My husband is in early stage 7. Because of prior problems with his leg, he can barely walk with a walker. He sleeps most of the time. Talks some. Eats well. I have had an excellent, patient CNA, Andrew, for the last 18 months or so, and he's gone from coming one morning a week to a more stepped up schedule, and my husband has been accepted into hospice. Hospice provides a couple of days of bathing him, but otherwise Andrew comes. It has worked out that L. can be got up, bathed and changed,shaved, etc; bed changed, laundry done, in 2=3 hours. Because I have outside interests I have him come three mornings for four hours and in that time he also does house and yard work (this is not required work for all CNAs but A. likes to be kept busy.) He also comes for an hour every night to do the change, toileting and putting him to bed.
So it comes out to about 25 hours a week that Andrew is here. We pay $18/hour to the agency and I pay him $15 for the household work he does; in all it comes out to somewhat under $2000/month, $24,000/yr. Around here nursing homes run ca. $85,000/YR. When he is not here, L. is in his recliner or his bed and watches tv mostly, and sleeps.
If you think you can cope with your spouse like I do, that's about what it would cost you. For me, having him home (so I don't have to run to the nursing home to feed him, etc) is the main benefit of having Andrew here, but the savings is considerable.
I had a (nonmedically certified) woman come in for 5 hours at a time, averaged 3 times a week (more if needed). I paid her $225/week which equalled out to be about $11,000 a year. Hospice came on board and they sent a CNA over 4 times a week to bathe him in the mornings..and dress him. That left it to me to do it only 3 times a week. (The helper didn't bathe him) The helper adored Foster, and lovingly watched over him fixed his food tray with yummy snacks and helped him manipulate his walker to and from the bathroom when he wanted to go. She allowed me to go out those hours for grocery shopping, banking, hair appointments, etc. I always felt like I was racing a clock when I was able to get out. I agree with Briegull, it was so much better for me to bring help in, I had resources to go to in the city should that have become necessary, and it was so much less expensive than placing him. That being said, please note that my husband was docile,... quiet, immobile for the most part, and there was never a real threat to HIS safety or mine.
We all do what we MUST do, and there is no right or wrong thing to do. We, as caregivers, usually KNOW the proper action we must take ...
Thanks so much for this valuable information. I have just begun the process of looking into what's available in this area should DH need to be placed at some point in the future. We are fortunate to have a LTC policy which also pays in home care and I need to get this into effect soon to start eating away at our 90 day elimination period. DH is probably stage 5 now and if it were not for the insurance coverage I wouldn't be looking for help yet.
In this area a person from an agency costs $15 an hour. At present we pay $15 an hour to an individual who does housecleaning and helps my husband, but we could find someone for less if it was more just sitting. So unpredictable what they will be like, and I want to continue to work.
Is it possible to get overnight help once in a while? I would love to have 7-8 hours of sleep one more time! I believe I average about 5-6 hours of sleep a night. Once, when DH was on heavy meds for pain due to his back, I slep a straight 6 hours, woke, checked on him, back to sleep.
I have a woman who comes twice a month for 2-3 hours. She gets $15 per hour. She would come more if I need her, particularly in the evening. The Adult day care DW goes to is $12 per hour. She goes 3 days a week, but I could increase that if needed. It runs from 8:00 to 4:00, or any portion. I pay only for what we use. Then I have a hospice volunteer who comes once a week while I go to Rotary. He takes her to dinner here at the Inn. I could get more hospice help, but don't feel I need it yet. So far I do the morning and evening changes, etc. She gets a shower twice a week at the day care center.
I am about half way thru the 60 day elimination period with our LTC insurance. It cost me $15.00 / hr. she has been great. She does almost all of the house work. She told me that she only does light house cleaning but she has not refused to do anything. She told me that she was there to assist my DW. All I have to do is ask the DW to do something and then the Aide will do it. I have not asked about mowing the yard yet!
It really is a big help and if you can afford it, it does take a load off. I am paying the min which is 4 hr / day which counts as a day on the elimination period. Once the LTC insurance kicks in they will pay for 8 hr/ day 5 days a week is the limit of the policy. I could have her come half a day on Monday and work half a day on Saturday it does not matter.
Moorsb, does your LTC insurance require the person you use be licensed by the state or certified in some way? Did you get someone through an agency? Mine states the person has to come through licensed agency or be licensed nurse, OT, PT or such.
Mowing the yard assistance would be greatly appreciated!
Judith--I think one of the reasons for using an agency you trust is that they do the background check (it's also one of the reasons you pay more per hour than hiring privately). Selecting the right agency is a critical issue--they all may not be equal. The one I went with is run by a young woman whose own grandfather had EOAD. She is tremendously supportive of her clients and families and goes above and beyond to help out. I did no additional background checks, but as a preventive, I have everything of value locked up.
Briegull's situation with the aide coming in 1 hour at night to handle the evening drill sounds ideal, but I wonder how many would be willing to do that? The agency I use has a 4 hr a day minimum, I've never asked about a split shift.
