Tag Archive | minimal assistance

Regaining confidence

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Recently I decided that it was time to let my sewing machine go. Besides, it
has been just sitting there collecting dust for over three years. Before I had surgery, I was already experiencing diminished feeling in my legs and feet. I could no longer use the foot peddle, but I held out hope that someday  especially aftermy surgery I would be back to making things. Well, that dream disappeared that fateful day when I got out of bed and lost all feeling from the waist down. But in the back of my mind I was still hopeful, as I believe that God gives usgifts and He wants us to pursue them.

So, before I listed my almost new sewing machine for sale, I decided to give
sewing and using the foot peddle one more try. Besides, I had promised my 9 years old grandson I would make him a blanket. He had picked out a soft greenand tan camouflage material with a dark green edging about two months ago with the understanding that it may be a terribly slow process especially if I had to make it by hand. I had resigned myself to having to sew the blanket by hand, but this is what happened.

Not bad for not having used a sewing machine in a little more than 3yrs. Lots of conversations with God asking him for strength, steadiness, and the ability to finish. My grandson loves his new blanket!

Well, looks like I will be keeping my sewing machine and continue creating. Although I doubted myself,God was there to show me that He is there every step of the way . He has restored some of my confidence which had faded in the midst of my injury. God wants nothing more than to restore us and to give us happiness. We can choose to see all the negatives or we can let the past be the past and keep moving forward making new paths. We can always tell a better story.

Little improvements

Standing doing my hair without any assistive devices! My balance has improved thanks to doing yoga with an instructor 2x per week (5 weeks so far) and using my LifeGlider.

I did have a recent fall🤪. I was bending down to pick something up off the floor, I had undone the safety belt on my walker as it was restricting me,there was water on the floor and my legs slipped causing me to loose my footing and down I went. Not smart on my part. Just because my balance and proprioception have improved some does not mean I don’t have to continue to pay attention to what I am doing. I still have to remind myself of walking hill to toe, to pick up my feet, and not to lean forward. Old habits are hard to break!

I am still excited about all the progress I am making. I know I am not doing this alone. Thank you everyone for your continued prayers and your words of encouragement. I know God is with me and because of this anything is possible. His promise to be my side every step of the way helps to keep me moving forward even when there are set backs.

When exteded care is needed- how to choose

Your loved one needs more care

Your loved one is hospitalized for what everyone thought was routine. A hip or knee replacement, or a recent bought of pneumonia. Yet, in comes the Case Manager or Discharge Planner who states that the patient needs “more “care but at a lower level. This person also states that the patient must be moved today and that you (the family) must find a place to go or if you are lucky they have found a facility that is willing to accept.

What does this mean? Most important, the patient and the family have the right to ask for more information. It is important for everyone involved to have correct information about the extended care being proposed because it could be as little 1 week or it could be a month or longer.

Next, be aware that the patient has every right to make his/her needs known and has the right to choose where they want to go. If the patient does not have the capacity to make their own decisions then the family will have to make these choices for them. In all cases, the family has the right to ask for a list of all the facilities in the area especially for the facility that has accepted the patient. The family should take the time to tour. Please do not leave this decision to the hospital personnel.The hospital personnel is not allowed to make recommendations, however,they are allowed to give the family facilities to choose from. The right facility will make a difference in the patients recovery.

What kind of care is needed?

Usually, when it comes to extended care the case manager or discharge planner is referring to a Long Term Care Facility that offers rehabilitation services. There are times where a lower level of care such as an Assisted Living is more appropriate.

An Assisted Living Facility does not normally offer extensive rehabilitation services nor do they offer 24 hours nursing care. This type of facility is great for the patient who needs minimal assistant with ADLS (Activities for Daily Living) such as dressing, eating, and taking their own medications. Most of these patients need only reminders and are able to make all their needs known. There are specialized Assisted Living Facilities that have memory units for Alzheimer patients. Even patients at this stage can make most of their needs known and still do most things for themselves like brushing their teeth and feeding themselves.

