How to find 24 hour nursing care for a parent?
October 16, 2012 10:59 AM   Subscribe

My father has recently moved to an assisted living residence, but we think he may need more constant care. Is 24 hour nursing or live-in caregivers affordable? How do you find the right person/service? This is in Toronto, Ontario.

My father is over 70 and has been hospitalized 3 times in the past 12 months for infections. He has Chrohn's disease, is on TPN (gets all nutrition via IV) nightly, has short bowel syndrome, an ostomy, diabetes and severe chronic pain.

After the latest hospitalization, we convinced him to move into a retirement home with 24 hour nursing care. They are great at the home, but he's also recently had severe anxiety and other similar issues. He keeps asking us to stay with him at the home, so a short visit can turn into a day long visit.

His daily medical needs are pretty complex. He's also really weak, so things like personal care and basic chores aren't being taken care. The home is handling these things fairly well, but a lot of it still falls on myself and my wife.

We want to look at the option of having 24 hour (or even 12-14 hour overnight) one-on-one care for him, but we have no clue where to start. Luckily, he is in a good place financially.

The most recent problems began as my wife and I were supposed to move to Toronto. We've delayed that as we work to sell off his house and get everything in order and then we will move him to an assisted living facility Toronto. We've been thinking that it may be better to have 1 or 2 permanent caregivers that take care of him in his own apartment.

So, I'm wondering how we go about finding this care. Are there services that provide this?

Do you hire a nurse privately? Obviously one nurse can't provide 24 hour care.

What's the approximate cost of theses sorts of things?

Any other tips or experiences appreciated.
posted by dripdripdrop to Health & Fitness (6 answers total)
Have you asked the management of the assisted living facility about what services they provide or who they might recommend? They have likely dealt with this before, so they would be my first stop.
posted by decathecting at 11:07 AM on October 16, 2012

So I'm a little confused as to what the situation actually is here. First you say that he's in an "assisted living" facility. That suggests, to me, a place where you basically have your own apartment, but there's staff available during the day to help with this and that as needed. Then you say that he's in "a retirement home with 24-hour nursing care." Which suggests an altogether more comprehensive level of assistance and supervision, i.e., round-the-clock support. But then you're saying that you want round-the-clock support, suggesting that he doesn't already have it.

I'm confused. Which suggests to me that you're confused too.

Here's the thing: senior living arrangements can run the gamut from completely independent apartment living in a residential area devoted to those over 65 but with no services that a normal landlord wouldn't provide to what amounts to a private inpatient hospital and just about everything in between. My grandmother lives in a retirement community where she currently has her own place, but there are two or three more levels of support in different residential programs around the (rather sizable) campus. Some have an aide come in a few times a day, but the Alzheimer's facility has 24-hour supervision in locked inpatient wings.

I guarantee you, there is a residential community out there that's doing what you're looking for. You just need to (1) figure out exactly what it is you're looking for, and (2) figure out who provides it. Something to keep in mind with the latter is that your father is likely to need more and more intensive care in the future, so a facility that can escalate their involvement is probably a good idea.

I think your best bet is probably to start with Toronto's long-term care facility list. Get in touch with the Homemakers and Nurses Services Program, go through their client intake process, and use the information they give you to determine the best fit for your dad. Even if you're not eligible for services, they'll probably be able to put you in touch with the programs and/or services you need.
posted by valkyryn at 11:10 AM on October 16, 2012 [1 favorite]

@valkyryn - ya a bit confused :) The place he is in currently in has 24 hour nurses available and they are handling the medical needs, weekly cleaning and laundry. This is in Ottawa though and we will be moving him to Toronto. We want to explore having his own nursing because then someone would be there through the night (not just available by call) and would be 100% familiar with his needs (a home always has multiple staff and turn-over, which requires us to train them on everything). We were thinking a dedicated caregiver could provide the same care as the home plus be a bit of a companion and help with the daily life stuff more.
posted by dripdripdrop at 11:26 AM on October 16, 2012

I have been facing some of these same issues with my mother and I can share with you what I have learned. This is in the US however, so there may be differences in what is available in Canada.