Cost is not so much an issue here. as Holland has an excellent public health care system. But I have been postponing getting help in because I didn't want to be tied down to a schedule. DH is restless and likes to go OUT. And on non-day care mornings he likes to sleep in till noon, and that's great. But lately he has been refusing to take his nightly bath. Although he does let me sponge bath him, I don't feel I'm getting him very clean (his Depends are almost always wet now). So today I called and I'm going to try to get someone in to bathe him twice a week. Another reason is that I've been advised to get him accustomed to having someone besides me help him. I'm wondering if he will be receptive to it. I hope. I have ordered a shower chair; that will make it easier for me and for someone else.
I used in-house help before I placed my husband. I used someone from an agency and paid $15 an hour if she stayed for 4 hours, more if she stayed less. I was just moving from one day a week, to two (one morning for respite for me, showers for him and one evening, emergency errands for me and a shower and being put to bed for him) when it became impossible to have him at home.
Remember, you can buy a lot more help than you think you can if they are not placed, so if they aren't running and they don't get physical, it should be an option. But with the best will in the world, if they are runners and/or get physical about it, you can't keep them home.
DH's LTC policy requires a certified agency or a non-certified aide under the supervision of a registered nurse. Because DH was both a flight risk AND physically violent, the doctors would only allow him to be at home if we employed a 24/7 live-in aide. So we have a live-in aide and we pay the agency $195.00/day; more on holidays. His LTC policy only pays for $112.50/day for a live-in. Hourly rates in our area (NW NJ) run from $20-$25/hour with a 4 hour minimum. So in our case it is as expensive as a facility but he's home.
I have an in-home agency for my husband and it is $16.50 an hour, and 9.5 hours a day because I work. I also have Hospice come each day and bathe, shampoo, and shave him and brush his teeth. The agency person gets him up, cleans him up, dresses and transferrs him to his recliner, feeds him his breakfast, lunch and two fruit snacks- one in the morning and one in the afternoon. I have to give him his medicines in the morning and at night. I have evenings and weekends alone with him and we manage so far. I use my five days of respite each month for one week of daycare, saving me $783.75 a month. My agency has a four hour minimum as well. But, they guarantee someone will be there every day, they have insurance on that person and as others have said, have screened them.
I am glad my husband is able to stay at home - and as long as I can manage, I'll keep him here. $4,500 a month is what I would have to pay for a nursing home...He doesn't qualify for medicaid, and we don't have LTC - I could kick myself for not getting it when we had the chance.
This is such good information! And, I so appreciate it. I am with DH almost every day, all day except for Thursdays. We generally go play cards in the morning. My driver takes DH home and then she takes me shopping. I take her to lunch about 2 times a month. That's about it. I do have a yard guy who comes 2X a month. and I hire 2 grandsons to do gardening, painting, etc. when I nee4d it. I'm beginning to wonder if he should be left alone even for those 2-3 hours once a week. How do you know when it's time to not leave him? He never wanders--YET--
I'm planning on putting in a shower downstairs in case we have to have someone live in they would have their own bathroom. It will also increase the value of the house.
Sometimes I get really overwhelmed-
Have already made the decision to stay in this house and have someone live in if necessary. (I should say WHEN necessary.) My daughter is having a fit thinking that I would be dumb enough to hire someone without a thorough background check and very good references. Well, I can't complain. I know she really cares but she is 3 hours away and gets scared.
I put doorknobs (that need a key to open them on the hall side IF LOCKED, and the little fingergrip on the other side so you can lock it or leave it unlocked on the bedroom side) on each of my bedroom doors, and all my jewelry, receipts, bank statements, anything with my account numbers on them, along with irreplaceable keepsakes are in one of the three bedrooms. I lock the doors every morning before going to work and unlock them when I get home. I know I'm probably being extra cautious, but I've heard stories about things disappearing, and I feel more "safe" this way. They have total access to the living room, bathroom, kitchen, den and "sun room" (which was the dining room and is now where my husband's hospital bed, recliner and one of those four drawer plastic chest of drawers on wheels are. His clothing is in the drawers, and the Depends and box of rubber gloves on top. This "sun room" is really part of the den, it just goes back another 12 feet, and he has the best view of the big screen TV for watching movies all day when he's not napping. He can see everything going on in the den as well, so it has worked out well for us.
I've added this for those who might wonder if they should or not.....it is strictly a personal choice - what you are comfortable with. Some have trusted employees who are watching their spouses, and that is great. I don't know these people from Adam, except that they have been screened before being hired. I needed my safety net.
I just made my first call to a home health care agency. Whew! Pardon me folks but I sometimes have to take baby steps. I am trying to start using the home care once a week to start the 90 day elimination period, one day = 7 days so 13 weeks to fulfill this if I can manage it.
The agency said first they send out an R.N. to evaluate him and I think she said they send the info to his doctor. But anyway, my question is WHAT CAN I TELL DH ABOUT THIS EVALUATION?
