Robert Maroncelli has been able to remain in his home with the help of live-in care from Visiting Angels.

Bob and his wife, “Mickey,” moved to their home in Buckingham Springs retirement community several decades ago after they retired. An accountant, who worked most of his career for the Internal Revenue Service, Bob continued to be active in his community and his church. However, as the years passed, several health problems started to cause mobility issues. As Bob became less mobile, his wife began acting as his primary caregiver.

When Mickey was admitted to the hospital because of worsening heart disease, Ann and her sister quickly realized that their father was going to need some additional help. “I knew of Visiting Angels already, and knew the woman across the street was using them,” Ann recalled. “I called around to a couple of home care agencies and Visiting Angels was the most accommodating and the easiest to work with.”

Visiting Angels began helping Bob periodically, whenever Mickey had to be hospitalized. The family was always satisfied with the care and companionship he received. When Mickey passed away, Ann turned to Visiting Angels once again. The agency found permanent, live-in assistance for Bob within several days.

“Tina moved in immediately, and my father has really taken to her,” Ann said. “She provides personal care and helps him with ambulating, and she also does some meal preparation and generally just makes sure he is well taken care of.”

Since Ann is busy with her own demanding career and her sister lives in Connecticut, the family feels incredibly fortunate to have a quality caregiver with Bob at all times. “There is an enormous sense of reassurance knowing that he is very well taken care of; that gives us a real peace of mind,” said Ann. With the assistance of Visiting Angels, Bob continues to live in his comfortable and spacious home, where he receives frequent visits from neighbors and friends from his church.

A Speciality Care Services caregiver, Amie Kanu, accompanies Mercedes
Palmer during all her
outings.

The oldest of four children, Mercedes began caring for the well being of her siblings and father as a result of the premature passing of her mother. At the time, Mercedes was only 21. She went on to pursue a career in early childhood education and to raise five children of her own.

Despite the demands of raising a large family, Mercedes excelled in her career. She became an integral figure in the Head Start movement in the 1960s and was one of the first Head Start teacher trainers in America. Later in her career she served as the director of several childcare centers, including one of the first corporate sponsored childcare facilities in America.

Several years ago, when her husband’s health began to fail, Mercedes naturally became a caregiver for him. However, as his condition worsened, the family realized they needed some additional support. They turned to Specialty Care Services, a licensed nursing provider offering a wide range of home care services. Since that time, the company has provided varying levels of care to meet the family’s needs, from part-time care in their home to full-time care in an assisted living facility.

“Specialty Care has been in our lives through so much,” said Anne, who explained that the family endured the tragic losses of both her oldest brother and her father within one month of each other between December of 2008 and January 2009.

Through it all, one of the constants in Mercedes’ life has been Amie Kanu, her caregiver provided by Specialty Care. “Amie is an extraordinary woman blessed with an extraordinary gift, and she gives so lovingly,” said Anne. “She is with my mother just about every waking moment, and she nurtures my mother.”

As a former vice president of an aging service network in the Hudson Valley region of New York, and having the responsibility when growing up of helping care for her grandfather that lived with them, Anne has both a professional and personal appreciation for the level of service that Specialty Care and Amie provide. “Amie is like having another sister there taking care of my mother. She is so intuitive and knows what she needs almost without asking,” said Anne.

For Anne and her siblings, it is extremely important that their mother, who has always taken care of everyone else, receive top quality care. With the help of Specialty Care and Amie, the Palmer family has been able to ensure that Mercedes – who recently celebrated her 86^th birthday – continues to enjoy the best possible quality of life.

Today, sitting in the home the couple has shared for more than 50 years, Betty Jane laughed as she recalled their uncommon love story. “We’ve really been together since kindergarten,” she said. As they grew older, the pair’s friendship deepened. Soon the two were dating, and when they turned 21, Betty Jane married Creston.

