Friday, April 18, 2014

Helping Caregivers Prepare for Emergencies

My wife, Clare, has Alzheimer’s, and was recently placed in the dementia unit of an assisted living facility.  However, when she was at home and I was her 24/7 caregiver, I had thought about what I would have done if an emergency had prevented me from caring for Clare each day.  This was an even more heightened concern once it became increasingly obvious to me that I would soon need hip replacement surgery.  If Clare were at home with me when I would have that surgery, I would have had to make arrangements for Clare’s 24/7 care for the period of my hospitalization and subsequent physical therapy in a rehabilitation facility.  Fortunately, by the time I needed my surgery I had already placed Clare in the assisted living facility, so she was well cared for during my hospitalization and rehab.  But what if I needed this surgery earlier, while Clare was still living with me at home?  What would I have done?

This worry comes up all the time among 24/7 spouse caregivers, especially those with no adult children or other close relatives living nearby.  Social workers should provide guidance to caregivers to make plans in advance should an emergency cause a sole caregiver to be unable to provide that 24/7 care for a loved one.

There are really only three options available to 24/7 caregivers if an emergency prevents them from caring for their loved one: rely upon family or friends, hire assistance from government or private agencies, or place a loved one in a respite or residential senior care facility on either a temporary or permanent basis.

Rely upon family or friends
If the caregiver is lucky enough to have family or friends who can come to the house to help out in an emergency, this may be an ideal solution.  There are no costs involved and the person needing care will be in a familiar environment with familiar faces.  However, family members and friends who suddenly find themselves in the role of a 24/7 caregiver may be easily overwhelmed when discovering all that caregiving involves.  Also, family and friends may only be available to remain for short periods of time.  However, if enough family members or friends are available, perhaps a “rotating” schedule can be prepared ... each day would be “covered” for 24 hours with different friends and relatives each providing several hours of care.  If no family members or friends can provide emergency coverage, then the caregiver must consider alternative solutions.

Seek assistance from government or private agencies
Hourly home companions, health aides, nurses, and even live-in help are all available for hire.  Such assistance can be for personal care, general supervision, to engage loved ones in hobbies and activities of interest, to do shopping, housekeeping, meal preparation, and a variety of other household tasks.  Caregivers should be urged to contact local, county, or state government health or senior citizen agencies, as well as local branches of the Alzheimer’s Foundation of America or the Alzheimer’s Association, to learn about available services where they live.  Local nursing homes, assisted living facilities, and senior care centers may also sponsor daytime programs, provide home care services, or even provide “respite” programs lasting days or weeks that can be part of a caregiving solution. 

However, caregivers must also be told that 24/7 home health care can be very expensive.  Expenses for such care will vary depending upon where one lives.  Where I live, the customary rate is around $20 per hour, meaning that costs for 24/7 care can add up quickly ... $480 per day, or $3360 per week.  Unless one has a long term health care policy that covers a large part or all of these costs, the loved one or caregiver can quickly go into debt.  Some 24/7 caregivers may think they are covered because they have long term health care insurance.  However, some long term health care insurance policies only provide coverage in assisted living facilities or nursing homes.  So caregivers must check their policies very carefully, if they even have such insurance, to see if home health care costs will be covered in part or whole.

Place your loved one in a facility
If a caregiver has already been considering placing a loved one in an assisted living facility or nursing home, and knows which would be chosen when the time comes, this becomes another option.  If a bed is available for a loved one, a sooner-than-planned placement would provide the 24/7 care necessary if a caregiver emergency arises.  Similarly, if an anticipated hospitalization or other event will prevent caregivers from providing that needed 24/7 care, then caregivers may want to consider an immediate placement of their loved ones. 

Just as with home health care, assisted living and nursing home placements are not cheap.  Where I live the cost in a typical assisted living facility is usually around $200 per day or $6000 per month.  Nursing home placements can easily be 50% more.  If caregivers have long term health care policies, they must check to see criteria for coverage.  And, if their loved one will be covered, caregivers must check carefully to learn what costs, if any, they may be responsible for paying.  For example, Clare’s policy had a 100 day deductible period and we were responsible for paying all costs during that time.

The responsibility of social workers
Caregivers must be advised to prepare for emergencies that may prevent them from caring for their loved ones, and to plan ahead for such a possibility.  Caregivers never know when an emergency or unanticipated event may make their caregiving for a loved one a lot more difficult, if not impossible.  The time to make such plans is before any emergency arises. 

Caregivers should be advised to speak with family members and friends, investigate sources of government or private agency assistance, and explore temporary and long term residential placement options should an emergency arise.  Caregivers who do that will be much better prepared to act if they ever need to implement emergency procedures to care for their loved one.

Published in Social Work Today e-Newsletter, online only.  Access at:

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