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Improve Your “Disaster Preparedness” in Home Health Care

Part I: Learning to Accept Home Health Care

    I found out recently that I knew less than what was necessary about home health care. I thought that with almost 25 years of working with Older Adults, from financial to legal issues, I was prepared for most late-life disasters.  Professionally, I’ve helped mediate family conflicts, managed corporate benefit plans, and personally weathered the aftermath of a major earthquake.  However, when I was recovering from a clumsy slip and fall, I found many gaps in my one-sided education. As a caregiver, both long distance with my mother in Virginia, and nearby, for several friends in West Hollywood, I’ve learned about the needs of single adults like me who lack a support network.  My six or seven close friends who had weathered the years with me were busy with their own lives, although each had faced a family caregiving crisis. A few years ago, I helped launch a new home health care agency, and wrote a marketing report on the Los Angeles caregiving industry.  But, until recently, I never needed a caregiver for myself.

What It Was Like When I Needed Home Health Care

I was forced to learn at the worst possible time, when I fell and broke my knee.  After being taken by ambulance to a large hospital emergency room, I was sent home, alone, to wait a week for surgery.  I was given a bottle of painkillers to help.  Very few friends were available during the days I was waiting for surgery, immobilized in a knee brace.  Ruth, an old friend from work, brought sandwiches and conversation, and Nancy drove me to my medical appointment.  Neighbors came by, offering grocery runs or garbage removal.  I knew I needed more help. Two days later, I collapsed in tears and frustration.  I wasn’t safe, and was getting more and more anxious.  It took days to negotiate with my apartment manager for permission to install grab bars in my bathtub.  I needed to find solutions to alleviate my fears and give me appropriate care. Navigating the caregiving industry proved to be complex.  Many agencies on the Internet made promises that were impossible to keep.  There was no time to be a recovering patient; quick decisions were necessary that affected my daily life.  Which agency should be trusted or hired? While marketing director with a home healthcare agency, I clicked with a particular Registered Nurse at a professional seminar; she founded and ran a caregiving agency.  It had operated for more than two decades, and she was happy to provide caregiving guidance.  Ellie did a home visit and an assessment, and called my case manager. They gave authorization for a caregiver for a few weeks. I found hope. For the next 9 weeks, caregivers worked with me during weekdays.  They ranged from inexperienced to very experienced. There were many differences between caregivers, between certifications and experience, and I had no idea of how to manage them in my small apartment.  I was immobilized with a broken knee.  Unless I asked them to perform a task, they would play with their cell phones.  I wasn’t sure what the rules were, but wanted to keep them busy.  The first woman offered to do more housework–clean the oven, windows, mini blinds–and really proved her talent.  However, when her small car broke down, the agency replaced her.  I was ready–we were not a good fit.  My apartment was really clean, though.  It was a stressful ordeal to change caregivers. Following the second caregiver, an insurance company mix-up delayed the reauthorization, causing a gap in care.  I was angry, isolated, dealing with insurance representatives who worked out of state, and who didn’t seem to care about my recovery.  My emotions were disintegrating as I waited, in pain and with minimal support, for several weeks. Finally, the paperwork came through, and Ellie’s agency sent a male caregiver to help who proved to be a good fit.  He was quiet, patient, and cooperative, and smiled easily.  His large van was easy to get in and out of, and he quickly settled into a comfortable routine.  He didn’t hesitate to provide efficient care. After about two months, the arduous weeks of physical therapy began.  I’m grateful that the caregivers helped me reach the next level of recovery.  I’m now walking with a cane and am feeling much stronger.

Lessons Learned:

  1. Ask the agency how much experience a caregiver has dealing with your type of recovery.  If you have personal apprehensions, ask for a replacement.
  2. Complex events can interfere with a patient’s recovery. An insurance case manager might be in another state and unavailable for same-day response.  When possible, leave extra administrative time to process authorizations.  Be very respectful, even if you are angry and frustrated.  They have limited time to help you, and they many patients to serve; give them the benefit of the doubt.
  3. As a Gerontologist, I improved my understanding of home health care, and will apply it to future consulting work.
 

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Wendy GoldmanImprove Your “Disaster Preparedness” in Home Health Care

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