“We know people love their homes, and want to stay in their homes for as long as possible. That is why it is so important to make simple changes to be safe and comfortable in your home,” says Elinor Ginzler, Director of Livable Communities at AARP. “There are easy and inexpensive ways to update your home to accommodate everyone and you don’t have to be an expert to do it. The earlier you start identifying and planning for improvements, the better your chance of enjoying your home for years to come.”

h3. Reasons Why Seniors Choose to Stay in their Homes

There are a variety of reasons why those 50 and older want to stay in their homes:

* Attachment to their home and neighborhood
* Close ties to friends, family and neighbors
* Proximity to favorite amenities, such as a grocery store they love, a cleaner they’ve always gone to or a favorite walking trail

Seniors can face physical challenges that can make it difficult, and sometimes impossible to stay in their homes without some degree of change to their environment. In fact, studies indicate that half of all falls happen at home and research suggests that one-third of home accidents can be prevented by easy home updates and preventative maintenance.

h3. Features to Avoid When Planning for Retirement at Home

* Low lighting
* Stairs with no handrails
* Loose area rugs
* Entrances with many steps
* Hard-to-grasp faucet handles and door knobs
* High cabinets

However, just as we do, homes themselves age too. It’s important for homeowners to make updates to ensure that their home remains a safe and comfortable environment. You wouldn’t skip out on your annual physical, so you shouldn’t neglect to assess your home.

h3. Steps to Make a Home Safer for Seniors

Aging parents, as well as their adult children, can take advantage of the fall season to prepare home for the winter season and holiday guests. Older adults and those who want them to feel safe and comfortable, can take easy, inexpensive steps to make home the ‘sweetest’ it has ever been.

The following 10 steps can make home a safer and more comfortable place:

# Install handrails on both sides of all steps (inside and outside)
# Secure all carpets and area rugs with double-sided tape
# Install easy-to-grasp shaped handles for all drawers and cabinet doors
# Use brighter bulbs in all settings
# Install nightlights in all areas of night activity
# Add reflective, non-slip tape on all non-carpeted stairs
# Install lever handles for all doors
# Place a bench near entrances for setting down purchases and resting
# Install closet lights, as well as adjustable rods and shelves
# Install rocker light switches and consider illuminated ones in select areas

Local hardware stores carry many of the products to make simple updates to homes for the aging. For more extensive renovations, homeowners should consider hiring a contractor who is licensed, certified and bonded to do work in that particular location.

h3. Things to Consider When Purchasing a New Home for Retirement

For those who are considering purchasing a new home for their retirement, assessing its livability is critical before making a purchase.

* Is there a step-free entrance into the central living area of the home?
* Are the doorways wide enough to move in a big-screen TV, or in some cases, a wheelchair or walker?
* Is there a bathroom and bedroom on the main floor?
* For a loved one with mobility problems, can the bathtub, toilet and shower be easily accessed?

These are just a few questions older adults should consider asking as they prepare to buy, ensuring that their retirement home will support them comfortably as they age.

AARP offers a wealth of information to guide homeowners in retrofitting and updating their home. To learn more about home design and how to evaluate your home, visit www.aarp.org/homedesign.

Certified Aging-In-Place specialists (CAPS) can help reconcile the need for a familiar environment with the need to prioritize safety and accessibility. Such specialists have been trained in the specific needs of the older adult population and unique ways to modify homes. They are also experts in designing common remodeling projects and on how to combat common barriers to accessibility.

One thing to keep in mind when considering a CAPS specialist is that they offer a service in drawing from their professional knowledge to help turn your ideas into an organized and thorough plan. However, no matter where you start in the process, a professional remodeler will have to be hired to make the actual modifications to your home. Some typical modifications that will increase access and maneuverability include brighter lights, bath and shower grab bars, countertop heights, multifunctional first floor master suites, and elevators.

CAPS was developed by The Remodelers Council of the National Association of Home Builders (NAHB) in conjunction with the NAHB Research Center, NAHB 50+ Housing Council and the AARP in order to address the growing number of consumers requiring these modifications.

CAPS professionals are mostly remodelers, but a number of general contractors, designers, architects and health care consultants who have been instructed in techniques for building aesthetically-pleasing, barrier-free living environments are also involved in planning.

To get started, figure out how much money you have to spend on the project and compare it to the cost of moving to a community. Also, seek referrals from others who may have had similar work done.

Before you commit to a remodeler, verify with your local state office of consumer protection and Better Business Bureau that he/she has the appropriate license(s) in your state. Ask for a written estimate of the work your remodeler will perform based on your own specifications. Be firm, but prepared to pay the total amount in full. Finally, select a professional with plenty of experience with your type of project. Remember, the lowest price does not always ensure a successful modeling project and home improvement is an investment that will pay dividends for years to come.

1. How does a home safety assessment play into the overall health care planning for an older person and how does it help prevent falls?

An effective home safety assessment plays a critical role in identifying ways to use the environment to support continued participation in an activity and minimize the risk for falls.

