Because many families only begin looking into home health care when the need is immediate, they find themselves discussing potential home care solutions for their aging parents or spouse using terms they may not fully understand.
In order to assist our friends and neighbors in making informed decisions, we’ve put together a brief primer on what home health aides, including the qualifications they have, the roles they play, and the tasks they can perform in providing in-home care and assistance to older adults.
Context: The Benefits and Challenges of Aging at Home
Today’s seniors live longer than in generations past, but with more time spent in their 80s, 90s and even 100s, more years are spent living with and managing chronic health problems. Longer life expectancies also mean that moving in with adult children or to assisted living facilities are not as practical as they once were, both from the perspective of sustainable living arrangements and financial planning. As it turns out, seniors prefer to remain in their own houses or apartments.
There are also practical reasons elderly individuals should remain at home whenever it is possible. The senior’s adult children are more likely than ever before to have full-time jobs and children of their own still at home. This may preclude an aging parent from moving in even if all parties wanted such an arrangement.
Aging at home affords the senior the ability to remain independent and in control of more decisions. What to eat, when to go to bed or wake up, what to do each day are all important choices that promote agency, can actually keep seniors cognitively sharper as they age and depression that is frequently associated with loss of control. Staying engaged in the social network they have developed provides psychological and cognitive benefits, as well.
Remaining in a familiar environment can avoid issues arising from confusion, including combativeness or paranoia that can interfere with other forms of care. Familiarity involves not just a physical layout but also personal affects, artwork and mementos.
A long-term care facility or nursing home should only be the last resort for elderly persons with serious health or medical issues. Unless the senior requires round the clock supervision or consistent medical care, there is no reason to place the person in a facility. Everyday life in a care facility means a senior is looked after by strangers, and residents have virtually no independence or privacy.
That said, seniors who remain at home often need some help. Errands such as grocery shopping or getting to appointments becomes more difficult when the individual can no longer drive safely. Using knives, cooking on a stovetop and other elements of meal preparation can become challenging and even dangerous if an individual experiences even occasional forgetfulness. Transferring positions, dressing and maintaining a regular daily routine, and personal hygiene can all become difficult for an older adult. An aging individual who lives alone must also deal with inevitable feelings of isolation, loneliness and depression.
Who a Home Health Aide Is And What They Can Do
A home health aide (HHA) is a professional caregiver with state-recognized training and certification to support their patients inside their home. In Florida, the training includes at least 40 hours of hands-on training through a state-licensed vocational school or directly by a home health agency. All home health aides must complete an HIV/AIDS training course and are required to maintain active credentials in CPR training.
Of course, these are just the minimal requirements to work as an HHA. Any nurse registry or home health agency that has been in business for several years (Boca Home Care Services has been assisting clients age in place since 1998!) will be able to help families find aides with years – if not decades – of experience and even familiarity supporting clients with circumstances similar to their own.
A home health aide’s role is to support their patients with a range of practical, daily activities. The formal Activities of Daily Living (ADLs) include getting in and out of bed or a chair, using the toilet, dressing, walking, eating, and bathing or showering. Assistance with at least two of these formally defined activities is usually required to have the cost of a home aide paid for by a long-term care insurance policy. More than 20% of adults age 85 and older require assistance with ADLs.
An aide can also assist with other activities in a senior’s daily life. The aging individual may need assistance with shopping, banking or other errands, or light housekeeping. He or she may need someone to help him feed his pet or walk his dog. Errands can be run with or on behalf of a client. Seniors may benefit from company and conversation, or from keeping up a routine of socialization, exercise or mental stimulation. An aide can provide transportation to and from appointments, whether they be doctors’ visits or time at the salon. They can do laundry, wash dishes, tidy up the house, and help seniors reach or retrieve things around the home that they should not be attempting on their own.
Home care aides look after the senior’s health. Seniors occasionally forget to take prescription medication or eat meals at mealtimes. Aides remind seniors to take medications on time and can prepare nutritious meals for the seniors, too. Aides also make sure that medications, diet and exercise are compatible with the doctor’s instructions.
Home health aides usually record a senior’s activities and progress. This helps supervising nurses or physicians understand if the senior is doing well, or if changes need to be made. Depending on the situation, aides may share this information with the senior’s family, allowing them to know how their loved one is doing, even if they do not live nearby.
Family members are often concerned about an elderly person’s safety and security. An HHA can take steps to ensure safety and security and reduce the risk of a fall or other incident. Doors and windows can be secured to eliminate the risk of a break-in. An aide can periodically check the phone to be sure seniors can make and take phone calls. The senior’s home will be clean and tidy to reduce the likelihood of tripping. An aging individual’s health, safety, and security will be priorities whether the aide is present or off-duty.
Side Benefits of Hiring a Home Health Aide
Home care aides help seniors stay active. In the home, this can mean playing games to keep his mind alert and sharp, assisting the senior with exercise routines so his body is limber and coordinated, or playing a musical instrument while the senior sings.
