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San Diego Elder Care

By: Cindy Hasz, Geriatric Care Manager

San Diego presents the elder care consumer with multiple choices. The basic question is, where will you be needing care for your loved one?

If you need to provide care at home then you can look at one of the many home care companies in San Diego for a caregiver to provide in home personal care services. These caregivers are considered “non-medical” personal care attendants and it’s important to understand the scope of their service. They are not allowed to do anything “medical,” from taking vital signs (blood pressures etc.) to blood sugars, to giving medications or doing anything “invasive” such as giving suppositories, insulin injections etc.

This comes as a big surprise to those who assume that caregivers can do all these things or that they are medically trained in any formal sense of the word.

Caregivers are allowed to give care around the activities of daily living or “ADL’s.” The term “activities of daily living” refers to a set of common, everyday tasks, performance of which is required for personal self-care and independent living. The most often used measure of functional ability is the Katz Activities of Daily Living Scale (Katz et al., 1963; Katx, 1983). In this scale, the set of tasks assessed are bathing, dressing, transferring, using the toilet, continence, and eating.

The ADLs are increasingly being used to measure disability. In general it has been found that ADL status is a good predictor of a wide range of health-related behavior.

This is important to understand as many families hire caregivers through a home care agency thinking they can perform quasi-nursing duties, assume responsibility for attending doctor’s appointments and transmitting doctor’s orders for care at home. They can do none of these things. They able to perform services based solely on ADL’s and not related to any medical need based on chronic illness.

If you need a medically trained professional to oversee care in the home and act as a liaison with your loved one’s doctors you will need a professional geriatric care manager who is either a nurse or a social worker. Medicare reimbursed “Home Health” Agencies cannot assume these longer term functions either. They are greatly limited by Medicare to simple home visits on what is usually a very short term basis.

Other options for San Diego Elder Care include: smaller residential care facilities for the elderly; larger Assisted Living Facilities; or Skilled Nursing Facilities.

San Diego has many options for quality elder care. If you have questions about how to assess your situation and find the elder care option that best suits you, please feel free to contact us. There is no one size fits all answer. Call today for your customized assessment.

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15 Apr 2013

Home Health versus Home Care

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San Diego Home Health Care or Skilled NursingWhen searching for San Diego Home Health or in-home skilled nursing services, keywords to look for are health care or home health. To be considered health care, preserving someone’s physical and mental well-being has to be through the services offered by medical and allied health professionals. Allied health professionals (distinct from medicine, dentistry and nursing) cover a broad range of services ranging from diagnostic, technical and therapeutic to direct patient care. Examples include Occupational Therapists, Physical Therapists, Clinical Psychologists, Dieticians, Paramedics and Health Administrators. Non-medical Caregivers are not considered allied health professionals, so the term health care does not apply to their services.

What services can home health provide? Some examples are physical therapy, wound care or medical monitoring (i.e. blood pressure or blood glucose levels). Anything that penetrates the body, such as injections, feeding tubes or catheters would be deemed medical, where someone who is properly trained or “skilled” is needed.

Medicare is the principle payer for San Diego home health care/skilled nursing services. These services are available under parts A and B. In order to qualify, a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician. Monies are typically provided for a period of up to 60 days. If the patient recovers sooner, then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.

For more information on how Medicare works with your specific case, you may contact HICAP, the Health Insurance Counseling and Advocacy Program. They give FREE Medicare and health insurance counseling here in San Diego through the California Department of Aging. For an appointment, call (800) 434-0222. There are also free legal services for senior citizens through the same program. This is very helpful if you have questions about powers of attorney and estate planning. For an appointment, call the metro office at (858) 565-1392.

The plan of care ordered by the Physician usually includes limited custodial care (non-medical home care) services to help the care recipient remain in the home. These would include a home health aide for an hour or two a day to help with ADLs (activities of daily living); bathing, dressing, toileting and transferring. If additional hours are needed for areas such as safety supervision, incontinent care or medication reminders, professional caregivers from a San Diego home care (distinct from health care) agency, are used.

(Source: San Diego Home Health Care Resource)

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elder couple walking together at the parkThe sweet melodies pierce through the viscous muck of depression that clings in the early hours of the day. Not Walker Percy’s “morning terrors,” which sounds dramatic and even fun in a weird, sick way. Depression isn’t even the right word -‑ this feeling isn’t even that well formed. It’s more of a low‑key emptiness with a definite edge.