As people become older and experience functional difficulties due to chronic illness or health problems, they commonly adapt by changing their behavior rather than their environment. Typically, a person will stop or decrease their participation in an activity that is becoming difficult to perform. But this can have a negative and cascading effect. Decreasing participation in a valued activity may result in less physical activity, isolation, and feeling depressed. It is also associated with the risk for falling. On the flip side, adapting strategies such as modifying the environment or energy conserving techniques such as pacing oneself or sitting instead of standing, can enable a person to continue in an activity that he/she values.

2. What modifications to the home safety assessment would you recommend to healthcare professionals who conduct these assessments as part of their treatment plan?

I would say observe a person within the home environment in order to consider the person’s actual performance, preferred ways of carrying out everyday tasks and personal safety goals. We know now that for an assessment to be successful we have to include a person’s own goals and functional difficulties and make our recommendations without infringing on that person’s personal choices and goal for autonomy.

3. When the patient is going directly home from the hospital, what is the best way for a hospital discharge planner to communicate the importance of home safety assessment to family members?

We recommend that families be provided a home safety checklist and be given a referral to an occupational therapist.

4. At what stage in the aging process do you recommend a home safety assessment be done?

Anyone who is having difficulty at home such as getting into/out of the tub, getting in/out of bed, climbing stairs, going outside, or buttoning a shirt — as small as it might seem — should consider the role of the environment in supporting their efforts to carry out the activity safely and efficiently. If these functional difficulties are brought to the attention of a doctor, he/she could refer the person to receive occupational or physical therapy in the home. Our research, as well as others, suggests that this can prevent a lot of problems down the road.

5. What is the role of medical alert service in a home safety assessment?

The medical alert system is important because it can save a life. In addition there is a great psychological benefit because it provides a valuable security measure, particularly for the person who lives alone or in an isolated area. If a person knows that they have the ability to contact someone, much of their concern and fear of falling can be alleviated.

Fear of falling is very important to address. It represents a real geriatric syndrome with pernicious psychological and physical consequences that affects people’s ability to engage in activities. Having a fear of falling can lead to physical decline, depression and social isolation. A medical alert service can help overcome fear of falling for many people.

From Connections: A Newsletter for the Healthcare Professional, provided by Philips Lifeline.

But among her various interests, nothing compares to her passion for teaching. And through her personal determination and research along with the help of Greg Sieb, an aging-in-place specialist, she can now remain at home working as an academic tutor.

For several months, Inabelle’s family and friends were urging her to move into an assisted living home. Due to the difficulty she has with mobility, they were concerned that living in her home would be too challenging and potentially dangerous.

“I didn’t want to move,” said Inabelle, “If a professional advisor said I needed to, I would have considered it.”

She then sought the help of Stephanie Thomopoulos, a geriatric care manager, who in turn suggested getting a stair lift and recommended specialists who could help Inabelle remain at home. Additional recommendations came from other individuals who had stair lifts installed in their homes.

After speaking with three different specialists, she said it was an obvious choice.

“Whereas it seemed the others were trying to make a sale, Greg from Granting You Access was interested in being a service and had a lot of great ideas,” she said, “He reviewed with me how I would approach my new lift and we made some modifications for a safe procedure.”

As her guide, he chose the model stair lift that he knew would be best for Inabelle.

“The other vendors gave me a variety to choose from,” she said, “But he made it very clear why this specific model would be a superior choice to any other stair lift for my needs.”

With the help of her aging-in-place specialist, Inabelle also has grab bars in conjunction with the lift as well as a shower chair and adjusted walker. They also worked together to move her furniture into an appropriate arrangement.

And for Inabelle, these changes have made all of the difference.

“It is such a blessing to be able to get up and down the stairs easily and safely without pain,” she said, “Greg is very creative in his problem-solving in terms of how you can live more effectively and safely in your home.”

Giving credit to her specialist, Inabelle said she was granted the access to her home that she was promised.

“Installing the stair lift has enabled me to live independently and have the freedom to do what I want when I want to,” she said.

And of course, Inabelle has the freedom to remain an academic tutor in what has become an accessible and safer home.

Care for You, a local home care agency, was called in to organize and clean Bill and Fran’s home. They also provided companion care for the couple, which included nutritious meals and cleaning and laundry service. As they began to get the situation under control, the family was able to make necessary care decisions. Fran would remain in assisted living where she could receive the care she needed. Now they needed to prepare their long-time home for sale.

