at public metered spaces.
* Provides that people with disabilities may not loan their placards to others.
* Provides penalties for making, selling, or possessing fraudulent parking placards.
* Provides penalties for blocking access aisles or parking in accessible spaces to deliver goods.
* Allows people with disability placards or license plates to receive fuel pumping services (refueling) for self-service prices at stations where both services are available.
* Provides that certain veterans with disabilities are eligible to receive specialty license plates for two vehicles. Additionally, they may also receive two disabled parking placards.
* Permits a vehicle displaying a disabled veteran’s license plate to park in any parking spot reserved for a person with a disability.

Looking for Local Information?  * Use www.Google.com and search on: Handicapped License Plates Your City State

Source: The Staff at www.RetirementConnection.com
Copyright © 2008 RetirementConnection.com. All rights reserved.

Guilt-Free Vacation Tips for Families Who Care for Seniors

As summer swings into gear, families across the United States are hitting the road and skies in hopes of having a relaxing summer vacation. Although vacations are supposed to be a time of relaxation and enjoyment, many families who live with or regularly care for a senior citizen spend their vacations worrying about their elderly loved one at home.

Leaving a senior at home during vacation shouldn’t be a guilt-inducing situation. There are a number of steps you can take to make sure your loved one is relaxed and comfortable while you are away.

* Leave seniors with the proper supervision. Ask a trusted neighbor or friend to regularly check in or, if necessary, hire an in-home care agency to stay with your loved one until you return. Many in-home care agencies, such as Right at Home, are able to provide in-home care on a short-term basis.
* Leave your travel itinerary and the phone number(s) where you can be reached. Also, schedule one or two phone calls to check in with your loved one, such as 8 p.m. on Wednesday.
* Stock up on groceries and make sure all prescriptions are filled through the end of your vacation. Also, leave your living area clean and clutter-free to reduce the risk of falling.
* Arrange for any transportation needs that might arise such as a trip to the grocery store or a doctor’s appointment.

It is important to make your time away relaxing an enjoyable for your loved one. Plan special activities that give your senior something to look forward to such as arranging for a family friend or neighbor to take your loved one to dinner or for a walk. Your vacation can be just as much of a respite for your senior as it is for you.

Source:  Right at Home  503-574-3674
For more information: www.RAHcares.com, 503-574-3674

Copyright © 2008 RetirementConnection.com. All rights reserved.

Glossary of Clinical Trials Terms

The following glossary was prepared to help the consumer become familiar with many of the common terms used in clinical trials.

ADVERSE REACTION: (Adverse Event.) An unwanted effect caused by the administration of drugs. Onset may be sudden or develop over time.

ADVOCACY AND SUPPORT GROUPS: Organizations and groups that actively support participants and their families with valuable resources, including self-empowerment and survival tools.

APPROVED DRUGS: In the U.S., the Food and Drug Administration (FDA) must approve a substance as a drug before it can be marketed. The approval process involves several steps including pre-clinical laboratory and animal studies, clinical trials for safety and efficacy, filing of a New Drug Application by the manufacturer of the drug, FDA review of the application, and FDA approval/rejection of application.

ARM: Any of the treatment groups in a randomized trial. Most randomized trials have two “arms,” but some have three “arms,” or even more.

BASELINE: 1. Information gathered at the beginning of a study from which variations found in the study are measured. 2. A known value or quantity with which an unknown is compared when measured or assessed. 3. The initial time point in a clinical trial, just before a participant starts to receive the experimental treatment which is being tested. At this reference point, measurable values such as CD4 count are recorded. Safety and efficacy of a drug are often determined by monitoring changes from the baseline values.

BIAS: When a point of view prevents impartial judgment on issues relating to the subject of that point of view. In clinical studies, bias is controlled by blinding and randomization.

BLIND: A randomized trial is “Blind” if the participant is not told which arm of the trial he is on. A clinical trial is “Blind” if participants are unaware on whether they are in the experimental or control arm of the study; also called masked.

CLINICAL: Pertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science.

CLINICAL ENDPOINT: See Endpoint.

CLINICAL INVESTIGATOR: A medical researcher in charge of carrying out a clinical trial’s protocol.

