Independent seniors may still need in-home care

There is no mistaking that most senior citizens, as they age, would like to remain as independent as possible, and this often includes staying in their homes as their need for personal care and medical services increases.

According to a survey by AARP called Home and Community Preferences of the 45+ Population, most adults want to grow older living in the home and community they know. Of the 1,616 respondents who participated in the July 2010 survey, three-quarters strongly agreed with the statement, "What I'd really like to do is stay in my current residence for as long as possible."

In the same survey, when respondents were asked about the different aspects of their community and how important they are, two-thirds said that being near friends and family is extremely or very important to them, as well as being near places that they visit, such as grocery stores, doctors' offices and the local library.

"(Home) is a known quantity. Your family is around you, your community is around you. It's not a sterile, institutional situation; you're not just a bed in a room," explained AARP spokeswoman Christina Clem.

Of course, there is that ubiquitous baby boomer generation that is going to have its hands in defining the future of in-home care as well. There are about 6 million seniors age 65 and older who need daily assistance, 4.6 million in the community and 1.3 million in nursing homes, according to the AARP Public Policy Institute. But because of the boomer generation, these figures are going to keep rising.

The number of Americans turning 65 or older is occurring at a rate of about 8,000 per day. By the year 2025, there will be 72 million boomers, which is more than double the 35 million in 2000.

And they aren't exactly shy about asking for what they want.

As Clem put it when referring to the growing push for more government and community support for home care: "The baby boomers say they want to stay in their home, and they're very vocal that they will advocate for it."

They also are getting more educated about what home-based care entails, in many cases because they are looking for ways to meet the needs of their own elderly parents.

Carrol McGowan moved to Las Vegas from Maryland a little more than a year ago to take care of her 93-year-old mother. She stays with her mother all day, and then a caretaker from Home Instead Senior Care takes over at night and during the weekends, giving McGowan a needed break and making it possible for her mother to have around-the-clock care in her own home.

"They have been invaluable to me. The people that work there are very loving and caring, and they really put my mother's needs first. ... They just do everything for her," she said.

The services provided by the caregiver include preparing meals, taking her mother on outings, helping her mother with bathing, making sure she takes her medications and simply being a companion, McGowan said. Her mother has Alzheimer's disease, she added, and Home Instead trains its employees to care for those with the condition.

McGowan, who is 54, hopes that when she gets older and comes to the point of needing assistance with everyday living that she will be able to stay home as well.

"(At home) it's the familiar surroundings that make you feel secure and I would want to stay at home and have people come in, caring people with a lot of sympathy and empathy for my situation."

Home Instead, which provides strictly nonmedical home care for seniors, was created in 1994 in Omaha, Neb., and now has more than 900 franchises worldwide, including offices in Japan, New Zealand, the United Kingdom and Switzerland. Within Nevada, the company's handful of offices have seen a 25 percent increase in business during the past year alone, according to Bonnie Reppert, who opened a franchise in 1996 that now serves Las Vegas, Henderson and Boulder City.

According to Reppert, along with the increasing need for home services is an expansion in the type of care that is being provided.

"We do offer more personal-care services than we did in the beginning. In the beginning it was more like housekeeping and transportation, errands, those kinds of services, and … as more and more people are wanting to stay home longer, they have more needs for personal-care services, which would include bathing, grooming, dressing," Reppert said.

Of course, home health also includes skilled medical services, although unlike nonmedical assistance this is usually short term and falls under the umbrella of Medicare as long as there is a determined need and someone is "substantially homebound," according to Amitabh Singh, owner and chief executive officer of Valley View Home Health Care. It is also for those who need intermittent care and not the continual intensive monitoring like that provided by a hospital.

It's usually for those requiring rehabilitation after surgery, a serious illness or injury, and includes services such as wound care, intravenous infusions, monitoring of medications and physical therapy, Singh said.

In the long run, this kind of in-home medical care costs less than being in a hospital, according to Singh. It not only benefits the patients who would rather recover at home, but the hospitals as well, he added.

