An interview with home care expert, Karen Skoretz
In many families, eldercare duties and decisions for their care fall to women. Because most seniors prefer to live at home for as long as possible and often refuse outside assistance, this can take a toll on the well being of the family members who care for them. Today’s holistic-based at-home-care options now offer support in ways that were inconceivable just a few decades ago.
Karen grew up in the long-term care industry starting as a Candy Striper, and for nearly 30 years since has held numerous management positions in various health-based non-profits, including Hospice Calgary and national REITs. Karen has been a direct caregiver to individuals in community home and family managed provincial programs. Her unique understanding of the health care system and options for support has helped hundreds of clients, and their families, transition to new care routines.
LC: COVID-19 raised concerns about health and safety standards at long-term care facilities across Canada at even the best of times. How have elders who live at home been affected?
KS: COVID-19 impacted families in a very profound way. Elders living at home have been more adamant to refuse in-home care or be put in a facility due to the pandemic. They’re afraid to go outside, which means they aren’t taking care of themselves as much (e.g., going for walks or to see their doctors when they should). This isolation can be further compounded for middle class and high-net-worth elders, because most community programs are geared towards low-income families. Despite all of this, elders who receive at-home-care seem to be faring better than many facility-dwelling counterparts.
Aside from the lower exposure to infectious diseases, seniors living at home tend to do better when it comes to health and safety in general. This is because at-home caregivers can keep a closer eye on issues that may arise – more so than many facilities can – due to the one-on-one care and support (versus one-on-seven support in an average care residence). They can observe things going on in the home on a daily basis, such as cleanliness or having expired items in the fridge that can cause bacteria and make them ill.
They can also notice health issues such as infections due to improper bathing or dehydration. A marked change in mental state is one tell-tale symptom of UTIs in the elderly, and is often mistaken for the early stages of dementia or Alzheimer’s disease, according to the National Institute on Aging (NIA).
LC: Some people believe that elders who are diagnosed with Alzheimer’s, dementia or have other disabilities should automatically be placed in facility care. What are your thoughts on this?
KS: Depending on severity, many people diagnosed with these conditions can continue to live independent lives in their homes with the right care. Over 61% of Canadians with Alzheimer’s are still living at home. The bigger concern is making sure family members are aware of whether or not their parent has one of these conditions, so that proper care can be given.
Covering up behaviours is quite common in the case of couples where only one spouse has Alzheimer’s, and the symptoms can be very subtle. Family members need to pay attention to even slight changes in behaviour, language and how elders take care of themselves.
If something doesn’t look right, there’s usually a reason. Pay attention to small signs, like mom getting lost going on routes she knows well such as going to a family member’s home or the grocery store. It’s human nature to wait until there’s a crisis to do something, like your mother heating the house with her stove and burning it out – or worse – causing a fire.
Lack of education on these matters is very common. People tend to get frustrated with elders rather than pay attention to odd behaviors or mental health issues, and they use medication to correct it. Doing so can potentially cover up an underlying issue and make things worse in the long run.
LC: How can at-home-care providers help meet the needs of families with elders who have impaired cognitive abilities or disabilities?
KS: Providing support from a consistent caregiver is vital to building trust in any relationship. Some at-home care providers use “shift fillers”, so there could be new people showing up who your family member doesn’t recognize. When looking for a service provider, make sure they give you a choice between letting someone else come in and rebooking with the same caregiver for another time.
A home care company that keeps in touch with family members on a regular basis to let them know what’s going with their high-needs elder, especially if there is a change in their behaviour or health, can give much needed reassurance that their loved one is well cared for. It can be as simple as alerting you that they’ve taken their medication or have just gone for an afternoon walk. Choosing a home care company that you feel you have a good connection with, who listens to your needs and treats your parent like family, can make all the difference.
LC: When choosing an at-home care provider, what might people consider to ensure the best fit for their loved one?
KS: When matching your loved one with an at-home care provider, there a few things to look at.
- Management Style – How does the company manage itself? Are their people friendly? Do they manage situations in a reasonable and timely way? Do they feel cold and clinical or take a warm, holistic approach to caregiving?
- Expertise – Do they have people on staff with the skills or experience needed to properly care for your loved one’s specific needs?
- Caregiver Fit – Do they match the temperament of the caregiver with the person they’ll be caring for? You may not want a high-energy extrovert tending to someone who is shy and easily disturbed.
- Cultural Sensitivity – Is there a good cultural fit? Caregivers who are knowledgeable about the traditions or values of the person they’ll be caring for can be more sensitive to their needs, and help them maintain and engage in cultural traditions.
- Flexibility – How flexible are they? Health and schedules can change quickly in life – does the home care company lock you in to term contracts that you have to pay out before being able to cancel?
- Fees – Do they keep adding in extra costs for add-on services? How much is actually covered in the care agreement or contract?
LC: How can people make the transition to at-home-care go more smoothly?
KS: You can help warm a reluctant family member to the idea of outside assistance by getting at-home care support early and starting small. Even if it’s just once a month, get them used to the idea of having a caregiver do something simple, like laundry. This will give them time to gradually build the relationship and create trust.
At-home support is more than medical. I can provide companionship, homemaking and personal care, or even include a handyperson, transportation and pet care support. And because they are trained caregivers (often with nursing backgrounds) they know what to watch for. Incremental help, starting long before a crisis occurs, is the best way to introduce care that can be added as their needs change, and help prevent unforeseen incidences.
LC: What do people typically get blindsighted by when it comes to elder care?
KS: Often, it doesn’t occur to people to be proactive rather than reactive. For instance, if you’re anticipating an upcoming surgery, such as a common hip replacement, you should make arrangements for support before surgery rather than waiting to see what you might need.
Many people rely on provincial subsidized home care, which is typically a lot less care than what people need. Right now, you’d be lucky to get assistance with bathing two times per week. Provincial support is task oriented and very limited due to cut-backs and staffing shortages. It’s a lot less stressful to have the care lined up ahead of time, than make these arrangements while you’re trying to recuperate or add more care for a family member.
LC: What costs should people be mindful of in eldercare?
KS: The Canadian health care system is designed to respond to crisis (i.e., immediate needs like surgery), so many people are surprised to learn that the average waiting list for facility care is two years. If you’re looking at independent and assisted living suites, the cost runs an average of $3,000 per month for a 400 square foot bachelor in Canada. High-end suites can run upwards of $6,500 per month depending on location. This doesn’t include additional fees for things like meals and administering medications.
Then, there are additional equipment needs that can wind up costing thousands of dollars extra, such as special bedding and mobility devices. Legal fees for paperwork in order to prepare for end of life are also often overlooked or not planned for.
LC: Any final thoughts you’d like to leave us with?
KS: At-home care is a practical and safe option for many Canadians today. Where 24-hour care is not needed, it can be an effective and affordable way to help family caregivers get back to just being daughters (or sons) again.
Lucy Conte, Content Manager
CWB Wealth Management
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