CLINICAL TRIAL: A clinical trial is a research study to answer specific questions about vaccines or new therapies or new ways of using known treatments. Clinical trials (also called medical research and research studies) are used to determine whether new drugs or treatments are both safe and effective. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people. Trials are in four phases: Phase I tests a new drug or treatment in a small group; Phase II expands the study to a larger group of people; Phase III expands the study to an even larger group of people; and Phase IV takes place after the drug or treatment has been licensed and marketed.

COHORT: In epidemiology, a group of individuals with some characteristics in common.

COMMUNITY-BASED CLINICAL TRIAL (CBCT): A clinical trial conducted primarily through primary-care physicians rather than academic research facilities.

COMPASSIONATE USE: A method of providing experimental therapeutics prior to final FDA approval for use in humans. This procedure is used with very sick individuals who have no other treatment options. Often, case-by-case approval must be obtained from the FDA for “compassionate use” of a drug or therapy.

COMPLEMENTARY AND ALTERNATIVE THERAPY: Broad range of healing philosophies, approaches, and therapies that Western (conventional) medicine does not commonly use to promote well-being or treat health conditions. Examples include acupuncture, herbs, etc.

COMPLETED: See Recruitment Status

CONFIDENTIALITY REGARDING TRIAL PARTICIPANTS: Refers to maintaining the confidentiality of trial participants including their personal identity and all personal medical information. The trial participants’ consent to the use of records for data verification purposes should be obtained prior to the trial and assurance must be given that confidentiality will be maintained.

CONTRAINDICATION: A specific circumstance when the use of certain treatments could be harmful.

CONTROL: A control is the nature of the intervention control.

CONTROL GROUP: The standard by which experimental observations are evaluated. In many clinical trials, one group of patients will be given an experimental drug or treatment, while the control group is given either a standard treatment for the illness or a placebo.

CONTROLLED TRIALS: Control is a standard against which experimental observations may be evaluated. In clinical trials, one group of participants is given an experimental drug, while another group (i.e., the control group) is given either a standard treatment for the disease or a placebo.

DATA SAFETY AND MONITORING BOARD (DSMB): An independent committee, composed of community representatives and clinical research experts, that reviews data while a clinical trial is in progress to ensure that participants are not exposed to undue risk. A DSMB may recommend that a trial be stopped if there are safety concerns or if the trial objectives have been achieved.

DIAGNOSTIC TRIALS: Refers to trials that are conducted to find better tests or procedures for diagnosing a particular disease or condition. Diagnostic trials usually include people who have signs or symptoms of the disease or condition being studied.

DOSE-RANGING STUDY: A clinical trial in which two or more doses of an agent (such as a drug) are tested against each other to determine which dose works best and is least harmful.

DOUBLE-BLIND STUDY: A clinical trial design in which neither the participating individuals nor the study staff knows which participants are receiving the experimental drug and which are receiving a placebo (or another therapy). Double-blind trials are thought to produce objective results, since the expectations of the doctor and the participant about the experimental drug do not affect the outcome; also called double-masked study.

DOUBLE-MASKED STUDY: See Double-Blind Study.

DRUG-DRUG INTERACTION: A modification of the effect of a drug when administered with another drug. The effect may be an increase or a decrease in the action of either substance, or it may be an adverse effect that is not normally associated with either drug.

DSMB: See Data Safety and Monitoring Board.

EFFICACY: (Of a drug or treatment). The maximum ability of a drug or treatment to produce a result regardless of dosage. A drug passes efficacy trials if it is effective at the dose tested and against the illness for which it is prescribed. In the procedure mandated by the FDA, Phase II clinical trials gauge efficacy, and Phase III trials confirm it.

ELIGIBILITY CRITERIA: Summary criteria for participant selection; includes Inclusion and Exclusion criteria. See Inclusion/Exclusion criteria.

EMPIRICAL: Based on experimental data, not on a theory.

ENDPOINT: Overall outcome that the protocol is designed to evaluate. Common endpoints are severe toxicity, disease progression, or death.

ENROLLING: The act of signing up participants into a study. Generally this process involves evaluating a participant with respect to the eligibility criteria of the study and going through the informed consent process.

EPIDEMIOLOGY: The branch of medical science that deals with the study of incidence and distribution and control of a disease in a population.

EXCLUSION/INCLUSION CRITERIA: See Inclusion/Exclusion criteria.