"Medicare is now making hospitals responsible for readmissions within a certain amount of time, and basically being penalized if patients with certain conditions come back to the hospital faster … so the critical nature of home health now is going to grow with this because home health is an integral (part) of ensuring the patient doesn't come back," Singh said.

Studies also have shown that patients taken care of in the familiar surroundings of their own homes recover faster and with better results, according to Jon Monks, administrator for Creekside Home Health Care, which provides skilled medical care.

"I think it's more affordable, the patients actually feel better quicker, faster, when they're in a more comfortable environment that they have control over," Monks said.

He pointed out there are several factors affecting in-home care. Because of the recession, many who have lost their jobs are choosing to stay home and take care of their elderly parents, for example.

There also are seniors who had planned to enter assisted living facilities who are putting it off because they haven't been able to sell their homes.

"I think everybody in this day and age is concerned about the cost at all levels of care - hospital, skilled, assisted living or private duty. I think everybody's just a lot more sensitive to the cost of the care," Monks said.

The nature of nursing-home care is also changing and will affect the future of home medical and nonmedical services, he added.

"Actually, over the last 15 to 20 years, the acuity in nursing homes has changed to where nursing homes used to be very custodial care, and we don't see a custodial care taking place in nursing homes at this point. It's all rehabilitation," he said.

How all of these factors play themselves out still remains to be seen, although there are strong indications that home-health care is going to experience incredible growth. According to the Bureau of Labor Statistics occupational outlook for 2010 to 2020, the number of home-health and personal-care aide positions is expected to grow by 70 percent during the 10-year period, which is "much faster than the average for all occupations," according to the report.

The number of positions in 2010 was 1,878,700, and approximately 1,313,000 jobs are expected to be added by 2020.

"There's a huge demand for health care workers and we hire constantly," said Reppert, who noted that her business has about 90 caregivers.

"We're very particular about who we hire, so we put any potential new hires through a real stringent preapplication process so we want to make sure we have the right people to provide the care," she added. "We prefer somebody that has either experience as a caregiver at minimum with a family member, but we do a pre-employment assessment that focuses on a personality that's suited to provide services to the elderly."

She noted that many of the caregivers she hires are between the ages of 45 and 65, and like the flexibility of part-time work. Others, she said, choose to make it a full-time job.

The health care sector is the fastest growing in employment and is expected to remain strong for a while. This includes jobs related to in-home medical care. Singh noted that the biggest need he sees locally for home-health employees includes nurses, and physical and occupational therapists.

"We are always hiring. Honestly, it's always a struggle, and especially a struggle for us because we have preferred to actually refuse patients now and then and slow down … rather than dilute the care," he said.

Benjamin Rine, local administrator for Home Bound Healthcare, which provides both skilled medical services and nonmedical caregiving, said that no matter the job, workers in the home-health sector need to be committed to providing the best one-on-one care possible.

"The people who work for us are there because they want to be there. ... We have a wide range of employment opportunity for people at all levels of their career development, but the goal is not financial in nature; the goal for the people that we want is patient care and that should come across very easily to the patients," he said.

He noted that most of their clients are not convalescing but receiving long-term personal care assistance for day-to-day activities and companionship, often providing relief to family caregivers.

Even though there seems to be a lack of understanding about home-health care, including everything from what kinds of services it provides to the costs, he believes demand will continue to grow as boomers learn more about it and agencies adapt to changing needs.

"As home-health companies themselves improve their offerings and refine their systems, and the industry itself kind of matures, I think that confidence will improve, I think that clearly the market is enormous," he said.

He even sees technology playing a larger role.

"There's a lot of money going into (research and development) for this industry, too. For example, technology, now with broadband and the cellphones are broadband, there are a lot of devices now that we're using to monitor patients in-home also.

"Technology's a great enabler, and as it improves, I think there will be specialists who are good at installing the technology, maintaining it, teaching people how to use it, finding things to do with it that wasn't designed to be done before."