How to Know When it's Time for 24 Hour Care
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Instant Download: Is It Time For 24 Hour Home Care? A Checklist

The decision to either start with 24 hour home care, or increase to this level of care, can be difficult.

As family members, we may not want to accept our loved one’s limitations or we live in denial about their dementia or illness. Don’t wait for a crisis to occur before making this decision. Be aware and involved. What you learn through this process will be invaluable.

This guide and checklist will help you through the transition from daytime care to 24 hour in-home care.

9 Benefits of 24 Hour In-Home Care

Providing care in the home allows an aging parent or spouse the ability to continue to live where they are most comfortable. Preparation can make the difference between calm and chaos. Learning to be an active partner will help.

The benefits of 24 hour care for your family include:

  1. Reduced agitation in people who have lost their sense of time and place. People with dementia often become disoriented to time and place. This can cause significant agitation. A care provider from a personal care agency can be a calm and reassure someone with dementia. Diversionary tactics like engaging in activities can be very helpful and improve quality of life.
  2. Reduced skin infections and urinary tract infections. With 24 hour elder care, someone is there to notice changes. Urinary tract infections are common in older people and can contribute to serious physical and mental problems. A 24 hour caregiver can be alert to this possible problem and notify someone.
  3. Reduced fall risk. Caregivers can support people who need assistance to get out of bed or are recovering from an accident or illness. Falls are the leading cause of death and disability for older adults. 24 hour care can go a long way towards preventing falls. A caregiver can assist someone getting out of bed, toileting and bathing. Decluttering can also reduce fall risk. A caregiver can take up throw rugs, declutter the area and suggest improved lighting. They can also accompany someone on walks.
  1. Lower risk of dehydration and related fainting. Dehydration is common with older family members. Part of this is due to a decline in the thirst mechanism as we get older. With 24 hour senior care, your loved one can be reminded to drink throughout the day. This can reduce the risk of fainting or other medical problems.
  2. Avoiding kitchen or bathing accidents. For people with dementia, the kitchen and bathroom can be dangerous! Even for a family member recovering from an illness, these two areas need to be monitored for safety reasons. Caregivers can make sure the stove isn’t left on and provide stand by assistance when someone is in the shower. If someone is unable to cook for themselves, meal preparation is an invaluable benefit of 24 hour care. Special dietary restrictions can be followed while creating balanced and nutritious meals are prepared on a regular basis.
  3. More time with a companion improves socialization. This is an underappreciated benefit of 24 hour care. Isolation can be devastating. Socialization, whether with the caregiver themselves or as a result of access that the caregiver can provide, can make a huge difference in someone’s life. Numerous studies have shown that socialization helps prevent cognitive decline. This doesn’t mean that having someone available 24 hours a day will “cure” dementia. However, it can improve mood, and decrease agitation.
  4. Meeting personal and medical needs at night or during the day. Nighttime can be fraught with anxiety if you are taking care of a family member. What if there is an accident or medical event requiring action? Even a trip to the bathroom in the middle of the night can be dangerous. You also have to monitor oxygen use and give medication reminders. You can rest easy with a caregiver who can take care of problems or alert someone who can.
  5. Preventing possible admission to assisted living or skilled nursing. Most people say they want to age in their own homes. When safety becomes an issue, 24 hour care can allow someone to stay home safely, sometimes indefinitely instead of going to a retirement home or memory care facility.
  6. Continuing or initiating an activity program. Physical and occupational therapy are time-limited activities covered by Medicare following and illness or accident. Caregivers are not licensed to provide these specialized services but can encourage someone to continue activities whether prescribed by a physical therapist or not. Even regular walking with a caregiver can have benefit for someone and keep them safe!

How 24 Hour Care Supports Seniors at Home

Jack’s story below is a good example of the many ways 24- hour care can keep someone safe and in their home. As you read his story, you may notice some of the same problems with your family member.

Jack is a gregarious 85-year-old man diagnosed with Alzheimer’s disease. He lost his wife several years ago and has been living independently in his own home. Although his health is relatively good, his memory has worsened over time. He forgets to eat and bathe and has recently taken up with a “girlfriend” who talks him into taking her out to eat. On his dime. Jack also opens to the door to anyone who comes around and has purchased several home security systems. He also reports falling at night on the way to the bathroom. His beloved dog has not been groomed or taken to the vet in quite some time.

Jack’s family becomes concerned about all of these issues and decides the only way to address them all is to hire 24 hour caregivers. Once the schedule is in place and the caregivers start, things improve immediately.

The caregivers prepare all of Jack’s meals and his nutrition improves dramatically. Jack is encouraged to bathe which helps most of the time with his hygiene. The caregivers go with Jack and his dog to the groomers and vet. Per family’s instructions, Jack is not to pay for his “girlfriend’s” meals. Not surprisingly, she disappears. Meanwhile, when people come to the door, the caregivers intercede and prevent Jack from signing up for yet another home security system. They also answer the phone and intercept scam calls. At night, the overnight caregiver is on alert for any issues that Jack has going to the bathroom.

