Home health care—coming of age

Census figures show that 9.2 million or 31 percent of people over age 65 live alone. By 2020 that number is estimated to grow to 15.2 million. Older Americans living alone due to the death of a spouse are increasing rapidly. Three quarters of older Americans who live alone are women. Almost half are just above the poverty line. Being alone increases the risk of poor nutrition and nursing home admission.

Children of older Americans are often not able to provide the kind of time needed to support an older parent living alone. Baby boomers have fewer children than their parents and their off-spring sometimes live far away. As boomers age, there are likely to be fewer family members able to provide in home care for them. Because of these trends, the aging population will come to rely on home health care agencies more than prior generations.

Many Americans worry about the prospect of leaving their homes due to a medical disability or aging. Caring for a relative in the home can be very stressful according to the Journal of the American Medical Association. It can even lead to illness for the caregiver.

The National Association of Home Care estimates 8 million Americans currently receive acute or long term care in the home. When skilled nursing services are needed, a doctor can work out a plan with a visiting nurse organization and supervise the continued services. When a lower level of care is needed, home health agencies, homemaker and home care aide services, medical equipment suppliers, hospice agencies, visiting and private duty nurses and therapists are available.

The Area Agency on Aging can provide evaluations and services for older Pennsylvanians. Local agencies often have adult daycare services to enable caregivers to continue to work outside the home. Some offer in-home care services to aid with daily activities such as dressing and bathing, in addition to Meals on Wheels and nutrition education, and family caregiver support.

Medicare and Medicaid provide coverage as long as one is homebound or recovering from a hospitalization. Many insurance companies pay for some or all aspects of home care because it is considerably less expensive than hospital or nursing home care. Although out-of-pocket payment may be required in some cases.

There has been increasing interest in reverse mortgages to help pay for long term care needs. In a reverse mortgage, one borrows against the equity in their home, but there is no payment schedule or requirement to repay by a certain time. The borrowed funds can be paid as needed or on a regular basis.

As with many aspects of life, advance planning can reduce the stress. It’s usually easier to make decisions when there’s no crisis. Determine in advance who will be available to help, how much money might be available, is staying in the home an option, what services will be needed and how will they be provided? It’s not fun to plan for being less independent, but it beats being unprepared for the day when home care is needed.

Information is available from most Area Agencies on Aging and through Pennsylvania’s Department of Aging or at: http://www.aging.state.pa.us/

The National Association of Home Care website http://www.nahc.org/Consumer/coninfo.html has information on finding and choosing a home health care provider.

And there is training for family caregivers of in home care at Penn State Hershey Medical Center at http://www.hmc.psu.edu/copelink/