Some would call it “dysthymia,” I suppose, but whatever you call it, I know it gets worse for the elderly.

I wonder how much of this strange malaise has to do with aging, because there is no particular reason for this uncomfortable psychic sediment. So I chalk it up to slow physical and mental deterioration.

Now there’s a cheery thought, isn’t it? My black Irish’s acting up. No doubt the biochemical oppression gets worse as you get older. If it’s overwhelming for middle‑aged people who are simply weary of the struggle, imagine how difficult it must be to be old and alone and stuck in a nursing home.

The air is stale, maybe moldy, and never carries the sacrament of natural sound. No bird song or crickets. No smells of the wild world wafting in through an open window: sage, rosemary, fresh rain. The pungent smells of life in the raw.

Only the sound of call bells ringing in the halls, other residents yelling, moaning, crying. Even while roaming the lavender hills of dreamland, those sounds will find them and remind them of where they are.

At least I can rouse myself, go get coffee, and shake it off like a wet dog in a dry place, but they cannot.

There are many in these places who are so sick that they no longer care for the titters of sparrows or the trill of a thrush, but the majority of our elders who populate “skilled nursing facilities” suffer most from a sense of being lost, an inexpressible fatigue, and a corrosive sorrow that aches much more than arthritis. For them, the sights, smells, and sounds of the natural world are a balm to fragile souls on the edge of giving up. A balm that planners of homes for future aging children need to take into account. San Diego elder care planners listen up!

Sunshine is proven clinically to be therapeutic.

Fresh air oxygenates all our cells.

Sensory stimulation -‑ tactile, visual, auditory -‑ brings comfort and healing to hypoactive and battered neurological systems.

Music innervates the soul.

Some San Diego elder care facilities now allow and encourage pets to live in with their elders. One Alzheimer’s place near me has dogs and parrots. They break the boredom no doubt, but our elders need more than a few canines and canaries to lift their heavy hearts.

The atmosphere in these places is usually tacky or at best sterile with little or no interaction with the magnetic forces of nature that God meant since the garden of good and evil to soothe our inner fragmentation.

Paradise lost is not so easily regained, but our aging loved ones need desperately to be reminded of it in a sudden breeze, smell it on a warm afternoon rising off the pine trees, and in the ocean fog rolling in as the day nears its end.

It is a long, hard trek through this life with a long‑time between rest spots. Sometimes the best way to find comfort is to help another who needs it more than you.

Take an elder you know to the ocean, or for a ride through the mountains to see the fall color, or sit with them on their patio and get some sun. Go for a stroll through Balboa Park, push their wheelchair, and feed the squirrels.

Even in small ways help them remember natural beauty and simple pleasures.

You might just find you are surprised by joy yourself.

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San Diego caregiversBy: Cindy Hasz, Geriatric Care Manager

Having spent a good part of the last year in San Diego working in the home health and home care field, I have come to understand that use of the independent contractor model is actually quite prevalent in home health care.

Hiring either private caregivers or caregivers through an agency who 1099’s their work force is dangerous on many levels. The attraction is that these caregivers usually cost less money than employee caregivers but the risks and exposure you take doing this are not worth the savings.

I’d like to explain here the clear benefits of using caregivers that are through a reputable home care agency. Hiring caregivers as employees through a certified Home Care Agency guarantees the following standards are met:

•  Caregivers are criminal background checked.
•  Caregivers have been TB tested.
•  General liability insurance is provided.
•  Worker’s compensation is provided.
•  Employees are bonded.
•  Services and fees are specified.

All the above is simply not true for most privately hired caregivers. The cost of hiring privately may be less in the short run but it may cost far more in the long run.  Most of those who do hire privately are incurring far more tax liability and personal exposure than they are aware. A few families do hire privately and then set the caregiver up as employees through a home business or accountant in order to pay taxes and cover other liabilities.

By the time all this is done however, the costs are near what an agency charges and the family remains without the built-in benefits of an agency not least of which is a 24/7 staff to arrange last minute replacement caregivers and to manage and discipline staff when needed.

If you are looking for home care agencies in San Diego, you can go to the CAHSAH website (Calif. Association of Health Services at Home) at and see which agencies are listed and interview several. Make sure to ask about their training program for their caregivers as well as if they have any clinical support and oversight available if needed. More and more home care companies are either hiring a geriatric care manager on staff or associating with a geriatric care management company to add a professional component to their model.

In the next article, I will address some of the further risks involved in hiring privately for your loved-one’s long term care in San Diego.

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