With an aide, an elderly person can stay active in the community. Not only is it easier and safer to participate in the community with an aide, it is more fun. An elderly person will not worry about having an accident, not arriving on time, or finding his way home. His aide will take care of these details so he can focus on having a good time.
An elderly person who lives alone at home is at significant risk from isolation and loneliness, which can be detrimental to bother their mental and physical health. Seniors who experience isolation and loneliness on a regular basis have a higher risk of depression and medical issues. With a home care aide, a senior never needs to experience isolation and loneliness.
Home care aides can also provide encouragement to seniors who are unmotivated or sedentary. While a senior will not be forced to do anything he or she does not want to do, encouragement can make a difference. If they have developed the habit of spending the entire day watching television, or sees no reason to get out of bed in the mornings, as aide can encourage them to find activities they will enjoy. Whether the senior takes up a new hobby or enrolls in a class at a senior center, he or she will be healthier and happier when their daily life feels productive.
What Home Health Aides Do Not Do
Non-medical home care aides do not provide skilled nursing services. This means they cannot change ostomy bags, insert IVs or prepare medication. They are also not physical therapists and do not design exercise routines for their clients. In most cases, the nurse registry or home health agency that a family is working with can refer a nurse or therapist to the client’s home to assist on these periodic needs.
Home care aides are also not expected to perform deep or heavy cleaning services. In some cases, an aide may actually insist on a sanitary cleaning service before commencing or resuming care in the home. It is their right, as professionals, to expect a hygienic work environment.
Although they may help in ways they feel comfortable, a home health aide should not generally be relied upon as a personal assistant when it comes to organizing business or personal financial affairs. Computer savviness is not typically a screening criterion used to identify a potential match.
How Much Does a Home Health Aide Cost?
This is a question we get asked all the time, and we understand why. However, the challenge in answering the questions lies in understanding that every client’s needs and preferences are unique.
In part, the cost of home care is driven by the scarcity of the skills and characteristics a client is looking for. Does an aide need to speak a less common language? Do they need to have experience with an unusual piece of medical equipment? Are there cultural norms with which they need to be familiar? Do they need to have a certain amount of physical strength to safely transfer a patient? These factors can all limit the availability of perfectly matched caregivers, thereby increasing the cost. Reasonably, if a caregiver has invested in incremental training, they expect to earn more when using that training.
Professional caregivers arrange their schedule to maximize their earnings while meeting their own personal needs and preferences. Aides typically charge more for short shifts that do not fill their preferred schedules, especially if they are timed or located in a manner that precludes the HHA from filling out the rest of their schedule efficiently.
Travel time to and from a client’s home may also impact the cost.
The longer a nurse registry or home health agency has been in business, and the larger a network of caregivers they maintain, the more easily they will be able to find and refer an aide who meets a family’s exact needs while helping the client keep costs manageable.
It is worth noting both that Florida has among the lowest costs of in-home care in the nation, and that no matter where your loved one lives, a bit of preventative care provided by an HHA can save the much higher cost of advanced-level care incurred after a fall or further cognitive deterioration.
The Flexibility of Adaptable Care
Home care aides are the most effective way of giving seniors the independence, dignity and freedom they want while remaining safe and healthy. As seniors continue to age, their needs tend to increase, particularly if they are managing one or more chronic conditions.
Fortunately, in-home care provided by home health aides is a fully scalable solution. Many clients begin with just a few hours a week; this allows them to get the assistance they need without a large financial commitment and while getting used to having someone come into their home. Initially, home care aides leveraged in this capacity will help with daily household chores and ensure that seniors avoid injury trying to do tasks that they are no longer physically capable of doing.
As the client continues to age at home, a HHA may begin helping with errands or meal preparation. Hours of service may increase as the caregiver is asked to come earlier to help with dressing or stay later to assist with bathing. If a client does make a trip to a hospital or rehab facility (elective or otherwise), an aide can attend to them there as a supplemental resource and advocate. If dementia or other chronic cognitive issues arise over time, the home health aide may be asked to take on even more in terms of mental stimulation, personal hygiene and providing a reassuring sense of companionship.
Assistance for Your Family's Senior Care Journey
Even as home health aides provide an effective, scalable care solution, we recognize that bringing someone into your loved one’s home can be daunting. By using a fully licensed home health agency or nurse registry, you can be sure that the caregiver who knocks on the door is vetted, insured, experienced and dedicated. Over the more than twenty-five years that we’ve been helping our friends and neighbors in South Florida with their homecare needs, we have referred aides into the homes of many of our own employees’ parents. We simply wouldn’t work with a homecare aide with whom we didn’t feel this level of comfortable.
If you or your loved one lives in Palm Beach or Broward County, call us to discuss with one of care specialists whether a home health aide is the right solution for your family.