First Choice In-Home Care Blog

Ron Tester, PT, COS-C, is the founder and Administrator of Advanced RehabTrust Home Health, a nationally-recognized home health agency serving North Texas.

According to the AARP, nearly 90% of seniors want to stay at home as they get older. What are some reasons more seniors are choosing to "age in place", as the AARP put it?
There are several reasons seniors want to stay home. Most important, they can keep their independence. Even if they have some help at home, they still get to eat what they want, when they want; get up and go to bed when they want; and do whatever they want without having to worry about an institution telling them what to eat, what to do or when to do it.

Also, most seniors want to be in familiar surroundings. No facility is ever going to feel like "home" the way home does. Even if they can squeeze their bed, couch and china cabinet into the new place, it's just not the same.

Third, leaving home for a senior living facility - even a nice one - often feels like "the beginning of the end." Many seniors who move away from home feel like they are resigning themselves to fate or "giving up."

Not only do many people prefer to stay in their own homes, but it can also be better for your health. The RAND Corporation reported statistics that hip- and knee-surgery recipients who recovered at home or received home health care were 35% less likely to be institutionalized than others who recovered in other recovery situations. What are some of the reasons why home health care is so beneficial for people's health, both mental and physical?
People get better faster and stay out of institutions for two primary reasons. First of all, people that go home usually have more opportunities to be active and self-reliant, helping them to become more independent. Even if they need a little help, they aren't lying in bed for long periods of time, pushing a button for every little thing. In many post-acute settings, people are told, "Don't do anything without calling for help." Sometimes that's appropriate, but a lot of the time it's also meant to protect the institution from liability if someone falls. At home, if a person wants to get up and go to the bathroom or get a drink of water, they don't have to push a button and wait 30 minutes for the aide to arrive and assist.

The other main reason people get better faster at home is the decreased risk of getting sick at home. Healthcare-Associated Infections are a huge problem in many institutions in the US. It's not just acute-care hospitals, either. Rehab hospitals and skilled nursing facilities also have high rates of Healthcare-Associated Infections. People who go home automatically reduce their risk of getting an infection that could potentially delay or derail their healing.

Home health care is becoming more and more important, year-by-year, as the elderly population continues to grow. Considering that the elderly population is projected to be around 19% of the U.S. population by the year 2020, how is the home health care industry adapting and changing to meet these demands?
Home health care is experiencing the most radical shift I've seen in more than 20 years, and the changes are most notable on either end of the spectrum of care. On the one hand, people are coming home from the hospital much sicker than they used to be. Patients with certain illnesses and injuries that used to warrant six or seven days in the hospital are going home in just two or three days. Even if they have wounds, IV antibiotics, and a catheter, the hospitals are sending them home quickly. Part of that change is driven by cuts in reimbursement, but part of the change is because healthcare officials are realizing that sometimes people can get better at home just as well as they can the hospital, with decreased risk of infection.

The other end of the spectrum, though, revolves around managing chronic conditions. In the past, people with chronic diseases frequently ended up in nursing homes. These days, more and more people are able to stay home and manage their diseases effectively. In fact, in 1999 the United States Supreme Court held in Olmstead v. L.C. that unjustified segregation of persons with disabilities constitutes discrimination in violation of title II of the Americans with Disabilities Act. In other words, confining people with disabilities to a nursing home when they don't need to be there is unconstitutional. Home health care is stepping up to the challenge and helping people manage chronic diseases effectively while keeping people safe in their homes.

Home health agencies offer a wide variety of services for their clients, from physical to occupational therapy to overnight services and telemonitoring. This just goes to show that there's no such thing as a cookie-cutter home health care solution or provider. Can you give an example or two of how you've helped design custom programs for your clients, to help them be as happy and healthy as possible as they get older?
We have several specialty programs that were designed to meet the needs of particular patients. For example, we work closely with orthopedic physicians to help their patients who have joint replacements bridge the transition from hospital to outpatient therapy. In the old days, someone with a joint replacement might have home health for a couple of months. These days, the orthopedic doctors want their patients up and out in the community as quickly as possible, usually within 2 weeks. We help them from the day they get home, initiating their rehab protocol, making sure they're safe moving around and that their home environment is safe. In two weeks the patient has usually made tremendous progress and is ready to transition to outpatient physical therapy where their rehabilitation continues.

Another specialty program we have is for people with congestive heart failure (CHF). People with CHF are hospitalized and rehospitalized so frequently that Medicare is penalizing hospitals that have too many people with CHF returning to the hospital within 30 days of discharge. To help people with CHF (and help the hospitals that serve them), we provide specialized teaching materials, as well as a home monitoring kit so the patient can learn to monitor their own symptoms and take action before they need to go to the hospital. We also have nurses on call to make sure that if a patient needs to be seen, they get seen right away. Rapid, timely care can mean all the difference for people with CHF.