The improvement in Jack’s life is dramatic. He is happier and healthier. Most of all, he is able to stay in the home he loves. Instant Download: Is It Time For 24 Hour Home Care? A Checklist

How to Know it is Time for 24 Hour Home Care

24 hour care is around-the-clock, daytime and overnight. While each state has its own regulations, typical options for 24 hour care include:

  • One caregiver who works a full day, with breaks, followed by 8 hours rest in the client’s home.
  • Two caregivers work in 12 hour shifts. The evening caregiver stays awake through the night.

Ask a Care Advisor in Your State

Look for these signs that it may be time to change from hourly to 24 hour care for your older spouse, parent or friend:

  • Frequent falls or compromised balance. This can be the result of dementia, a neurological problem, or following and accident.
  • Confusing daytime and nighttime, frequently awake in the middle of the night, or agitated in the dark
  • Recent hospitalization or stay in a rehabilitation facility after a hip fracture, stroke or heart attack
  • Fainting or confusion from dehydration
  • Difficulty eating or drinking without assistance
  • Wandering from home, by foot or vehicle, and getting lost or confused
  • Confused or frightened by short absences of family, friends or caregivers
  • New or increased bathroom accidents
  • Leaving the stove on unattended
  • You are afraid to leave the person at night or are not getting regular sleep because you are tending to their nighttime needs

Instant Download: Is It Time For 24 Hour Home Care? A Checklist

Getting Started With 24 Hour Care

Most people look to a licensed, bonded agency to fill the need for care for an aging parent or spouse. Hiring through an agency brings peace of mind and security.

24 hours is a long time. Coordinating care should be a partnership between you and the agency you choose. The more involved you are, the better things will go.

Questions to Ask About 24 Hour Home Care

Ask your home care agency these questions to get started with 24 hour home care for your elderly parent or your spouse:

  1. How many caregivers should I expect during a shift? How are shifts divided?
  2. Can I interview each of these caregivers? Can I have each caregiver meet with my elderly parent, or my spouse, to see if there is a good fit?
  3. Will these same caregivers rotate throughout the week?
  4. What if someone can’t make their shift? How do you handle “fill-in” caregivers?
  5. Can family caregivers share duties with agency caregivers? How will we coordinate this?
  6. Who do I speak to if there are problems?
  7. How many of the caregivers are certified nursing assistants?
  8. What specific tasks is a caregiver allowed to perform?
  9. Will a supervisor visit my home? How often?

Coordinating 24 Hour Home Care Without an Agency

You may be tempted to hire someone you know or hire a private caregiver to care for your aging parent or spouse. Do this with your eyes open and attention to detail.

  1. You will be responsible for payroll, taxes (if the person is classified as an employee), workman’s comp, and liability insurance.
  2. You will be responsible for managing and coordinating schedules for all your parent or spouse’s care.
  3. You will need to find, often on short notice, replacements for caregivers who can’t make their shift or take another job.
  4. Check with your homeowner’s or renter’s insurance agent. Learn if your policy covers liabilities for domestic workers.
  5. Check your state’s minimum wage and overtime pay requirements.
  6. Some states do not allow “live-in” caregivers, or exchanging domestic parts of wages for “room and board.”

Having a consistent team of caregivers is more important than people realize. Consistency and continuity of care build trust. Different caregivers coming in at different times of day can be confusing. It can also lead to poor communication. Consistent caregivers leads to consist care.

However, t is not uncommon for a favorite caregiver to leave. Talk to your parent or spouse about their feelings. Reassure them that you and the agency will find a suitable replacement. Check in frequently to see how things are going and request adjustments as needed.

Paying for 24 Hour Care

24 hour care is frequently less expensive than a private room in a skilled nursing facility or memory care. Let’s take a look at ways to pay for home care.

Long Term Care Insurance

Some long-term care policies provide a daily amount toward the cost of care at home. Many policies have 90-day waiting periods. If you qualify, consider tapping into this resource. If you choose a home care agency that processes these claims on your behalf, you’ll save yourself hours of paperwork and daily record keeping.

Medicare

Many people believe that Medicare pays for home care. Medicare does pay for medical services that take place in your home, with a doctor’s order. This includes nurse visits, and physical and occupational therapy. Medicare does not pay for non-medical care in private homes.

Work with Professionals

A financial advisor or elder care attorney can look at the big picture and make recommendations for structuring finances to pay for care.

Be flexible and patient through this process of setting up 24 hour care. Work closely with your home care agency to provide safe, consistent and quality care to your aging parent or spouse.

Sometimes lost in all the planning is the person receiving the care! Unfamiliar people coming into the home and providing intimate care can be a shock at first.

Make an effort to honor and respect your aging parent or spouse’s wishes and needs. Include them as much as possible in selecting caregivers. Respond to their ongoing concerns once staff are in place.

Instant Download: Is It Time For 24 Hour Home Care? A Checklist

About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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