Advantages of Home Care
Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 11 million Americans receiving care, probably about 8 million or 75% are in their own home or the home of a family member or friend (ie: Home Care). Most people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though care giving needs might warrant a different environment.
Often the decision for Home Care is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it's much less costly and more loving for a daughter to have her widowed mother move in to the daughter's home than to liquidate mom's assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.
Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support. But despite the psychological advantage, a home may not always be the best place for those receiving care or for the caregiver.
The Plight of Caregivers
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia during home care. Or a son may live 500 miles from his disabled parents and find he is constantly traveling to and from home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don't have the time to watch over loved ones and those needing care are sometimes neglected.
Another problem with full-time home care is the risk of burnout. Caregiving can be very stressful and demanding. In the case of a healthy spouse or a child living with the disabled person at home, caregiving can be a 24 hour, 7 day a week commitment. But even for the caregiver not living in the home, looking after a loved-one or friend can consume all of the caregiver's free time.
Surveys and studies consistently show that depression is a major problem with full-time informal caregivers. This is typically brought on by stress and fatigue as well as social isolation from family and friends. If allowed to go on too long, the caregiver can sometimes break down and may end up needing long-term care as well. A typical pattern may unfold as follows: 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support. 20 to 36 months--the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless. 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled in a facility. Without intervention, the caregiver may become a candidate for long-term care as well.
Problems With Home Care
For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don't need the supervision of a 24/7 caregiver. There are, however, some care situations that are not suitable for home care.
One is where a couple or individual have either cognitive or physical disabilities that confine them to a bed or chair all day in one room. If the caregiver can spend only minimal time in the morning and evening and will be absent the rest of the day, those receiving care literally become imprisoned by their environment. They receive little or no social stimulus and may spend day after day just sleeping or watching television. They typically get no exercise other than moving to or from the bathroom and often they suffer from poor nutrition and dehydration due to lack of adequate food and fluid intake. Drinking and eating are deliberately avoided to lessen trips to the bathroom or to avoid soiling a diaper. Malnutrition and dehydration often result in poor mental reasoning or stupor, thus contributing to the daily routine of only sitting, sleeping and enduring the TV. This is not a noble way to finish out one's life. And we are doing these people an injustice by keeping them imprisoned in this manner at home. They should either be in a good adult daycare center or in the more stimulating environment of an assisted living facility.
The other situation where the use of home care should be weighed against other alternatives is where a caregiver is in over his or her head and either doesn't recognize it or won't admit it. The care is just too difficult to handle beyond a period of a month or more. Short-term the caregiver can handle it. Long-term, help is needed. To make matters worse, some overloaded caregivers won't ask for help. If the person receiving care is cognitive, he or she is probably aware of the caregiver's plight but may contribute to the problem by trying to support the caregiver's role. Both may not know there are other alternatives. If you are in this situation or know someone who is, there are a number of state and county services available to help. In 1965, Congress passed the Older Americans Act. Along with subsequent amendments, this act provides guidance and funding to the States to give help to caregivers. All states offer programs at no cost or very low cost which might include: counseling, caregiver training, respite care, adult day care, meals, support groups and much, much more. IT IS VITAL FOR THE HEALTH AND LONGEVITY OF ALL CAREGIVERS TO MAKE USE OF THESE SERVICES. We have compiled a list of each state's web-based, caregiving services. These services are typically provided by area agencies on aging. Click here to find caregiving support in your state.
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