Looking for something between assisted-living and a live-in-nurse. Help?

August 4, 2009 4:35 AM

GrandmaHelp Filter: What's the name for a live-in assistant/nurse who visits the house of an elderly person 3-5 days a week, helps them with grocery shopping, etc? What's the best way to find referrals for quality people that perform this service in South Florida?

My grandmother's health is failing. She's in her mid-90s and in Florida. My family and I are in the midwest. She'd prefer to not go into an assisted living facility. All of us have jobs that can afford us to visit every few months, but none of us can stay down there long term. She owns her condo on the 20th floor of a high-rise in North Miami Beach. She requires a walker to get around and her hearing is failing.

My family would like to hire someone like a nurse to visit her 3-5 times a week to help check up on her health, but to also spend a few hours with her. This person would potentially take her food shopping, or do her food shopping for her. Help her with laundry and putting the food away. Help with meal preperation. Etc.

1.) Is there name for this type of person?

2.) What's the best way to find this type of person?
- When she was in the hospital recently, an orderly stole cash out of her purse while she was using the bathroom. Trust levels are low right now so we're wary of just picking a random company name in the yellow pages without a referral. So, are there sites where there are ratings and reviews for people/services like this? Without knowing what they're called, or what to search for, I'm not sure where to begin.

3.) What should we expect to spend on services like this? We're not wealthy, so we need to be budget conscious.

4.) Is there anything else we should be thinking of?

When I say above that her health is failing. She's just getting more and more fragile given her age. Her vital organs will likely start to shut down in the near future according to a doctor. Mentally she's fairly sound with no signs of alzheimers or dementia.

This has been emotionaly trying for my mother so I'm trying to help her, and my grandmother, by asking this question.

Thank you for your help!

posted by xotis to health & fitness (14 comments total)

"home help" is what I've seen it called. But they're not live-in (which you specify in your opening sentence).
posted by zadcat at 5:05 AM on August 4

Often called Home Health Care, and they can in fact be live-in.
posted by entropic at 5:07 AM on August 4

Since trust levels are low, make sure you let grandma be involved in the hiring decision.

Consider talking to other neighbors in the development and see if they have a service they like. Maybe they even have similar needs and can go halfsies with a home help aide.
posted by gjc at 6:18 AM on August 4

Another option would be moving to a different building where they have staff for this kind of thing. I've heard that there are senior living buildings that have "steps" of services available. For the spry, it's just a community. For the slightly disabled, they have helpers available. And if a resident becomes more disabled, they have more classic nursing home services available for them. But they continue to live in their home/apartment, and the services come to them.
posted by gjc at 6:23 AM on August 4 [1 favorite has favorites]

We engaged a series of people to provide these services for my father-in-law, who lived in Deerfield Beach (the company was based in Boca Raton but doesn't go below Ft.L). It started out as half days 3 times a week and then progressed in frequency and intensity; by his death, at 102, he had 'round-the-clock home care, still provided by the same agency. At one point he and a neighbor got a price break by "sharing" a single caregiver full-time. Most of the caregivers were female and many were Jamaican or from various South American countries. Some of them wound up accompanying him on big adventures (e.g., to visit family in the MidWest, to attend weddings, etc.).

Based on our experience, the more explicit you are about your expectations, the better. We learned that there is a big divide between service providers who cook (or not), do light cleaning (or not), help with minor medical issues like changing bandages and applying ointment (or not) and, especially, behave as companions vs behave as though their major reponsibility was to be around to call 911 if necessary. For the latter, it's important to be sure that the caregiver can communicate well in your grandmother's primary language and that any accents aren't more than she can parse. For the stuff like light cleaning/cooking, some view it as within their job descriptions, while others are quite offended and consider it beneath them. The agency had its own classifications which can seem capricious and designed by liability lawyers; the definition of "medical care," for example, included things any competent ten year old could handle but necessitated a level up in caregiver and, of course, a price hike.

Hence, the more explicit you are (about everything), the better. While it's great if your grandmother can make her own preferences clear, she may not feel entitled to specify things like how she likes fried eggs prepared. Tell them she likes to do the crossword in the morning; they can read her the clues if her eyesight is poor. List the possible excursions (groceries, doctor, friends, donut shop, salon, library, etc.) and how often your grandmother likes to do them. Anticipate the degree of formality your grandmother might expect. Reminisce with your grandmother in front of the new caregiver as a way of providing clues about the vibrant person inside. If your grandmother is open to new experiences, as was my FIL, she may enjoy getting to know someone new who could introduce her to new places and people. My FIL enjoyed teaching some of his skills to a few of the aides.

My FIL found the agency he used when his wife became ill a decade earlier; he got references from neighbors. I noticed that the hospice folks who attended him near the end seem to know which companies provided good help and which didn't; they didn't exactly dish, but they clearly knew. Your grandmother's physicians may also have some suggestions, especially if she sees a gereontologist.

Regarding price, my memory is fuzzy but I seem to recall that it wasn't all that expensive in part because some of it was covered by his health insurance and/or Medicaid. Good luck to you.
posted by carmicha at 6:43 AM on August 4 [1 favorite has favorites]

Possibly a visiting nurse?
posted by scratch at 7:44 AM on August 4

What's the best way to find this type of person?

When my grandparents needed this kind of help, they hired "the girls" through their church. The organization was something like the Catholic... no, I can't remember. But if your grandmother is a church member, that could be a place to ask for help.

Sitter City has elder care, and they can run background checks.
posted by The corpse in the library at 8:20 AM on August 4

What you want to do is set up a meeting with the local Council on Aging. They can give you recommendations for agencies and help you navigate some of the issues you may well face. I also heartily recommend this book.

