Elder Care Options Continue to Grow
When aging and its related ailments begin to slow the mobility of a loved one, families must consider their options. Some decide to become full-time caregivers, while others choose to have their loved one in a residential care facility. But there’s a third option that has grown in popularity over the past several years, especially in Frederick County. Home care gives families the option of having a professional caregiver provide a wide range of services, including grooming, dressing and walking assistance, medication reminders, safety supervision, meal preparation and running errands—all in the comfort of the client’s residence.
“Nine out of 10 families that I talk to all say the same thing—they would rather age in place and stay at home where they belong instead of having to move to a continuum of care community or assisted-living because they know eventually that means they will end up in a nursing home,” says Carole Luber, owner of Frederick’s Right At Home In-Home Care & Assistance. “You’ve got the baby boomers all coming to the age of turning into seniors and the population is just increasing, and there are fewer adult children to provide care. They are working. They are taking care of children themselves, so they are turning to home care because that’s where their parents want to be. If given a choice, they want to stay at home.”
As the youngest of eight children, Luber knew she was a good fit as a caregiver to her father because she had worked at a hospital for 13 years. But trying to juggle a young family and helping her father was difficult. “I knew I couldn’t do it alone with just myself,” she says. “I was there from 8:30 a.m. to 3:30 p.m., Monday through Friday, but we did need somebody to help come in the evening to provide care to him when I couldn’t be there. … I thought, he raised all of those children. I am going to do as much as I can to give him his wishes.” After her father passed away and after also providing care to her father-in-law, she and her husband decided to open Right at Home.
“They want to be at home”
Janice Deiuliis, owner of Visiting Angels, believes the generation her Frederick-based home healthcare business takes care of is probably the most independent she has ever seen. “They are so proud of what they have accomplished in their home and they don’t want to leave it” to go into a facility, she says. “They also have an old fashioned idea of what a nursing home is. Today, assisted living is like a country club, but most seniors think of them as a nursing home where they put you on the porch in a rocking chair and leave you there. They just don’t want to go. They want to be at home.”
Deiuliis remembers, as a child, seeing her mother take care of her grandparents. While all the family members helped as they could, she recalls seeing how exhausted her mother was from being a caregiver. Deiuliis started Visiting Angels in 2009 and enjoys being able to give clients “a better quality of life as long as possible. Helping the families be relieved that somebody is there and they don’t have to always be there.”
I can’t tell you the number of times over the years where the spouse who was providing care actually became ill and passed away before the person they were caring for because they weren’t sleeping properly,” –Carole Luber, owner of Frederick’s Right At Home In-Home Care & Assistance
Home care is usually not covered by insurance because caregivers are there to mainly provide preventative support care such as making sure an individual safely gets out of the shower or holding their walker as they stand from a seated position. Families can have someone come for as little as an hour a day all the way up to 24/7. “Sometimes it’s uncomfortable for a dad to have his daughter or granddaughter giving a bath,” Luber says. “They don’t want them to be seen in that light, so they are more apt to let a professional come in and help with the personal care than a family member.”
Having additional outside help can provide family members who usually provide care with a much-needed break. “I can’t tell you the number of times over the years where the spouse who was providing care actually became ill and passed away before the person they were caring for because they weren’t sleeping properly,” Luber says. “They weren’t eating. They weren’t taking care of themselves. They weren’t getting to the doctor and they had some kind of condition going on that they weren’t aware of because they weren’t properly diagnosed and simply couldn’t take the time out for themselves.”
“We become part of the family”
Brad Snively, owner of Home Instead Senior Care in Frederick, says some of his clients have adult children that do not live in the area, so caregivers “become the eyes, the ears, the reporting, the stimulation and they can have the phone calls” notifying family members about issues or progress. “The big part of it is communication with [family members] and letting them know how things are going.”
By having professional home caregivers, roles may be re-established among family members. “We say our motto is, ‘We take it personal,’ and to a great extent we do become part of the family,” Snively says. “We become part of the family that is really addressing those day-to-day needs that the daughter can’t be there for because she is still working.”
Snively’s own father was diagnosed with a brain tumor back in the 1990s when home care was mostly limited to registered nurses. Sometimes he would get a call at 10 p.m. that a nurse wasn’t showing up. “The gut-wrenching feeling of not having somebody when you are just wasted from caring for somebody was killing,” he recalls.
“The toughest part of this business is getting attached to people and losing them,” –Brad Snively, owner of Home Instead Senior Care
His father later passed away but his mother, who is now 90, was adamant that she wanted to stay in her own home even after open-heart surgery and a massive stroke. Snively was commuting between Chicago and Maryland while working as director of sales for a large company when he decided to make a change and started Home Instead more than six years ago. His mom is one of his clients. “I love being hands-on with our clients,” he says. “Instead of looking at a computer and trying to figure out who this person is and their hours and everything else, I know where they live, who they are, what they like. We love taking flowers to them and doing special things when there are special occasions and things like that. … The toughest part of this business is getting attached to people and losing them, but it is part of that business. Knowing that you have done everything you can for them. Even in obituaries you’ll see, ‘We thank the staff of Home Instead for all their contributions with my dad or with my mom,’ and it means a lot.”
“It’s harder than you think”
Frederick resident Andy Haller became symptomatic in 2005 with Huntington’s Disease, a progressive breakdown of nerve cells in the brain, and had to quit working in 2006. Two years ago, his wife, Sandy, had to quit her job when it became too difficult for him to be home alone all day. “We’ve known for a long time that it was going to come to this and I’ve known for a long time that I would have to take care of him, but it is a lot different—I posted something on Facebook the other day. It said, ‘You may think you understand something, but until you experience it, you don’t,’ and that is so very true,” Sandy Haller says. “You think you have an idea of how it is going to be but it’s harder than you think. He’s only 57, almost 58.”