EXPANDED ACCESS: Refers to any of the FDA procedures, such as compassionate use, parallel track, and treatment IND that distribute experimental drugs to participants who are failing on currently available treatments for their condition and also are unable to participate in ongoing clinical trials.

EXPERIMENTAL DRUG: A drug that is not FDA licensed for use in humans, or as a treatment for a particular condition (See Off Label Use).

FDA: See Food and Drug Adminstration.

FOOD AND DRUG ADMINISTRATION (FDA): The U.S. Department of Health and Human Services agency responsible for ensuring the safety and effectiveness of all drugs, biologics, vaccines, and medical devices, including those used in the diagnosis, treatment, and prevention of HIV infection, AIDS, and AIDS-related opportunistic infections. The FDA also works with the blood banking industry to safeguard the nation’s blood supply. Internet address: http://www.fda.gov/.

HYPOTHESIS: A supposition or assumption advanced as a basis for reasoning or argument, or as a guide to experimental investigation.

INCLUSION/EXCLUSION CRITERIA: The medical or social standards determining whether a person may or may not be allowed to enter a clinical trial. These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions. It is important to note that inclusion and exclusion criteria are not used to reject people personally, but rather to identify appropriate participants and keep them safe.

IND: See Investigational New Drug.

INFORMED CONSENT: The process of learning the key facts about a clinical trial before deciding whether or not to participate. It is also a continuing process throughout the study to provide information for participants. To help someone decide whether or not to participate, the doctors and nurses involved in the trial explain the details of the study.

INFORMED CONSENT DOCUMENT: A document that describes the rights of the study participants, and includes details about the study, such as its purpose, duration, required procedures, and key contacts. Risks and potential benefits are explained in the informed consent document. The participant then decides whether or not to sign the document. Informed consent is not a contract, and the participant may withdraw from the trial at any time.

INSTITUTIONAL REVIEW BOARD (IRB): 1. A committee of physicians, statisticians, researchers, community advocates, and others that ensures that a clinical trial is ethical and that the rights of study participants are protected. All clinical trials in the U.S. must be approved by an IRB before they begin. 2. Every institution that conducts or supports biomedical or behavioral research involving human participants must, by federal regulation, have an IRB that initially approves and periodically reviews the research in order to protect the rights of human participants.

INTENT TO TREAT: Analysis of clinical trial results that includes all data from participants in the groups to which they were randomized even if they never received the treatment.

INTERVENTION NAME: The generic name of the precise intervention being studied.

INTERVENTIONS: Primary interventions being studied: types of interventions are Drug, Gene Transfer, Vaccine, Behavior, Device, or Procedure.

INVESTIGATIONAL NEW DRUG: A new drug, antibiotic drug, or biological drug that is used in a clinical investigation. It also includes a biological product used in vitro for diagnostic purposes.

IRB: See Institutional Review Board.

MASKED: The knowledge of intervention assignment.

NATURAL HISTORY STUDY: Study of the natural development of something (such as an organism or a disease) over a period of time.

NEW DRUG APPLICATION (NDA): An application submitted by the manufacturer of a drug to the FDA – after clinical trials have been completed – for a license to market the drug for a specified indication.

OFF-LABEL USE: A drug prescribed for conditions other than those approved by the FDA.

OPEN-LABEL TRIAL: A clinical trial in which doctors and participants know which drug or vaccine is being administered.

ORPHAN DRUGS: An FDA category that refers to medications used to treat diseases and conditions that occur rarely. There is little financial incentive for the pharmaceutical industry to develop medications for these diseases or conditions. Orphan drug status, however, gives a manufacturer specific financial incentives to develop and provide such medications.

PEER REVIEW: Review of a clinical trial by experts chosen by the study sponsor. These experts review the trials for scientific merit, participant safety, and ethical considerations.

PHARMACOKINETICS: The processes (in a living organism) of absorption, distribution, metabolism, and excretion of a drug or vaccine.

PHASE I TRIALS: Initial studies to determine the metabolism and pharmacologic actions of drugs in humans, the side effects associated with increasing doses, and to gain early evidence of effectiveness; may include healthy participants and/or patients.

PHASE II TRIALS: Controlled clinical studies conducted to evaluate the effectiveness of the drug for a particular indication or indications in patients with the disease or condition under study and to determine the common short-term side effects and risks.

