Better care for Grandma

May 15, 2012 7:03 PM

Please tell me about your in-home elder care solutions in the US, specifically in the rural Northeast/upper Midwest.

Or anywhere rural, really, but I am in the rural Northeast.

My 90-year-old grandmother lives in her own home and her family would like that to remain so. She has diabetes, is unsteady on her feet and uses a walker, and needs assistance in the restroom. She also has frequent bouts of minor illnesses like nausea, back pain, or depression that require a little medical know-how but mostly some attentive sympathizing.

We currently have home health aides that we hired privately who care for my grandmother and do cooking and housekeeping. They are, for the most part, lovely, good-hearted people, but they require a lot of guidance on things like an appropriate diabetic diet, how to give medications (ie, should a liquid medication be dissolved in water or given straight), and how to engage my grandmother socially to help assuage some of her boredom. They also require a certain amount of interpersonal management- the day shift caregiver has problems with the afternoon shift caregiver, the night caregiver doesn't do enough cleaning and it's not fair to the afternoon shift caregiver, etc. We pay $1800-$2000/week for this level of care.

None of my grandmother's children are really happy with the level of care or the caregivers themselves- but they believe that we have the best level of care for the price we are willing to pay and that there are no better options. They feel that working with a home health agency (to get a better quality of caregiver) or a social worker/visiting nurse (to manage the caregivers to some extent and give suggestions on stimulating sedentary activities or meal preparation and possibly manage household funds for things like groceries and occasional meals out) would not provide enough benefits to be worth the cost.

I suspect that there might be a better solution, but I'm not sure what that is. Are they right that we would pay an HHA agency substantially more than two grand a month? Did you use a similar service recently and are willing to say what that cost? Am I right that an elder-care social worker could light up my grandmother's world or at least have better ideas about managing an elderly person with declining cognitive abilities? Did you work with a social work who lit up your elderly relative's life? Did you get a financial conservator or attorney to take charge of your relative's finances? Is there some other elder-guru we could consult? If so, I would love to hear all about it.

posted by Snarl Furillo to human relations (10 answers total)

You mention two different amounts - 2k/week and 2k/month. I assume you mean the former, but it would be helpful if you could clarify.
posted by arnicae at 7:11 PM on May 15, 2012

Ah, cripes. Yeah, 2k/week.
posted by Snarl Furillo at 7:12 PM on May 15, 2012

Also, does she want to stay at home? Has she visited any of the assisted living facilities in the area? Many of them have some really neat ways to get engaged socially, and many are tailored to differently-abled persons. For example, my Grandma's assisted living place has different floors. The youngest residents, in their 60s, treat it as an apartment building with support if they need it. For folks that need a lot of support, there are floors that have 24/7 nursing. There are great community activities and get togethers to do just about anything from beading to yoga to books.
posted by arnicae at 7:13 PM on May 15, 2012

I would call agencies in your area and ask what they charge for the level of care your grandmother needs. Unless prices are considerably out of whack from your area to mine (and they might be) 8K a month should provide very good service.

Personally I'd look at non-profits first.

Barring that, make out specific and detailed charts for the assistants to follow, how to administer meds, what to cook, what to clean and when etc... get their input on what is reasonable to expect but insist it is done. And if it is not. Hire someone else. The benefit (one of the benefits) of working with an agency is that if a specific employee is not working well they have to deal with it.

good luck
posted by edgeways at 7:55 PM on May 15, 2012

If you're looking for someone to consult with - either by yourself, or as a family - I can recommend Janice Wallace, the Eldercare Coach. I've consulted with her myself - for issues less difficult than yours, admittedly - and found it to be worthwhile.

http://www.caringforcaregivers.com/
posted by jeri at 8:52 PM on May 15, 2012

Some areas or counties have daycare or day programs for older adults which can provide some activity and stimulation a few days a week. I don't know about cost, but it may be cheaper than a private caregiver if your grandmother is able to get out of the house some.
There may be resources at your local hospital or through an area agency on aging. Also some employee assistance programs will provide help with eldercare- not sure how effective they are but it may be worth checking out. Your experience with private home health aides sounds somewhat typical of what I've heard from other folks- there does need to be some oversight/management usually. Best of luck-sounds like you are taking good care of her already!
posted by bookrach at 4:08 AM on May 16, 2012

We employ a full-time live in carer for my grandmother. The specifics and costs of that are not relevant as this is in the UK. But there is one thing we did that might be relevant. We contacted a local dementia charity and found some people through them with expertise in engaging older people, and then employed these people to provide respite for the full-time carer. They visited my grandmother for a few hours every day and did things like talking to her about family history or playing cards. It helped that some of them had professional backgrounds similar to my grandmother and were able to talk to her about that. We eventually stopped employing these people because factors relating to my grandmother's dementia meant it was often not working well and she'd get aggressive with them. But on the occasions when it did work, it was great.

I realise your grandmother hasn't got dementia, but it still might be worth talking to charities who work with older people to see if they can recommend people who have skills in working with older people. We also had some success in employing social work students for similar respite / stimulation visits.

It did take quite a lot of people management to co-ordinate carers and timings - in fact we employed someone with experience as an advocate for older people to do this.
posted by paduasoy at 6:53 AM on May 16, 2012

I have a 101-year-old great aunt who still lives in her own farmhouse in the rural midwest. She has no children so my dad & his brother went through the process of hiring a Bulgarian woman a few years ago to live with my aunt round-the-clock. I believe the woman had some nursing background before she moved to the US, and she helps my aunt with bathing, using the restroom, cooks for her, etc. She doesn't have many medical problems for her age. The Bulgarian woman was hired through some local agency that employs Eastern European women to be live-in caregivers; previous to her, my dad hired a Polish woman from the same agency to care for his father in his last years. For both my aunt and grandfather, the care has been excellent and these women require absolutely no supervision. A lot of big city newspapers have classified sections listing foreign men/women who are looking for live-in caregiver jobs. You might want to look into something like that. (Also, I think the woman who takes care of my aunt earns about $1,000 or week or less but her living/food expenses are all included in the job.)
posted by jabes at 6:01 PM on May 16, 2012

Jabes and Paduasoy, how did you handle respite care for the live-in caregiver? Did they also work nights/holidays/weekends? Getting someone for weekend nights and holidays is currently a big hullabaloo for us. My grandmother also is a pretty light sleeper, so I'm not sure what would we do to get the live-in uninterrupted sleep. Hmmmm. I like the idea, though.
posted by Snarl Furillo at 5:38 PM on May 17, 2012

For the live-in caregiver, she works and is paid round-the-clock (I saw my dad this week and found out she makes about $5000 a month, cash, which is less than they'd pay if my aunt was in a nursing home). She takes a day off maybe every couple of weeks? When she's off, my aunt is in good enough health to be on her own during the day, and one of her nephews checks in with her a few times a day. I think the caregiver has to get up during the night to help my aunt use the bathroom but that hasn't presented itself as much of an issue, I don't think. The best thing about hiring non-Americans for these types of jobs is that usually their family still lives in the home country, and they are working to send money back, so holidays/weekends tend to not be a problem. The woman staying with my aunt has a husband in Bulgaria but no family locally; she has a few other live-in-aide friends, but usually sees them for lunch or those types of things, rather than taking whole days off. The same situation happened with the Polish woman who cared for my grandfather years ago.
posted by jabes at 12:15 PM on May 21, 2012