If you are a caregiver and need help, chances are that assistance is available in your community. There are many different government and privately funded services that may be available. Most of the programs and services mentioned in this guide are federally funded through the Older Americans Act. You can get information about these services and programs in communities throughout the nation by calling the Eldercare Locator at 1-800-677-1116. Staff is available from 9:00 A.M. to 8:00 P.M. EST, Monday-Friday.

While some services are free, others are fee-based. In-home and community-based services that you might find helpful include:

• Personal and in-home services
• Home health care
• Transportation
• Meals programs
• Cleaning and yard work services
• Home modification
• Senior centers
• Respite services including adult day care

Personal and In-Home Care Services

Personal and in-home care assistants help with bathing, dressing, preparing meals, house cleaning, laundry, toileting, and other personal “activities of daily living.”

Home Health Care

Home health care includes such care activities as changing wound dressings, checking vital signs, cleaning catheters and providing tube feedings. Home health care staff also may provide some personal care services and light housekeeping.
If the older person for whom you are caring is recuperating from an accident, operation, or illness, he or she may be able to receive home health care assistance through a Medicare certified home care agency. If older persons cannot care for themselves because of physical functioning, health problems, or because they no longer are able to mentally process things, they may be eligible for skilled nursing care or physical, speech, or occupational therapy. In these cases, home health care also may be available. Ask your older relative’s doctor if your family member is eligible for these services.

To find out more about home health care, check “Home Health,” a publication by the Centers for Medicare and Medicaid Services (CMS)-formerly the Health Care Financing Administration (HCFA)–the federal agency that administers the Medicare program, or talk to the doctor who is caring for your family member.Medicare usually pays for home health care services for two or three hours a day, several days a week, and for the medical care provided by a doctor, nurse, or other health professional. Such care tends to be for a limited time.

If the person for whom you are caring has a limited income and assets, he or she may be able to receive home health care, personal care, or hospice services as well as occupational, physical, or speech therapy through Medicaid (a federal-state program, administered by CMS at the federal level). Some older persons with limited assets and income are eligible for help through both the Medicare and the Medicaid programs. If this is the case, your care receiver may be able to obtain personal and/or home health care services on a long-term basis instead of being cared for in an extended care facility. Otherwise, in-home and community-based services may be available through an Area Agency on Aging.

Middle and higher-income persons often pay out-of-pocket for personal and home health care services. If you hire staff through a home care agency, ask the agency how they screen their staff and if staff is bonded. Agencies charge you for the costs of doing business; i.e., for management, administration, and recruiting workers. This can be quite expensive, but there are ways to make help more affordable. For example, you can explore the possibility of directly hiring a personal or home health care assistant. If you choose to hire help, be sure to check their qualifications and references carefully. Remember, you will then be an employer, and you may need to cover Social Security and other benefits. (See the Section on How Do I Hire a Home Care Employee?)

Respite Care

Respite care can be a voluntary or paid service. It can be provided in your relative’s home, in an extended care facility, such as a nursing home, or at a senior center or adult day care center. Respite care can extend for a few hours or for several weeks. It provides the caregiver with opportunities to take care of personal affairs, to get some rest, or to take a vacation.

Transportation

Transportation services are vitally important to older persons with limited mobility. Transportation enables them to go to their doctors, to the pharmacy, and to attend to day-to-day activities.

Many public mass transit systems are fitting buses and other vehicles with hydraulic lifts and other aids to assist older persons and others that have physical disabilities. Sometimes several transit systems operate independently of each other. Transportation options may be available through private companies and private non-profit organizations. These include public fixed-route, demand-response, ride sharing, volunteer drivers, limousines, buses, vans, and regular and special purpose taxis. Some services provide an escort to assist older people.

To arrange transportation for an older person in your community, contact your local Area Agency on Aging (it is listed under “aging,” “elderly,” or “senior services” in the government section of your telephone directory). Area Agencies on Aging provide older persons and their caregivers with specific information and assistance in getting transportation and other supportive services in the community.

If you want information about safe driving and older drivers you may want to contact the National Highway Traffic Safety Administration.

Meals

Good nutrition can help to improve health and control a range of conditions and diseases. The National Elderly Nutrition Program, funded by the Administration on Aging, provides meals to older persons in need and their spouses. Older persons who participate in the group meal program have an opportunity to socialize, receive nutrition education, and take part in other activities, including health screenings.

Elderly persons who are ill or frail may be able to receive a government-subsidized home-delivered meal. To find out about home-delivered meals programs and other meals programs, please contact the National Eldercare Locator or your State or Area Agency on Aging.

If these meals are not available, see if your grocery store prepares food orders for pick-up or if it provides home-delivery service. A growing number of grocery and meal services are available via the Internet including some that offer organic, ethnic and kosher foods. Many local restaurants deliver meals without additional charge and some even offer senior discounts on meals. A growing number of restaurants offer special low-fat and low-salt meals.

There also are local and national franchised meals delivery services. These are listed in the yellow pages of the telephone directory under “foods-take out”; some can be found on the Internet.

Cleaning and Yard Work Services

An Area Agency on Aging may be able arrange for chore and yard maintenance services or put you in touch with religious, scout or other volunteer groups that provide one-time or occasional services to older persons who need help. Of course, you can hire a cleaning service or yard maintenance firm, but this may be more expensive than hiring someone that works as an independent contractor.

Home Modification, Improvement, and Weatherization Programs

Home modification and repair programs can make homes safer and more energy efficient. They can result in greater independence for an older person with disabilities. The Home Modification Action Project at the University of Southern California’s Andrus Gerontology Center has online consumer oriented information and publications on accommodations and modifications and how to pay for these. There is information on how to make dwelling units safe for persons with Alzheimer’s Disease. There also is information for builders, a library of useful publications on housing adaptation, and links to other useful web sites.

Senior Centers

Seniors Centers offer older people a safe environment where they can take part in a range of activities led by trained personnel that promote healthy lifestyles and where they can develop a network of friends.

Meal and nutrition programs, information and assistance, health and wellness programs, recreational and arts programs, transportation services, volunteer opportunities, educational opportunities, employee assistance, intergenerational programs, social and community action opportunities and other special services are often available through a senior center.

Adult Day Care Services

For older persons with serious limitations in their mobility, those who are frail, and those who have medical and cognitive problems, adult day care centers can provide care in a safe, structured environment. Adult day care can provide relief to working caregivers and respite for full-time caregivers. Adult day care services include personal and nursing care, congregate meals, therapeutic exercises, and social and recreational activities.

Most adult day care centers, like senior centers, are supported through public and non-profit organizations. Fees may range from a few dollars a day to close to $200, depending on the services needed. The National Council on the Aging maintains a directory of adult day care centers and links to other related sites.

Additional Resources and Reading Lists

The Administration on Aging-operated National Aging Information Center Internet Notes home design web page is full of web sites that provide useful information on home modifications, home design, and home safety for the elderly.

To find out about eligibility requirements for benefits under both the Medicare and Medicaid programs, go to the Health Care Financing Administration’s dual eligible web site.

Source: The Administration on Aging. www.aoa.gov
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