If the patient needs “more” care, which may require things such as I.V. antibiotics, physical therapy, occupational therapy, and/or speech therapy then a Long Term Care Facility that offers rehabilitation is appropriate. These facilities are often referred to as Nursing Homes, Long Term Care Facilities, or 24 hour nursing facilities. These types of facilities assist the patients with all medication needs including pain management as well as with their ADLS. They help the patient recover and regain their strength.

Who can reside in a LTC (Long-term Care)

Long Term Care Facilities are no longer just for the elderly. Patients of different ages may reside in the same facility as long as everyone’s nursing needs are met. Nursing Homes may only take patients that they can provide adequate care for. Adequate care refers to providing all necessary nursing care that are ordered by the attending physician. This would include their medications, therapy, and assisting the patient their ADLS (i.e. going to the bathroom/getting dressed). It does not refer to their age.

The age of the patient can be as young as 21, but the facility must make sure that the patient is compatible with the other patient(s). For example, a 21-year-old cannot share a room with a 76-year-old (unless both patients can make their needs known and have chosen to be in the same room). Typically younger patients share a room with other young patients or reside/ in a private room. Also, the facility must ensure that there is age appropriate activities for everyone. For example, providing video games or movies, such as Fast and the Furious, for the younger patient is great, but these same items would not be age appropriate for the elder patient. Activities for all age groups must be provided.

Long Term Care facilities in California must follow Title 22 regulations as well as Federal regulations.

Finding the Right Kind of Care for your Family Member

Families each day families face the question, my loved one is ill and/or I can no longer take care of him/her so what are my options?

Before, anyone gets started they must first evaluate the situation thoroughly.  One must answer the following crucial questions before proceeding:

  1. What type of illness is affecting the elder? Is temporary or permanent?
  2. Can the person be left alone for any length of time? And if so, how many hours per day does the elder need extra help if they remain in the home?
  3. Has the person’s mental or physical capacity declined to the point where that they now need 24 hour supervision but still need minimal assistance with their activities for daily living (ADLS)? Or have they declined to the point where they need 24 hour nursing care?
  4. What type of assistive devices (canes, walker, wheelchair ) do they use daily? (This often helps determine where the placement of the individual).
  5. What finances are available?

Although many people today plan for their retirement they do not plan for the unexpected illness. So when this happens often times the entire family has a dilemma of how to pay for the type of care your loved one may need. In some cases, the option of long-term care insurance is available and can help. But, long-term care insurance will only pay when the circumstance meets certain criteria. Also, it pays secondary to the person’s primary insurance.

Because of the high cost of medical care outside the home, many times families will opt to take care of their love one at home. Unfortunately, many families find that their elderly parent or other loved one requires much more care than they can provide. So the family and the patient are left wondering what to do next.

Everyone has the right to have a better understanding of the elder care system and the potential costs involved. It is important for everyone involved in the lives of our cherished elderly population and other ill patients to have as much information as possible so that a calculated and overall better made decision transpires.

There are several options available to families these days. Two of the important factors which influence the decision on where to place your loved one are the financial ramifications and the other is the type of care needed.

With the high cost of medical care these days many families opt for taking care of their loved one at home. There are still options available to help make this easier both physically and financially.

The family can hire an outside agency to help care for their loved one, but  often have a  high cost. Services charge an hourly rate usually ranging from about $18 to $25 per hour. If over-night care is necessary then the cost goes up. Many cannot afford this service. Yet, there are advantages to this of type of care as some  agencies are hired for a short amount of time. For example, if the elder just needs assistance with shopping or the lunch meal then the agency can provide a caregiver for 2 hrs per day to assist them. This would be far less expensive than placing the individual in an Assisted Living or Board and Care.

