Last year, Inez Gardner noticed that her 87-year-old mother, Mamie, wasn't herself anymore. She would leave the phone off the hook, forget to turn off the oven, and get lost even in familiar places. Gardner, 43, an accountant with the state of Illinois, lived with her mother in Mamie's Evanston, Ill., home. "My mother had made it clear to us years ago that she wanted to remain in her home," says Gardner. But how could she fulfill that wish and still ensure her mother's safety? It took months, but Gardner and her four brothers and sisters found a solution: a nearby adult day-care center where their mother could spend each weekday engaged in a host of supervised activities, such as gardening or sculpting, then return home in the late afternoon. "I don't know how we could have helped her stay at home otherwise," says Gardner. "And she's really happy."
Gardner's case isn't unusual. As longevity increases, more and more adults are becoming caregivers to their parents. And most elderly people, like Mamie Gardner, want to live out their days right in their homes. As a result, some 6.25 million elderly, or about 16% of the population over age 65, are receiving home care, up from 4.6 million in 1980. That compares with 1.5 million in nursing homes. But looking after Mom and Dad isn't always possible. Many adult children live far away or already are overcommitted with their own jobs and kids. So they're turning to a growing array of services, from volunteer programs to home health-care agencies, aimed at helping the elderly stay put. "There are many more solutions to help people stay in the home than ever before," says John Geoghegan, chief executive of CareGuide.com, a Web site that provides information to families.
The options are so numerous that deciding which to use can be bewildering. One starting point: Eldercare Locator, a government-funded information and referral service that can point you to the nearest Area Agency on Aging. These partially federally funded agencies have knowledge of local services, although their usefulness can vary widely. You also can try Internet sites. At Extendedcare.com, you fill out a questionnaire about the elderly person's condition--whether, for example, he can get dressed or bathe without help, as well as such questions as how much responsibility other family members are willing to take. You then will get a list of appropriate nearby resources. Careguide.com also provides resource listings.
You may enlist the help of a geriatric care manager, but they're expensive, usually charging $200 to $500 for a two- or three-hour consultation. The geriatric manager, often a nurse or social worker, will confer with you and go to your parent's home to assess the situation and recommend the type of care needed. That's not as simple as it sounds. For example, you may think Mom should have a registered nurse, but a manager, who may be more objective than a family member, might suggest a companion instead, after assessing your mom's ability to bathe, cook, and perform other key activities.
He will also save you a lot of legwork by suggesting where to find care. For $40 to $150 an hour, you can even use him to do the hiring, act as a supervisor, or pay the bills. "We've even been given power of attorney, in case something needs to be signed while the children are away." says Erica Karp, president of Northshore Eldercare Management, an Evanston company that provides geriatric-care managers. You can find a geriatric manager through a local hospital, social services agency, or by calling the National Association of Professional Geriatric Care Managers in Tucson.
TRADING FAVORS. You can, of course, find a home care worker by taking out a classified ad or using an employment agency specializing in eldercare. But the person you hire won't come with any backup, and you'll have to handle all the paperwork. A safer route is to try a home health-care agency. Most offer nursing, including Medicare-reimbursed acute care, as well as less-skilled care that's not covered. They'll send a nurse to do an evaluation, much like a geriatric care manager, then dispatch someone able to provide the appropriate level of care. They'll also handle payroll, taxes, and all the red tape. A home health aide can run $12 to $16 an hour; a nurse, $25 an hour or more. Round-the-clock care costs anywhere from $120 to $175 a day. These prices are $2 to $4 an hour more than if you hire someone on your own.
Adult day-care centers, the solution hit upon by the Gardners, offer a range of services. Look for one that will pick up the elderly person at home and bring her back at day's end. Most of the 4,000 centers are run by nonprofits and cost $40 to $60 a day, including transportation and meals. While Medicare and Medicaid won't cover these costs, long-term care policies will. Some centers are more medically focused, with a staff of doctors and nurses; others emphasize structured social activities. Although typically open only on weekdays, these centers can keep the elderly from becoming isolated and depressed.
Other innovative services include CareXchange, offered by Blue Shield of California to Medicare recipients in four Southern California counties. It's a volunteer program through which seniors help each other out. One volunteer might repair a leaky faucet for someone in the program who, in return, might drive him to doctors' appointments. For the past three years, for example, Lyn Anderson, 77, of Glendale has driven fellow seniors on errands. They, in turn, have repaired things in her house and even escorted her home from cataract surgery. To join, a Medicare recipient just calls 800 445-2520 and asks to be put in the database.
Social HMOs, meanwhile, provide the elderly with benefits ranging from home health aides to geriatric-care managers. Four such plans are in operation, classified as demonstration projects by Congress and limited to a maximum enrollment of 36,000. Costs vary regionally. So Scan Health Plan in Long Beach, Calif., is free, while Senior Advantage II in Portland, Ore., is $176 a month. For more info, try www.socialhmoconsortium.com. A senior also can join a new private program that guarantees home care at any level, from companions to in-home nurses, for however long it's needed. Cadbury Continuum, a Quaker-run nonprofit in Cherry Hill, N.J., charges $350 a month for this service, for example. But members must shell out $20,000 to join and must be in good health at enrollment. Cadbury also runs an assisted-living facility and nursing home, just in case.
Whichever service is chosen, the hard reality is that paying for it will be a stretch for many middle-income people. As Medicare generally covers only 100 hours of home care prescribed by a doctor, most home health care isn't included. Long-term health insurance can defray some expenses. So start thinking about it early on. A policy for a 60-year-old providing $200 a day in home health-care and nursing-home benefits will cost about $1,965 a year. The sooner you start tackling the issue of home care, the better off you will be.