For clients with medical conditions, how might they go about having the right medical equipment in their home? Is this something that the home health care providers tend to bring? Does this equipment have to be rented or purchased?
Every situation is different, so we always evaluate each person individually and make individual recommendations based on what they need and what they are trying to do. Like most home health providers, we don't sell medical equipment, but we do work closely with the doctor and the medical equipment company to make sure that our patients know what they need and how to get it. If it's something that will fit in my car (a walker or a bedside commode, for example), I (like my staff) am happy to pick it up from the medical equipment company and deliver it to the patient. Larger items, like power wheelchairs or hospital beds, are usually delivered by the medical equipment company in their van.

As to whether equipment is leased or purchased, that decision is almost always driven by the insurance company's policies. Some insurance companies prefer to rent, some prefer to buy. If an item is not covered by insurance, I almost always recommend people consider purchasing the item if they think they are going to use it for any length of time. For example, a knee scooter can cost $130/month to rent or $180 to buy. It almost always makes sense to buy.

If someone's insurance doesn't cover the purchase of the item, or the patient doesn't have the means to purchase the item, there are often informal networks where we can ask other providers if someone has the needed item and would be willing to donate it. I'm always amazed at people's generosity and willingness to go the extra mile to meet the needs of our patients.

How might a senior, or their family, decide what level of home health care they need? They might need 24/7 supervision or just a few hours a week. Also, how might a client organize their life to make the most of the help while they have it?
The best way to figure out what is right for a senior and/or the family is to have an honest conversation and include the home health company in the conversation. Some patients are afraid to admit they need help, and some family members are afraid to admit they need a break. I recommend people say, "This might be a hard conversation to have, but it will be worth it if we can share our feelings and concerns honestly."

Some patients are in denial about how much help they need and think if they accept help they might be shuffled off to a nursing home. The opposite is usually the case - if they don't get the help they need they are much more likely to fall or need help which would result in a trip to the hospital or the nursing home.

Some family members care for mom or dad until they are completely worn out, but feel guilty about asking for help. The relationship between parent and child turns into a relationship between patient and nurse/caretaker/medication aide. Often times this results in losing the most important part of what the relationship should be. I've seen huge improvements in family dynamics when the son or daughter finally admitted they needed some help.

When someone is getting help, I encourage them to be fluid and open. Some people say, "I'll never ask for help with bathing" or "I don't want anyone else to help me make dinner." My encouragement is always to be open and experiment. Often the help the patient is resisting is the help they need the most, and when they get that help, the sense of relief is palpable. More than once I've heard, "I can't believe what a difference it made when I had just a little bit of help with _____."

For those looking for health care for their aging loved ones, who might be sensitive about the subject, how might they go about bringing it up in a tactful way?
As I mentioned before, I recommend a kind but honest conversation. "Mom, I love you, and because I love you I want you to know I think we both need some help...." I also recommend everyone stay open and communicate openly about the process. If something doesn't feel right, don't abandon the idea of getting help altogether. Instead, share what you're feeling and adapt. I strongly advise against springing the "help" on someone. I have seen family members hire someone and send them to "help" their unsuspecting parent who hasn't been told they're about to receive "help." That sort of surprise makes the recipient of the help even more resistant to getting help and can cause a lot of resentment.

When seeking a home health care provider in their area, how might clients and their families research the companies to make sure their loved ones are going to get the best help possible?
Depending on the type of care one needs, I recommend that they check http://medicare.gov/hhcompare, or search the Better Business Bureau's website. My favorite method, though, is to ask your doctor, your neighbors, people you know from church or a social group. Once you get a few names, check out what people are saying on Facebook, read the reviews on Google and Yelp. Don't be thrown off by one bad review, though - some people refuse to be happy no matter how good the care is, just because they are mad about needing help in the first place.

Once you find a couple of potential companies, talk with them over the phone or meet with them face to face. Don't settle for the first company you find. And if you do decide on one company and they turn out to not be a good fit, don't be afraid to make a change and work with a different company.

For people that are choosing to age in place, how might a senior find communities or things to do in their area, to stay occupied and social?
I recommend people ask their friends and neighbors, and Google your town name + "senior center." Even if you don't have one in your town, there may be one close by. And if you still can't find one like that, start volunteering. Join a service organization or volunteer at a school. You're likely to find other community-minded folks that are fun to socialize with.

One of the best things about home health care is the personalized, individual attention, which is something that was quite out-of-balance in older senior communities. How can this individualized attention help a senior not only age gracefully, but flourish?
Individualized attention is the single most important factor when it comes to helping a senior (or anyone) flourish. It reminds us that we are not a category - "senior" or "retiree" or "resident" - but that we are Bob and Ellen and "me." "Seniors" may have trends, but individuals deserve to be treated like the person they are. One of my favorite examples - I was recently talking with a 70-year-old old retired hairdresser that was crazy about Metallica. Going to Metallica concerts made her feel young, alive and vibrant. She loved them so much she recruited her friends and her grandchildren to go with her. That sense of individualization, of independence and doing what makes a person feel alive (even if your neighbors think you've got a screw loose) is the key to flourishing at any age.

We hope you've found this interview with Ron Tester informative.  If you'd like to know more about finding the right in-home service provider please contact us at First Choice In- Home Care today!