Another way is for families to apply for in-home support services if they meet the criteria. The IHSS Program is available in California (other states may also have similar services available, please check with your Medicaid program).The IHSS Program will help pay for services that will help the elderly person to remain safely in their own home. This is an alternative program to long-term care (nursing homes), assisted living or board and care facilities. Eligibility requires the person to over 65 years of age, or disabled, or blind. Disabled children are also eligible for IHSS. Also listed below are other eligibility requirements:

  • Is the person a currently receiving Supplemental Security Income/State Supplementary Payment (SSI/SSP); or
  • Does the person meet all the eligibility criteria for SSI/SSP except that their income is more than that of the SSI/SSP income levels; or
  • Does the person meet all the eligibility criteria for SSI/SSP, including the income requirement, but still is not receiving SSI/SSP; or
  • Is the person a Medi-Cal recipient who meets SSI/SSP disability criteria?

Some of the approved  IHSS services are housecleaning, meal preparation, laundry, grocery shopping, personal care services (such as bathing, grooming and toileting), assistance with wound dressing changes, stoma care, companionship to medical appointments, and protective supervision for the mentally impaired.  For other services provided check with the program directly.  Family members can provide these services in lieu of an outside agency provide the services.

The problem with this model is that most elderly patients need more than just a few hours of care. The IHSS program will approve up to 4 hours of paid assistance depending on what they determine the need is. In that case the burden falls upon the family to care for the person for the remaining 20-22 hours hrs per day.

If the family finds that caring for the elder in the home is too difficult they can opt for other residential care options such as a Board and Care or Assisted Living Facilities. The term residential care refers to a facility where non-medical long-term care is provided in a single family residence, a retirement residence or in any appropriate care facility.

A Board and Care facility is usually a 1-6 bed facility and has a home like environment being set in actual residential homes. The potential resident must be able to take their own medications with minimal assistance, they should be ambulatory but can use assistive devices such as a walker, should be able to feed themselves with minimal assistance. This type of facility is completely private pay. Meaning the family or resident will have to pay out of their pocket. Some do accept SSI/SSP as payment, but they are difficult to find and the patient has need very little assistance. The cost per month for this type of facility can range from $1500 on the low-end to $ 4500. The cost will depend on the “level of care.” This means, for example, that for the basic room and board there is one price, but if the resident needs more assistance such as with bathing and grooming and/or with taking medications there will be an increase in cost. But on average the cost of a shared room in a 6 bed or smaller facility is $2500 per month and for a single room is it $3500 per month. Again, keep in mind that these facilities do not accept insurance payments.

Another type of residential care facility is the large Assisted living facility which provides assistance with Activities of Daily Living (ADLs), but allows one to live as independently as possible for as long as possible. Assisted living exists to bridge the gap between independent living and nursing homes. Residents in assisted living centers are not able to live by themselves, but do not require constant care or 24hr nursing care either. Assisted living facilities offer help with ADLs such as eating, bathing, dressing, laundry, housekeeping, and assistance with medications. Assisted living is not an alternative to a nursing home, but an intermediate level of long-term care appropriate for many seniors. Many of the facilities also have special memory care units for those with Alzheimer and Dementia that are not at the advanced stages which require more medical care. The cost per month for this type of facility ranges from about $3,000 to $5,000. The level of care needed is what affects the cost. You just basic room and board it is in the $3000 range. If the resident needs assistance with meals or dressing for example, the cost will be higher because a higher level of care is provided. Another factor in cost is if the resident lives in a shared room or a private room. Again, these facilities are private pay only. Meaning they do not accept insurance payments of any kind.

The final type of facility is the Long Term Care also known as a Nursing Home. In these facilities they provided total care. Meaning they provide assistance at all levels. There is not just supervision 24hrs per day, there is actual medical care provided 24 hrs per day. Assistive devices such as wheelchairs and walkers are welcome. The main difference is that nursing care such as wound care, IVs, injectable medications, and mechanic feedings are allowed. Resident that require outside care such a hemodialysis can still attend their treatments and then have 24 hr nursing service to monitor them. The care provided is much more extensive in Long Term Care. The cost is much greater, but insurances are accepted and Medi-cal does pay for services at this level. The average cost is about $5200 for shared room to $7000 for a private room. The charges are for the total care of the patient including their medications and the visits with the facility physician. If the resident is a private pay patient then the fees may vary as the medications would not be included in their care unless the resident has Medicare part D.

Our elderly population deserves  treated with respect and dignity.