Usually if your parent is in an assisted living situation (assistance available but not necessarily right with him all the time), you can supplement that with additional private caregivers if there is a need. The facility that the parent is living in has probably worked with other agencies before and can help set that up for you. You might, for example, feel like you want a one on one caregiver to be there through the night and then maybe another caregiver to be there for a few hours at some point during the day, and then the gaps in one-on-one care could be handled by the assisted living facility.

In my opinion, it's better to go with an agency for providing the private care as they will have staff available to fill in when his usual caregiver is ill or needs to take a vacation. If you go with one person that you have personally hired, you have to scramble if that person calls in sick.

Obviously, this care is not cheap. In the southern US where I am, it's about $20/hour for sitter-type care (not a registered nurse). Also, in the US this is a private pay option (not Medicare or Medicaid). Perhaps things are different in Canada.

You have my sympathy, these decisions are hard and it feels like a huge responsibility to get it right. Good luck.
posted by SweetTeaAndABiscuit at 12:01 PM on October 16, 2012

Definitely call HNSP. Again, you may not qualify for their programs, but they'll probably know what private programs will best suit your needs based on your particular situation.
posted by valkyryn at 12:24 PM on October 16, 2012

We have been going through this process with my father and now mother. We are in Ontario. As you probably know medical care is a provincial thing so the process is the same in Ottawa, Toronto, London etc. Here is a summary of what we have learned.

There are two types of places you can go for eldercare. A "nursing home" or long-term care facility is subsidized by the province and is dramatically cheaper but access is completely controlled by your local CCAC (Community Care Access Centre). You cannot just walk-in off the street. You must go through their intake and assessment process, be qualified, have an immediate need and go on a waiting list. Almost all long-term care facilities have waiting lists in Ontario. It took my mother two years to get to the top of the list and be offered a bed. Rooms can be ward, semi-private or private.

The other type is a "retirement home" or assisted-living facility. These are private facilities that charge market rates and have levels of care going from nothing right up to hospice care but definitely charge accordingly. Rooms are usually all private.

You can also try to bring care to your father.

The same CCAC that controls long-term care can provide free nursing and health care aides if the need is there. They come and do an assessment of your father to see what his needs would be. They are limited to 14 hours maximum a week, I believe, and they don't do babysitting. The worker must be working. So they cannot be there "just in case" over night. They must be cleaning, helping with dressing, helping the patient eat etc. You can also access nursing, wound care and physical and occupational therapists through CCAC.

CCAC will provide this free care in your own home or in an assisted-living facility in addition to whatever care might already be there. They will not provide this extra care in a long-term facility. Once you go long-term all other CCAC services are cut off. CCAC is seriously under-funded and they will always be wanting to assess and re-assess your dad to see if they can reduce the level of care they provide. The intent is that this care keeps your dad out of long-term facilities that are over-booked and wait-listed already.

CCAC sub-contracts all their care to the same local private companies you could just hire yourself. St. Elizabeth's, VON etc. etc. Just google Toronto Home Care Services. You can hire someone to do overnights, be there 24-7 or do whatever needs to be done but you will definitely pay for it, by the hour. We pay $20/hour for someone to help my mom with getting up in the morning and assisting her with eating. Overnight hours, weekends and holidays cost more.

You are allowed to bring private care into a retirement home and a long-term care facility to augment the normal care. We are currently using a combination of CCAC care, private care and an assisted-living facility for my mother.

Seconding what was said above that you need to use a company rather than hire an individual. If you hire an individual you are screwed when they are sick, go on vacation or quit. With a company they cover absences.

Feel free to memail if you need any more info. I hate that I had to become an expert at this stuff.
posted by pixlboi at 1:52 PM on October 16, 2012

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