PHASE III TRIALS: Expanded controlled and uncontrolled trials after preliminary evidence suggesting effectiveness of the drug has been obtained, and are intended to gather additional information to evaluate the overall benefit-risk relationship of the drug and provide and adequate basis for physician labeling.

PHASE IV TRIALS: Post-marketing studies to delineate additional information including the drug’s risks, benefits, and optimal use.

PLACEBO: A placebo is an inactive pill, liquid, or powder that has no treatment value. In clinical trials, experimental treatments are often compared with placebos to assess the treatment’s effectiveness.

PLACEBO CONTROLLED STUDY: A method of investigation of drugs in which an inactive substance (the placebo) is given to one group of participants, while the drug being tested is given to another group. The results obtained in the two groups are then compared to see if the investigational treatment is more effective in treating the condition.

PLACEBO EFFECT: A physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance.

PRECLINICAL: Refers to the testing of experimental drugs in the test tube or in animals – the testing that occurs before trials in humans may be carried out.

PREVENTION TRIALS: Refers to trials to find better ways to prevent disease in people who have never had the disease or to prevent a disease from returning. These approaches may include medicines, vaccines, vitamins, minerals, or lifestyle changes.

PROTOCOL: A study plan on which all clinical trials are based. The plan is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following a protocol are seen regularly by the research staff to monitor their health and to determine the safety and effectiveness of their treatment.

QUALITY OF LIFE TRIALS (or Supportive Care trials): Refers to trials that explore ways to improve comfort and quality of life for individuals with a chronic illness.

RANDOMIZATION: A method based on chance by which study participants are assigned to a treatment group. Randomization minimizes the differences among groups by equally distributing people with particular characteristics among all the trial arms. The researchers do not know which treatment is better. From what is known at the time, any one of the treatments chosen could be of benefit to the participant.

RANDOMIZED TRIAL: A study in which participants are randomly (i.e., by chance) assigned to one of two or more treatment arms of a clinical trial. Occasionally placebos are utilized.

RECRUITING: The period during which a trial is attempting to identify and enroll participants. Recruitment activites can include advertising and other ways of solicting interest from possible particpants.

RECRUITMENT STATUS: Indicates the current stage of a trial, whether it is planned, ongoing, or completed. Possible values include:

* Not yet recruiting: participants are not yet being recruited or enrolled
* Recruiting: participants are currently being recruited and enrolled
* Enrolling by invitation: participants are being (or will be) selected from a predetermined population
* Active, not recruiting: study is ongoing (i.e., patients are being treated or examined), but enrollment has completed
* Completed: the study has concluded normally; participants are no longer being examined or treated (i.e., last patient’s last visit has occurred)
* Suspended: recruiting or enrolling participants has halted prematurely but potentially will resume
* Terminated: recruiting or enrolling participants has halted prematurely and will not resume; participants are no longer being examined or treated
* Withdrawn: study halted prematurely, prior to enrollment of first participant

RISK-BENEFIT RATIO: The risk to individual participants versus the potential benefits. The risk/benefit ratio may differ depending on the condition being treated.

SCREENING TRIALS: Refers to trials which test the best way to detect certain diseases or health conditions.

SIDE EFFECTS: Any undesired actions or effects of a drug or treatment. Negative or adverse effects may include headache, nausea, hair loss, skin irritation, or other physical problems. Experimental drugs must be evaluated for both immediate and long-term side effects.

SINGLE-BLIND STUDY: A study in which one party, either the investigator or participant, is unaware of what medication the participant is taking; also called single-masked study.

SINGLE-MASKED STUDY: See Single-Blind Study

STANDARD TREATMENT: A treatment currently in wide use and approved by the FDA, considered to be effective in the treatment of a specific disease or condition.

STANDARDS OF CARE: Treatment regimen or medical management based on state of the art participant care.

STATISTICAL SIGNIFICANCE: The probability that an event or difference occurred by chance alone. In clinical trials, the level of statistical significance depends on the number of participants studied and the observations made, as well as the magnitude of differences observed.

STUDY ENDPOINT: A primary or secondary outcome used to judge the effectiveness of a treatment.

STUDY TYPE: The primary investigative techniques used in an observational protocol; types are Purpose, Duration, Selection, and Timing.

