In-home providers in Henderson, NV
August 2, 2014 8:02 AM   Subscribe

My mother has end-stage cancer (2-3 months), and has opted for in-home hospice care. Please help me with recommendations for in-home care providers in the Henderson/Las Vegas, NV area.

We recently learned that my mother's cancer has metastasized even further into her lungs and liver. Given the chance of success she has decided against further chemo or radiation. She has been in the hospital for the past few days but is being transferred to an inpatient hospice facility. We expect she'll be allowed to go home sometime next week.

Mom is on Medicaid and is signing up with Nathan Adelson Hospice for hospice care. NAH provides what sounds like two or three visits a week from their nurses, focused on medication and pain control. None of the rest of her care is covered, so we are looking for a home health aide to help with meals, showers, getting to the bathroom, and such. (Before anyone asks, none of the family members are in a position to provide this care.) Based on her progress in the hospital, the doctors said that Mom won't need 24 hour care at first, but of course we expect her needs to grow.

Here's the specific things we are thinking about/looking for:
- Recommendations for (or warnings against) in-home providers. Mom lives in Henderson.
- An idea of what it will cost. We have been told 24-hour care runs $100-$300 a day - is that true, and are there expenses they are not telling us about?
- Does it make sense to try to find an individual provider or should we go through an agency?
- How does it work with the variable needs? I expect that in the first few weeks she will just need meals and help getting around, but she may need 24 hour care later. Can I expect the home care provider to switch schedules every week?
- Experiences with Nathan Adelson would also be welcome.
posted by frizz to Health & Fitness (6 answers total)
I can't comment on Nathan Adelson and I live in the Chicago area, but I can give you some general info based on my experience coordinating home hospice with caregivers and their schedules.

Unless someone weighs in with specific recommendations for caregivers and/or agencies, I would suggest you ask the hospital and the inpatient hospice facility who they recommend. In the case of my mother, they wouldn't make specific recommendations (at least not on the record) but were very helpful in providing lists of good agencies in the area, along with prices and other information that allowed me to narrow the list considerably before I ever placed a phone call.

Be sure to interview the agencies you are considering. They all seem to have people whose jobs entail coordinating with the family and they are happy to meet you and answer questions. And, if you can, have your mother meet prospective caregivers before they are assigned to the case. I always tried to be on-site for any new caregiver's first shift, but the agency was happy to do it when I was unable to be there.

In general, you pay hourly, with a declining per hour rate the longer the shift. But the hourly rate is such that, beyond a certain number of hours, it's cheaper to have 24-hour care. Agencies require a bed and a guarantee of no more than "x" interruptions per night for their 24-hour caregivers. It may even be state law where your mother lives.

With my mom's agency, the only additional costs were a per-mile rate if the caregiver ran errands with her own car, and an added fee if they sent someone in my place to do a detailed orientation for a new caregiver.

When my mother was in home-based hospice, the caregiver agency was absolutely wonderful about changing the schedule and coverage as her needs for assistance increased. I was very grateful to them for that. If you bypass an agency and hire caregivers directly, it will be cheaper but every time you need more or different hours, you pretty much return to square one. Good caregivers are in pretty heavy demand and sometimes you have to work your needs around the schedule of someone you and your mother like.

I know how difficult this time is for you. Don't hesitate to reach out to the hospice people for advice and even counseling as you work your way through. That's part of their job and they do it well. Thank goodness for hospice workers. They are truly angels.
posted by DrGail at 9:11 AM on August 2, 2014 [2 favorites]

I just went through this with my father. Going through an agency for home health care aides is definitely better than sourcing care from individuals because the agency can bring in people if someone calls out sick or your mother needs additional shifts added. For my dad, he had two shifts (9-4 and 11-9) for a while until he needed 24-hour care. The two shifts ran us approximately 300/day, but in your area it may be less. When we shifted to 24-hour care it wasn't much more because of the declining hourly rate situation DrGail mentioned. (Also, in our area, the overnight shift did not require a bed or any guarantees about interruptions per night, but that could be different in your area.)

Changing needs are also a good reason to go with an agency. At first, my dad only needed help with preparing meals and sometimes with bathing. As he got weaker, his needs increased, so the agency would change his care plan so that each aide had specific tasks and knew what the increased needs were. The agency also had a nurse assigned as his caseworker, and she coordinated with the hospice team to make sure everyone was up to speed on his changing needs.

