Marcella Poppe is 86, and her husband, Louis Poppe, is 88. The Spokane residents are not interested in living in an old-folks home.
But they knew they needed help if they were to stay in their own home, a stairs-free apartment where they’ve lived going on nine years, after selling the house they’d owned for 46 years.
Hiring a caregiver – someone to help Louis Poppe put on the “boots” he wears to reduce swelling, do some laundry, help prepare lunch – was intimidating at first, said Marcella Poppe, a retired nurse. And it means sacrificing some privacy. But to stay in their home, it’s a good trade, she said.
“You feel more comfortable in your own surroundings,” Poppe said. “Maybe someday we’ll have to make an adjustment, but not until that day comes. We’re quite pleased with what we can do.”
As the population ages, more seniors are opting to bring caregivers into their homes rather than moving into care facilities, said Anne Whigham, a manager with the Home Care Referral Registry, a statewide program with an office at Aging & Long Term Care of Eastern Washington. Funded with state and federal money, the program is for Medicaid recipients who qualify for in-home services.
The registry is a “nursing-home diversion” program, Whigham said.
“Most people want to stay home,” she said. “They don’t want to go in a facility. The state developed this program back in the ’90s because they could see nursing home rates were going up.”
They’ve stopped rising, she said, even as the population has aged, because of in-home care programs.
“People have choice,” Whigham said. “They get to choose who they want to take care of them. They get to be in their home. They get to have some freedom. We have 90-year-olds who can be in their home because somebody can come in and check on them.”
Most of the registry’s clients would otherwise move to a care facility, which would cost the state more. It performs background checks and provides training for caregivers, building skills such as bed transfers, meal preparation and cleaning procedures. They learn to recognize mental health problems so they can report signs to a case manager.
Case managers visit clients, assess their needs, and provide a list of trained caregivers who could meet them. It’s up to the client to interview and hire someone.
Registered nurse Jennipher Ama started Spokane Valley’s Family First Senior Care, a private in-home care agency, in 2005. She’d worked in assisted living centers and nursing homes, but said she couldn’t provide the one-on-one care she wanted to give in those settings.
“People think, ‘Oh, when I get older I’m gonna have to go to the old-folks home,’ ” Ama said. “You’d hear that all the time. I’m starting to see a shift – people do know this is an option.”
Caregivers can be hired directly – by placing an ad or engaging a neighbor or friend – as well as through agencies like Family First or through registries like the Home Care Referral program. Hiring a caregiver directly may cost less. But going through an agency or registry has advantages.
Some factors to keep in mind when thinking about hiring a caregiver:
• Consider the changes in your life or your relative’s life. Chief among indicators a caregiver could help, Ama said: The current caregiver, such as a spouse or adult child, is feeling burned out or neglecting their own job or health; the client’s home is in disarray or disrepair; they’re not taking medications properly; they’ve suffered a fall.
• Maybe an assisted living center would be better. There’s no clear line defining when a senior should stay in their home and bring in a caregiver or move into an assisted living facility, Ama said. But the top consideration should be the client’s wishes, she said.
Some people crave the social aspects an assisted living center can provide, she noted. But when a senior wants to stay in their home and can do so safely, she thinks they should.
For clients who need more acute care than a caregiver can provide, caregivers can work alongside home health care workers – nurses, dietitians, therapists – or hospice organizations. A client can have help from more than one category.
• Clients should be clear about their needs. Whether it’s housekeeping, laundry, shopping, preparing meals, companionship, bathing or help getting dressed or going to the bathroom, the caregiver should know what’s expected of them. Write a job description, or at least a detailed list of your expectations.
Ama said her agency visits clients to assess their needs and tailor a plan to meet them. Its services range from three hours a week to 24 hours a day, seven days a week.
• In-home care agencies must be licensed by the state. The agency should be able to display its license. You can also check the Department of Health’s website.
• Even if you hire directly, someone should be checking in. State law requires agency supervisors to drop in unannounced on the caregiver on the job once a year. Ama said her agency does drop-in visits about every 60 days. Even in direct arrangements, a person who lives alone and hires a caregiver should make sure a family member knows the details about their hired caregiver – who they are and when they’re scheduled to work – and ask them to drop in periodically during the caregiver’s shifts.
People tend to be more trusting interacting with a stranger in their own home, Whigham said.
“We get lots of reports of people that have been financially abused, and more emotional and mental abuse than physical,” Whigham said. “Not all are substantiated, because it’s he-said, she-said, but you have to be really, really careful.”
• Reference, screening and background checks can ward off trouble. Licensed agencies are required to perform FBI fingerprint and Washington State Patrol background checks, Ama said. Her agency adds drug-screening and driving-record checks and another layer of state checks along with behavioral and personality tests designed for the caregiving industry. The personality tests give them clues about new employees that can help the agency match them with clients.
Individuals hiring privately should follow up on provided references and can conduct background checks on their own through the court system, Whigham said.
• By law, agencies must insure their workers. By hiring privately, Ama noted, a client risks a lawsuit if the caregiver is injured at their home.
• Insurance or other programs could help foot the bill.
Neither private health insurance nor Medicare covers caregiver services, Ama said, but Medicaid does cover caregivers for qualifying clients. Some long-term care insurers also cover caregiving. The Veterans Administration may offer assistance in some cases.
If you’re paying privately, costs can vary significantly. At Ama’s agency, three hours a week of services cost $68.25 a week, or about $275 a month, Ama said. At the high end, 24-hour caregiving costs $275 a day, or close to $8,000 a month.
• Personality matters.
Ama visits the client and does an assessment of their needs, working with them to identify tasks the caregiver should perform. She also asks about their personality – and what kind of person they’d want in their home, making it more likely she can match clients and caregivers who like each other. If it’s a poor fit, Ama said, the agency finds another caregiver.
“It’s definitely key for it to work that the client and the caregiver have to connect,” Ama said. “They have to be comfortable with each other.”
Sometimes finding the right connection is a process of trial and error, Whigham said. If a first caregiver isn’t working, clients should speak up and try another.
“It’s really about finding that match, finding out who clicks together,” she said.