SUSPENDED: See Recruitment Status

TERMINATED: See Recruitment Status

TOXICITY: An adverse effect produced by a drug that is detrimental to the participant’s health. The level of toxicity associated with a drug will vary depending on the condition which the drug is used to treat.

TREATMENT IND: IND stands for Investigational New Drug application, which is part of the process to get approval from the FDA for marketing a new prescription drug in the U.S. It makes promising new drugs available to desperately ill participants as early in the drug development process as possible. Treatment INDs are made available to participants before general marketing begins, typically during Phase III studies. To be considered for a treatment IND a participant cannot be eligible to be in the definitive clinical trial.

TREATMENT TRIALS: Refers to trials which test new treatments, new combinations of drugs, or new approaches to surgery or radiation therapy.

WITHDRAWN: See Recruitment Status.

Source: ClinicalTrials.gov, AIDSinfo: Glossary of HIV/AIDS-Related Terms, 4th Edition, CenterWatch, Inc. Patient Resources: Glossary., ECRI (formerly the Emergency Care Research Institute)., Eli Lilly and Company: Lilly Clinical Trials Glossary., MediStudy.com Inc: ClinicalTrials: A-Z Glossary, National Cancer Institute. http://clinicaltrials.gov

Provided by: The Staff at www.RetirementConnection.com
For more information: http://clinicaltrials.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

Enjoying retirement, traveling, spending time with family or exploring new activities and interests are part of growing older. But age can also bring with it anxiety and worry, and some unique concerns about health and well-being and taking care of family. These concerns are usually grouped together in an area of law known as “elder law”. The following is a thumb-nail of topics that an elder law attorney can help with.

Estate Planning

Estate planning is really caring for your loved ones, seeing that they are provided for, and making sure your property is distributed according to your wishes. This can be accomplished through a variety of techniques, including wills and/or living trusts.

Durable Power of Attorney

A person can appoint someone else to manage his financial affairs if he is unable to do so. This Durable Power of Attorney is a preferred way of providing for the proper management of one’s financial affairs in the event of incapacity.

Advance Directive for Health Care

A person can give health care instructions to his physician and name a person to make health care decisions, such as the selection of hospitals, doctors or type of medical treatment, if he is unable to make those decisions for himself. This is called an Advance Directive for Health Care. This document also allows a person to give specific instructions about life support measures.

Guardianship & Conservatorship

If a person becomes incapacitated and has done no advance planning, the only legal means by which even a family member can take care of that person is to petition the court for the appointment of a guardian and conservator. This process is an ongoing and court controlled proceeding that is time consuming and expensive. It is the least desirable way of property and personal management.

Medicaid

Medicaid eligibility rules are complex and ever changing. Strategies for long term care planning and asset protection are always in a state of flux. An elder law attorney can guide you and your family through the many challenging issues that arise as life circumstances change.

When the end nears…

Healthcare crisis management is one of the biggest reasons people seek out an elder law attorney. But, the best time to find an elder law attorney is before a crisis. Advance planning avoids many problems, and helps achieve peace of mind for yourself and your loved ones.

Article Provided by:
Kathy Belcher, McGinty & Belcher, Attorneys
503-371-9636, www.mcginty-belcher.com

Copyright © 2008 RetirementConnection.com. All rights reserved.

Who is Getting ADL Assistance?

Many older community-dwelling adults reside with a caregiver, either family or nonfamily members. This living arrangement may result from one or more of the following situations: marriage, cultural norms (1), or the financial need or functional impairment of the care recipient (2).

Combined data on discharged patients from the 1998 and 2000 National Home and Hospice Care

Surveys reveal that 76 percent of those 65 years and over usually lived with their primary caregiver during the episode of care. A primary caregiver is an individual who is responsible for providing personal care assistance, companionship, and/or supervision to a patient (3). Over 80 percent of the primary caregivers in our sample were informal caregivers: spouses or children (including daughters-in-law or sons-in-law). More males than females lived with their primary caregiver, 90 percent versus 68 percent (p < 0.001), most likely due to men being cared for by their spouses who outlived them.

Oftentimes, co-residence with a primary caregiver is initiated when an older adult shows signs of activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations that require caregiver involvement (2). Moreover, having a caregiver and receiving assistance with ADLs are strongly associated with using home health services (4). This analysis uses data from the 1998 and 2000 NHHCS to examine ADL assistance received by home health patients ages 65 years and over and the extent to which receipt of services is related to sex. The NHHCS collects data about characteristics of home health care and hospice agencies and their patients using agency reports and medical records. The surveys collected information about the primary caregiver the patients had during the episode of care. It also collected information on the receipt of services for ADLs during this episode.