Definitely utilize the hospice people for help with getting everything set up. They will also have resources for you to help you handle your own emotions and grief - make sure you take care of yourself too.
posted by bedhead at 12:09 PM on August 2, 2014

Also make sure the hospice folks provide you with an equipment list and a place to obtain rental equipment. I would get a commode for bed-side, hand-held shower head, and shower chair to start. Know where to get a rental hospital bed and wheelchair for outings. Assess your mom's house and get rid of all trip hazards, arrange things so she won't have to use stairs as much as possible. This equipment for home comes at additional cost to nursing.

Agency workers will prepare meals and also shop for you. Be aware though that if your care giver is out shopping then she will not be home to help with your loved one. Getting as much as humanly possible delivered is an additional cost so as to maximize time spent in the home.

You may find other expenses as you go. For example, your mother may need different clothing, such as a larger stock of nightgowns, clothes without zippers or buttons, non-skid socks, or supportive slip on shoes to support independent dressing and toileting as long as possible.

You need a good referral for an agency since the two I worked with were sort of a pain. Definitely go with an agency since individuals can get sick, have family emergencies, etc and you don't want to have to scramble to find care.

Good luck
posted by crazycanuck at 9:17 AM on August 3, 2014

Best answer: Hi, I am a hospice/palliative care nurse in Vegas and henderson. I can give you a lot of information about all the big hospices in this area and some of the little ones too. I think it is going to depend on what your situation is to be honest. nathan is fine, established and the care seems to be good but they are entrenched and so sometimes I think they don't try as hard. Their call response times used to be pretty bad but I think they are working on fixing those issues. also, when a big hospice has their own free-standing in-patient unit, they really push patients into using it as it is very expensive to run and they need a high census. I can't publicly list the hospices I would avoid at all costs but please message me and I'd be happy to give you my opinion. And Medicare has recently changed how hospices are reimbursed for medications so you'll want to be really careful who you go with, a lot of hospices will try to DC meds that may need to be kept just so they don't have to foot the bill. Pain management is another one to really question, if a hospice tells you they predominantly use methadone for pain then be careful, methadone is super cheap so a lot of hospices are going that way but it can be really tricky to titrate and I hate the "this is what we use for everyone" mentality. Also be careful about DME, make sure the hospice is going to gibe you a full electric bed for example and not stick you with a hand crank one for cost control (assuming you need a bad). Ask what company they use for DME and what the response time is for service issues. And, if you end up not liking the hospice you pick, you are allowed to sign off or change AT ANY TIME. And if they tell you that you MUST be a DNR then they are lying liar faces and avoid them. I mean you should be DNR but it is absolutely not a requirement for hospice. Anyway, I can go on for hours but if you want advice specific to our area let me know.
posted by yodelingisfun at 11:04 AM on August 3, 2014 [1 favorite]

And shoot, Nathan has social workers whose job it is to help with things like finding 24-hour care, you may end up not needing it all depending the disease course. Care givers here run around $20-$30 an hour in general and they are not licensed. Nathan should give you a CNA at LEAST a few times a week to help mom bathe and dress, if they don't then change hospices. CNA's are so important to hospice care. Caregivers cannot give mes so keep that in mind, technically they shouldn't even hand mom a tylenol (same with CNA's, no meds).
posted by yodelingisfun at 11:09 AM on August 3, 2014

Response by poster: Just a follow-up on how our hospice and caregiving worked for my mom, who died six weeks after this post.

We went with Nathan Adelson Hospice, and they were absolutely fabulous. Every single person we worked with was kind, helpful, and professional. They always went above and beyond in responding to our questions. And they had no problem with us (the children) calling the nurses for check-ins, etc.

We also used Angel Care for home care. They charged $14.50 / hour, and the two staff who worked with us were very thoughtful and compassionate. They spent hours talking to my mom and listening to her stories. They cooked and cleaned, and at the end, they also bathed her and changed adult diapers. One even helped us advocate for higher-quality medical equipment, which we would not have known to ask for. She was also able to see the signs of dying more quickly than the nurses, which gave us time to get there for the final moments.

Things we learned:
- Ask lots of questions. If they are patient through those, they will likely be patient throughout.
- Ask for care workers who have experience with the process of dying. Without this, we would have all missed the final two days
- The social worker was critical in getting us equipment and services. Advocating with her meant my mother got a few extra comforts that she otherwise might not have received.
- Medical staff (NPs or RNs are -- for liability reasons -- less likely to be straightforward about the time left and want to provide hope. I wish I had asked more directly. Luckily our care worker filled in the blanks for us.

I'd say we lucked out in so many ways. This process was relatively easy, and everyone we interacted with was fabulous. It made the most difficult times tolerable and comforting.
posted by frizz at 1:12 AM on September 20, 2014 [2 favorites]

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