Agencies are more expensive than just hiring people through Craigslist. No matter how you cut it, you're almost certainly looking at $20 an hour minimum. Will insurance/medicare cover it? Your council on aging will know.

What we've done with my aunt is pretty much hire people we already knew - underemployed just past college students, artist friends who need a little extra income - and it's worked out really well. However, we're all in the same neighborhood, so you may want the security of agency help.
posted by mygothlaundry at 9:10 AM on August 4

Home health aid is the person who visits and does light chores, maybe helps her get the mail and groceries. Visiting nurse helps her bathe, changes dressings, assesses health issues, checks medications. There's a lot of variations.

By far, most of these people are terrific and trustworthy, but because they will be in her home, and she is becoming frail, you'll want to lock up valuables, just in case you're the unlucky one who gets a bad apple. Look in the deadtree edition of the phone book, in the community guide section, for the agency that coordinates services to the elderly, which mygothlaundry is talking about.

Her vital organs will likely start to shut down in the near future Does she have a diagnosis? or a pessimistic doctor? If she has a diagnosis, then you'll have some idea what to expect.

My Mom was pretty happy in independent living. She ate 1 meal a day in a common dining room, and staff checked status on all residents 1x day, but she was otherwise living in an apartment, and she enjoyed being around so many people. When her health got worse, we were able to make family arrangements.
posted by theora55 at 9:56 AM on August 4

Hospice care can be a great resource if she has a prognosis of living (generally) 6 months or less. Hospice programs are usually available at no cost to the patient, and provide caring staff and volunteers to assist with whatever needs to be done.

Ask the doctor if a referral is appropriate.
posted by rdauphin at 10:46 AM on August 4

Yeah, what you start with, there, is a Home Health Aide. Home Nurse is more expensive but does more medical-type things. You may have to graduate from Home Health Aide to Home Nurse as your grandma deteriorates -- but be prepared for that to be a gradual thing, where you have HHA three times a week and HN 1x a week or something similar.

My grandma is 97, with severe arthritis and general frailty. She has a Home Health Aide five times a week from 8 AM to about 1 PM. Family fills in the rest of the time (and, I should mention, GETS PAID FOR THEIR TIME -- vitally important if family is doing any significant percentage of elder care) because grandma cannot walk, cannot wheel herself around in a wheelchair, cannot dial 911 on a phone, has difficulty feeding herself, cannot use the bathroom alone, cannot dress or bathe herself, etc. She is totally mentally competent, incredibly frustrated by her failing body, and very, very sharp-tongued. *sigh*

Home Nursing Agency (the people we pay to do stuff for grandma -- they are not RN nurses but they will bathe grandma and take her to the bathroom and dress her and stuff) charges us $17.50 an hour in rural Pennsylvania. So that you have some idea of what a Home Health Aid can do, here's the stuff our Home Nursing people do for grandma:

Help her out of bed in the morning.
Take her to the bathroom, help her pee/poop, clean her up after
Clean her dentures and put them in
Wash her, dress her
Do her hair
Help her into her chair
Fix her breakfast and coffee or juice.
See that she takes her pills
Check her blood pressure (it's a machine cuff, not the stethoscope/watch method)
Fix the TV to appropriate channel and volume (grandma can't work the remote)
Make phone calls for her (dial and hold phone so she can talk into it)
Adjust chair, fetch tissues, turn pages in book, set up book on book stand
Determine what she wants for lunch, fix lunch, put it in front of her, arrange her bib
Help her do her PT and breathing treatment thing (so she doesn't get pneumonia)
Light housecleaning -- picks up dishes from breakfast/lunch, strips and remakes bed, does grandma's laundry, takes out trash, etc.
Read exciting parts of the newspaper for her (she can see to read but can't hold the paper)

Grocery shopping, doctor appointments, general outings are all done by family -- we live nearby and there are a lot of us, so we do not pay people to do those things for grandma. Also, most of us are pretty good at transfers (to car, to bathroom, etc) and can manage with a wheelchair and grandma when we are on outings.

So, what you need for right now is a Home Health Aide, one that can drive. For later, you will probably need both a Home Health Aide and a Home Nursing person. It is significantly cheaper for us to maintain grandma at home as long as we possibly can. We've run the numbers and even with the extensive help we have now (family gets paid, home nursing agency gets paid, grandma gets someone with her 24/7), it's costing us about 1/2 of what a medium-nice nursing home would run... and the food's better at home plus also she gets individual attention.
posted by which_chick at 12:09 PM on August 4 [1 favorite has favorites]

Nthing Home Health Aide.

I have a friend that does this. He lives with the older couple and gets groceries, helps around the house (not cleaning, but putting screens in windows, reorganizing bookshelves), chores like getting the oil changed on the car...

If you all are up for it, maybe having a live-in who does this stuff in exchange for room with a salary on top of it, might be worthwhile?
posted by k8t at 4:46 PM on August 4

Back in 1996, I did payroll for an agency doing this, in Milwaukee. It's early in my morning, and I'm surprised how poor my memory is, I can't even recall the name of the agency, but I think it was a national organization. The home aid workers got paid less than half of what was being billed. I rarely met any of the workers, they didn't usually appear at the office. I haven't even thought of that place in years. It was a very complicated payroll, quite fun. Rates of compensation varied according to responsibilities and customer (even at the level of general help). The spread between charge and pay on nurses was much lower than with the plain aids.

All that is to say, at least back then, agencies were charging quite a premium over the cost of labor. The advantages of an agency may not out weigh this cost, depending on insurance.
posted by Goofyy at 10:26 PM on August 5

Oh, I should have added: Aid was billed at $25 per hour, nurses were starting at $50. But that's 1996 figures, in Milwaukee.
posted by Goofyy at 10:31 PM on August 5