Significant differences were found between the sexes in the receipt of ADL assistance. Specifically, more women than men received assistance with any activity of daily living overall, 53 percent compared to 42 percent, respectively. Almost half of the female patients (45 percent) received assistance from a home health agency to bathe or shower compared to more than one-third of male patients (35 percent). Eating assistance was almost twice as likely among female patients as male. In addition, 25 percent of females received assistance from the agency in using the toilet room compared to 16 percent of males.

What do these data tell us?

The NHHCS data reveal that although men were more likely to live with their primary caregiver, women were more likely to receive formal services related to personal care. This demonstrates that informal caregivers, particularly of older women, do not provide all the necessary assistance; therefore, the patient still requires the help of formal care services. Although one would presume that women’s older age caused them to receive more help, the data show that the difference in mean age was statistically, but not clinically, significant: 78.66 (standard error (S.E.) = 0.39) for women versus 77.39 (S.E. = 0.41) for men. On the other hand, the data reveal a significant difference in the percentage of females, 85 years and over, compared to males: 25 percent versus 18 percent, respectively (data not shown). Generally speaking, receiving assistance suggests more functional limitation or impairment, whether acute or chronic, among women for which the primary caregiver is unable or unwilling to provide. In fact, a recent publication emphasizes the importance of informal caregivers in our long-term care system and also reveals that many of them have health problems themselves (5). This may explain, in part, why many informal caregivers do not provide assistance in all personal care activities, such as bathing or showering, eating, or using the toilet room. Future NHHCS surveys (the next one will be administered in 2007) that collect information on who assisted the sampled patients with each ADL will provide data to address these issues more. Such data will also provide information about the potential needs of and the subsequent services necessary for patients after discharge from a home health agency.

Conclusion

There are significant differences between community-dwelling older men and women living with a primary caregiver in the services they received from home health agencies. A greater percentage of women than men received assistance for personal care activities, such as bathing or showering, eating, or toileting, even while residing with a primary caregiver. This underscores the importance of community resources (i.e., formal care services) that provide older women and their caregivers with ADL assistance and other services to help alleviate the burden of care due to functional limitations.

References

1. Himes CL, Hogan DP, Eggebeen DJ. Living arrangements of minority elders. Gerontology: Social Sciences 51B(1): S42?S48. 1996.

2. Mickus M, Stommel M, Given CW. Changes in living arrangements of functionally dependent older adults and their adult children. Aging Health 9(1): 126?143. February 1997.

3. Haupt BJ. Characteristics of hospice care discharges and their length of service: United States, 2000. National Center for Health Statistics. Vital Health Stat 13(154). 2003.

4. Kadushin G. Home health care utilization: a review of the research for social work. Health So Work 29(3): 219?244. August 2004.

5. Ho A, Collins SR, Davis K, Doty MM. A look at working-age caregivers roles, health concerns, and need for support. Commonwealth Fund pub. #854, August 2005.

Source: Lisa L. Dwyer, M.P.H., Division of Health Care Statistics, National Center for Health Statistics, www.cdc.gov

Provided by: The Staff at www.RetirementConnection.com
For more information: www.cdc.gov

Copyright © 2008 RetirementConnection.com. All rights reserved.

Generics: a Great Way to Cut Health Care Costs

A great way to cut health care costs is to find a generic drug that works just as well as your expensive brand-name drug. But how can you be sure that a generic is as good as the drugs you see advertised on TV?

It may help to learn what a generic is.

Generic drugs are simply drugs whose brand-name patent has expired. They may look different because the brand-name drug is protected by trademark. They may contain different inactive ingredients (such as coloring) that have no effect on the drug’s performance. But the active ingredients that treat the medical condition are the same.

The Food and Drug Administration (FDA) requires all drugs, including generics, to be safe and effective. The FDA tests drug-manufacturing facilities routinely, and tests all generic drugs rigorously to make sure they are “bioequivalent.” That means they have the same active ingredients and can be expected to work the same way in the body as the brand-name drug. They also must have the same dosage, strength and form (such as pill or liquid).