Receiving treatment through Johns Hopkins Medicine, doctors suggested Andy be placed in an adult day services program which provides care for seniors and individuals with medical conditions. Though not actually home care, day services do allow people to live in their home, while receiving services at another location. Sandy brought him to Daybreak Adult Day Services in Frederick in November. “I had my reservations about it when Hopkins first mentioned it but once I got him in there, once I met Christina [Forbes, program director] and the staff and I got him in there, it’s worked out very, very well,” Sandy Haller says. Andy Haller now attends Daybreak three days a week.
Open from 8 a.m. to 4 p.m. Monday through Friday, the facility provides transportation, along with breakfast and lunch, and a full slate of activities like giant crossword puzzles, bingo, miniature golf and chair exercises designed to work out body and brain. “Some folks come just a couple days a week, which is a great way to get out of the house and be with other people,” Forbes says. “We have plenty who come five days a week as well. The other huge benefit is to the family caregiver who now has a couple of days a week to take a break.”
“They have purpose. They have something to look forward to and that is incredible. Their sparkle is back in their eye. Their caregivers are walking a little bit lighter. We make a difference every single day and you can visually see it.” –Christina Forbes, program director, Daybreak Adult Day Services
Forbes estimates that half of her clients have adult children as caregivers, with the other half having spouses provide care. “I meet so many seniors,” Forbes says. … “They come in this room [when they join Daybreak] and they are mad. They don’t want to be here. They are angry at their children or their spouse. They are often dishevelled. They are not looking their best. One of my great joys is after two weeks that they are here, they are dressing up. The ladies are wearing makeup. They are wearing jewelery. They have friends. They have purpose. They have something to look forward to and that is incredible. Their sparkle is back in their eye. Their caregivers are walking a little bit lighter. We make a difference every single day and you can visually see it.”
On a recent morning, Frederick residents Mary Wolinsky and Ellen Berney are busy playing dominoes with several other women. “You use your mind [here], which we need to at our ages,” says Wolinsky, who recently turned 93. “I love the friendships and the food is good.” Berney, a retired registered nurse, says she enjoys everything about Daybreak. “I had to be active,” she says. “It’s really interesting and I love it.”
“Better than anything else you can imagine”
At Right At Home, the biggest challenge for Luber is finding people who care about patients as much as she does and share the same values and ethics. “People are so vulnerable,” she says. “I feel it is my job to protect them and keep them safe so we’ve got to make sure when we are trusting caregivers to go into the home that we have done our background [checks] and research and interviewed them completely and make sure they are qualified. … A lot of times you have to go with your gut instinct. The first thing I ask myself is, ‘Is this person somebody I would have been comfortable with providing care for my own mother or father?’ They can come in and say all the right things and they can have their license through the state of Maryland and say they have the training, but that doesn’t stop us from giving them rigorous training.”
The job can require a combination of physical and compassionate care. “Our caregivers are the bread and butter of our business,” she says. “A lot of times I say they are our unsung heroes because day in and day out they are the ones who have to deal with patients who are grumpy because they don’t feel well. … Our caregivers have to know how to put that behavior aside and not take it personally. A lot of times it is the disease speaking and the nature of the illness, so when somebody says, ‘I hate you!’ or, ‘Get out of my house!’ or, ‘You don’t know what you are doing!’ they have to take a deep breath and take a step back and realize the person is unhappy because they aren’t in control of their own life so sometimes [and] their way of coping is taking it out on the caregiver.”
Mary Hartsock joined Right at Home as a caregiver at age 79 after her husband died. “I thought it was something I could actually do,” she says. “I was on my own and I thought ‘Gee, I feel good. Why don’t I work?’” She worked as a caregiver for 13 years until stopping this January. Now, the 92-year-old does office work every Thursday. In her years as a caregiver, she says that during her first interaction with clients she would take cues from them. She didn’t go in and act like she was taking over. She would ask what they liked and what they wanted her to do.
Home Instead’s Snively says, “It’s as terrifying for the senior having that person walking through the door the first time as it is for the caregiver that is walking in the door because they are strangers.”
“I don’t have to tell you, it is very competitive for caregivers and it is a difficult position to fill. What we can sell is flexibility, training and trying to build a career.” –Brad Snively, owner of Home Instead Senior Care
And it can be tough to fill positions. From approximately 40 applications, Snively says he is lucky to get five to eight good caregivers. “We try to sell Home Instead to them just as much as they are interested in a job,” he says. “I don’t have to tell you, it is very competitive for caregivers and it is a difficult position to fill. People want to go to work for a place where they say, ‘OK, it’s 8 a.m. to 5 p.m.’ What we can sell is flexibility, training and trying to build a career. … We want them to really think of it as a career not just a job that they can call out for. The reality of it is you call out sick for Walmart, they are going to find somebody else. [But if] you call out sick an hour before you are supposed to show up at a client’s house that may be in Washington County, we struggle and jump through hoops to find a replacement.”
Caregivers must agree to initial and random background checks and drug screening while employed by local companies. Quality assurance checks are also standard. Snively says the most rewarding part of his job is getting cards or emails from family members praising caregivers.
“When we get that kind of feedback from a family or from a client, it’s better than anything else you can imagine in this industry,” he says.