Working with Bill and Molly, Care for You began the enormous task of sorting through all the possessions in the three-story, 4,000 square-foot home. The work covered the entire property, including a garage, wrap-around porch, and lawn. Items in the couple’s storage facility in Gaithersburg also had to be sorted. Possessions were sorted into four distinct categories: trash, donation, estate sale, and those that Fran and Bill would keep. Staff members arranged and monitored the move of items to the assisted living apartment, and also cleaned out Molly’s basement. Care for You then held an estate sale with both homes’ goods. When the process was complete, staff cleaned the Borders’ home inside and out to ready it for sale while unpacking and settling Bill and Fran into their new apartment. After seeing the work that Care for You had completed at her parent’s home, Molly decided to have them do landscaping work at her house to add the same curb appeal.

Only a few weeks after the house sold, the family faced several new challenges. Fran and Bill’s car was wrecked, Bill quit driving, and Fran fell and broke her hip. During this difficult time, Care for You companions continued working with Bill, adding transportation to their list of services. They also helped Fran through the rehabilitation process, helping her to remain orientated and working to reduce her fear. When Fran returned to the apartment, companions stayed with her every day and night until nursing care became necessary.

Molly sums up their experiences: “I look at where we were a year ago, and I don’t know how we would have made it without Care for You.” She continues, “The difference with Care for You is their people. They really do care. They connect emotionally, as well as do whatever physically has to be done. I knew that I could count on them.” Care for You remains in touch with Molly, Fran, and Bill, and its Lawn and Garden Division continues to maintain Molly’s yard.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place-receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.

Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:

Is the provider Medicare/Medicaid certified?
If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).

How many years has the provider been in business?

Is the provider associated with a larger health care group or hospital?

Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?

Will the agency help you find the best homecare options for you?

Does the provider have a written policy describing the patient’s rights?

Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?

Will the provider give you written information describing how they commence and discontinue services to patients?

What backup does the patient have if their caregiver cannot show up at the scheduled time?

What are the internal complaint procedures?

Will the provider give a list of citations they have received from state surveyors over the past year?

Does the provider have a nursing supervisor on call and available 24 hours per day?

How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?

What types of reimbursements will the agency accept?

Will the provider give a list of references?

Article adapted and checklist borrowed from the Maryland-National Capital Homecare Association’s (MNCHA) and the National Association for Home Care’s (NAHC) websites. For more information, please visit their websites at www.mncha.org or www.nahc.org.

What is a PRS?
A PRS is a relatively simple tool to help keep the user in contact with friends, family, and, if needed, emergency services. Each system has three elements: a portable radio transmitter (help button), a console connected to the user’s telephone, and a response center to monitor the calls. In case of an emergency (a fall, chest pains, suspected intruder, etc.), the user simply calls for help by pressing the button on the radio transmitter.

The console picks up the signal (much like an automatic garage door opener) and automatically phones the response center (even if the phone is off the hook). The call is routed to the response center where the caller is identified through special coding. The monitoring center’s first response is to talk with the user and verify that an emergency exists. This can be done through two-way voice communication or by calling the user back on the phone. Next, monitors will call responders or emergency services to answer the call for help (even if they can’t reach the user by phone).

The features offered by many PRS providers are expanding at an astounding rate. Some systems now offer services such as companionship – the user just pushes the transmitter button and can talk with the response center for any reason. Other systems offer a speaker phone feature with their PRS that allows the user to answer the phone from wherever they are in the house, preventing accidents and aiding the disabled. Staff at the response centers often receive extensive training in such fields as gerontology and stress management, so they can better serve their clients.

As with any other purchase, seniors should seriously consider their specific needs and budget constraints before deciding on any one system. It is a good idea to get written quotes from several companies before making a final decision.

For more information about specific PRS vendors, check with the office of the state Attorney General, local consumer affairs office, or the Better Business Bureau to see if the company has had any complaints filed against them. Your local hospital may also be a good resource to look into; many hospitals offer PRS rentals, which are affordable and reliable.

For additional general information about personal response systems, consumers should consult the Federal Trade Commission’s report entitled “Personal Emergency Response Systems.” The report is free. Consumers can have a copy mailed to them or can review the information online. To request a copy of the publication, call 1-877-382-4357. The report is also available on the FTC’s website. Visit www.ftc.gov/bcp/conline/pubs/services/pers.htm to view a complete copy of the report