In fact, many brand-name drug manufacturers even make and sell the generic versions. According to the FDA, brand-name manufacturers are involved with about half of all generic drug production.

Then why are generics cheaper? Patents give drug manufacturers exclusive rights to sell brand-name drugs for a number of years. During that time, they charge high prices to cover the average $800 million for research, development, getting the patent, marketing and advertising to bring each new drug to market.Generic drug manufacturers don’t have these up-front costs. Plus they compete with other manufacturers. As a result, generics cost 30 to 80 percent less than brands.

Finally, many studies show that the “new” brand-name drugs may not be safer or work better than older generic drugs. The bottom line: Generic drugs have the same therapeutic benefit, quality, purity and safety as brand-name counterparts. They help reduce drug costs while maintaining care quality. Many health insurers charge copayments for generics that are substantially lower than the copayments for brand-name drugs.

To learn more, talk with your doctor, pharmacist, other health care professional or health plan representative. If you want to find out if there are generic options for your prescriptions, Consumer Reports’ Best Buy Drugs and the Agency for Healthcare Quality and Research give cost-effective prescription options for common medical conditions.

Source:  CareOregon, www.CareOregon.org, 800-224-4840
For more information: www.CareOregon.org, 800-224-4840

Copyright © 2008 RetirementConnection.com. All rights reserved.

Finding Quality Home Health Care

As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.

In looking for a home health care agency, the following 20 questions can be used to help guide your search:

1. How long has the agency been serving this community?

2. Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.

3. Is the agency an approved Medicare provider?

4. Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations?

5. Does the agency have a current license to practice (if required in the state where you live)?

6. Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?

7. Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary?

8. Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?

9. How closely do supervisors oversee care to ensure quality?

10. Will agency caregivers keep family members informed about the kind of care their loved one is getting?

11. Are agency staff members available around the clock, seven days a week, if necessary?

12. Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?

13. How does the agency ensure patient confidentiality?

14. How are agency caregivers hired and trained?

15. What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?

16. How does the agency handle billing?

17. Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?

18. Will the agency provide a list of references for its caregivers?

19. Who does the agency call if the home health care worker cannot come when scheduled?

20. What type of employee screening is done?

More About the Screening Process

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have.

For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first. Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem.

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

* Illnesses/injuries, and signs of an emergency medical situation
* Likes and dislikes
* Medications, and how and when they should be taken
* Need for dentures, eyeglasses, canes, walkers, etc.
* Possible behavior problems and how best to deal with them
* Problems getting around (in or out of a wheelchair, for example, or trouble walking)
* Special diets or nutritional needs
* Therapeutic exercises
* In addition, you should give the home health care provider more information about:
* Clothing the senior may need (if/when it gets too hot or too cold)
* How you can be contacted (and who else should be contacted in an emergency)
* How to find and use medical supplies and medications
* When to lock up the apartment/house and where to find the keys
* Where to find food, cooking utensils, and serving items
* Where to find cleaning supplies
* Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure)
* Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them)

A Word of Caution …

Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

How Can I Pay for Home Health Care?

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance. Medicare is the largest single payer of home care services.

For More Information

AoA recognizes the importance of making information readily available to consumers, professionals, researchers, and students. Our website provides information for and about older persons, their families, and professionals involved in aging programs and services. For more information about AoA, please contact: US Dept of Health and Human Services, Administration on Aging, Washington, DC 20201; phone (202) 619-0724; fax (202) 357-3523; Email: aoainfo@aoa.gov or contact our website at www.aoa.gov.

Medicare and Home Health Care

The Medicare program will pay for home health care if all of the following conditions are met:

1. The patient must be homebound and under a doctor’s care

2. The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)

3. The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient

4. The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”

5. The home health care agency providing the services must be certified by the Medicare program.

6. To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at: http://www.medicare.gov/.

Learn more About Home Health Care

There are several national organizations that can provide additional consumer information about home health care services. These include the following:

The National Association for Home Care www.nahc.org

The Visiting Nurse Associations of America www.vnaa.org

The Eldercare Locator www.eldercare.gov

To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging at 1-800-677-1116 to help connect you to these agencies.

Source: U.S. Department of Health and Human Services Administration on Aging, www.aoa.gov

Provided by: The Staff at www.RetirementConnection.com
For more information: www.AoA.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.