I'm thinking perhaps I'll just tell him the truth (how novel) which is that we have to get this elimination period out of the way so that we won't have to continue paying those monthly premiums every month. And that we'll just get minimal help in here and they will help with laundry and house keeping, etc. once or twice a week.
Jeezz.....did I answer my own question? He's in stage 5 and very aware of his situation. (I started to say quite cognizant but caught myself) But I don't want to start any paranoia on his part.
It is mostly for an observation - as to your home, how he behaves, what he can still do for himself, etc. Just tell him you are looking to get help with the housework and to be there when you need to run quick errands. That they are nice enough to come to your house for you to interview instead of you having to go to their offices.
They need to see how much work will be involved to help them to send the "right" person for now.
I wouldn't mention anything about "elimination period" or evaluation to him.
Mary, I put dead bolts on my mom's closet after she died, and while my dad was alive for just the reasons you listed. We had had theft of all sorts of things..that stopped it.
Terry--I agree with Mary, that is the line I used when introducing in-home help. Fortunately, light housekeeping is included as part of their duties, so your husband will see that the aide is actually doing what you said. It makes the aide seem less like a babysitter.
The agency I use tries to match up aides that the both the patient and caregiver will like. We have had an assortment of ladies come in, there was some trial and error involved. My husband doesn't like it if the aide is too young (college age)--I think he finds it demeaning. That's really his only issue, besides having difficulty understanding a Jamaican accent. I prefer someone who is self-directed and likes to clean. One of the aides we had did not want to clean toilets (she didn't work out here in the long term) and preferred to cook rather than clean. So I had her make dinners for us while she was here, but in the long run, I prefer someone who likes cleaning and likes to be busy.
As I mentioned we have a live-in (male) who is from Africa and who has been honest and trustworthy - nothing stolen, however we've had some breakage of dishes, etc. but nothing major. Agencies do background checks, reference checks and provide workers comp for the aide. Their aides are bonded and they take care of payroll taxes, etc. Like Marilyn's agency, the one we use tries to match the aide with the client; I always stress the importance of having someone who has experience dealing with a dememtia patient because DH can be very stubborn and difficult to redirect.
Terry, I would talk to a few agencies to see which one you think is a good fit for your situation. And as others have said, since they do light housekeeping, just tell him the aide is coming to help you. That worked for us.
mothert--we are talking about privately owned home health agencies. If the LO has a long-term care insurance policy, in order to be covered, services must be received from a state-licensed home health agency.
Does medicare ever pay for home health care? I'm thinking the 4 hour periods some have mentioned. It would be great to have that at least once a week. I've seen references to medicaid but nothing on medicare..TKS!!
Alas, medicare does NOT pay. I pay privately. If you get on to Hospice, they will pay for a couple of times a week of an aide coming but they come for just an hour or so and wash them. We didn't have Long Term Care, but we did have some money set aside, and that's what's paying for the home health. If you have little income, and can be on medicaid, or on veteran's health care - be sure to check that out if appropriate - you can get some home health paid for instead of nursing home care. But home care in general - and ASSISTED LIVING - are not paid for by medicare. (but you can deduct the costs on your income tax)
Medicare did pay for home health care for Claude three different times. The first time he had a TIA, fell and hurt his back and legs as he fell. His doctor ordered it. He had an RN, physical therapist and an aide to help him bathe for two months.
The last two times, he was falling frequently and he had an RN, a physical therapist and an occupational therapist come to the house. In fact, it was the Home Health RN who realized he was rapidly declining and notified his PCP. He then went on Hospice. We didn't have to pay anything out of pocket for either home health or hospice.
Medicare also paid for home health for me. Doctor ordered. I wonder if that has anything to do with it.
But the medicare people paid came after "incidents". Not just out of the blue when you decide you need help... and only for a limited time, not the years that you may need them for AZ.
Here in Australia I would pay about $10 AU an hour for household help, and about the same for help with DH when I require it. I have not enquired about the cost of N/H's as yet and hope I won't need to place DH in to one for a long time yet, but one never knows.
Sylvia - do a advanced search for Australia and you will find at least two others who have come in the last year. One is Debbie (there are a few Debbie's here) and the other is Maggs. If they are still around or there is an email address under their profile, you may be able to connect up with them to compare notes on care and what is available in Australia.
I think that another factor in whether Medicare pays for home health care is whether you are improving. If you don't improve they quit paying. Someone with dementia is not going to improve.
Shannon, Yes you can deduct home care if your Doctor has written a care plan and stated the need in writing, but be careful unless you go through an Agency you must pay Medicare taxes, and unemployment taxes. Also Adult Daycare is included. You need a Doctor order showing the need.
Thank you guys - I will get the doctor to write it as a need just in case! :) We do go through an Agency so the taxes, etc. should be covered. Getting someone to come in has been such a lifesaver for ME! It is actually a man (so he's almost like a buddy to my DH) and he can run errands, do some housekeeping, etc. Since I still work fulltime it has given me a little bit of my life back. Shannon