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Accessing community services is difficult to understand due to incredible fragmentation and the huge amount of service providers in the field. Providers of services are funded by the federal government, state government, local cities, and private profit and non-profit organizations. Most individuals are not aware that there is an aging network available throughout the United States. The federal organization responsible for senior services, is the Administration on Aging. This federal organization supports state agencies on aging with resources and funding. All state departments on aging work with planning units or Area Agencies on Aging. These organizations are responsible for coordinating senior services on a county level. To obtain information about the services available in your community contact (1) the information and assistance line with the local Area on Aging that is listed under the county in which one lives, and (2) the local senior center. Local senior centers collect brochures and provide information regarding service providers and available assistance.
Services in the community range from providing services within the home, to community based services such as, Adult Day Care or, Respite Care. Community services are available to support caregivers in taking care of elderly relatives. When the caregiver becomes exhausted, or the elderly person does not want to live in the home of a relative, a range of choices from small six bed residential care facilities, to assisted living facilities are available. Skilled nursing homes are the choice of last resort. Individuals are often placed in these facilities when it becomes emotionally, and physically impossible to care for them
Caregiving for an elderly person is extremely isolating. It is well known that the burdens of caregiving impacts the caregivers' physical health, ability and opportunity to socialize with others, and can lead to depression. Even though services are available, caregivers are often reluctant to use them for several reasons:
Caregivers:
- Are not aware of community services.
- Are trying to maintain financial assets for future institutional placement.
- Feel guilty about not providing the care themselves.
- Feel that it is their "moral" obligation to provide all care, all the time.
- Believe that "no one" can care for their loved one, like the immediate family can.
- Don't want their elderly adult to be with "those other" disabled individuals who have illnesses worse than their loved one. (Waller, 2002)
It is important for the caregiver to be aware of these beliefs and assumptions. Although most individuals want to honor their parents by providing care for them, this is not always feasible or the best solution. Caring for a person who has cognitive impairment is extremely difficult and emotionally exhausting. Caregivers who seek community resources and outside help and realize they cannot do it on their "own" will be better able to delay placement until it is absolutely necessary.
Family caregivers often become enmeshed in their role and believe they "should" care for the individual, or they believe "no one" can care for their loved one, like they can. The caregiver becomes isolated from friends and family, may lose confidence in his/her ability to work, and tend to be reluctant to utilize available community services. This can often create a "cascading" effect where the caregiver becomes ill and depressed.
Listed below are different services available to community members.
- Area Agency on Aging--is listed under each county within the United States. Area Agencies on Aging are a valuable resource and provide information regarding: home care services, transportation, nutrition sites, health insurance counseling, available housing, and community based adult day care centers.
- Senior Centers--senior centers are the community focal point of senior services and can provide information about private caregivers, home health care agencies, and home care available within the community.
- Housing Services-- assisted living facilities, residential care facilities for the elderly, continuing care retirement facilities are often listed in directories that are free to the consumer. Assisted Living Facilities are facilities that are larger than 6 beds. Individuals pay a monthly rental fee, and additional charges for management of medication or home care services. Meals are provided at the facility and individuals live in a safe and supportive environment. Residential Care Facilities for the Elderly are smaller board and care facilities that provide services in a home-like environment usually no larger than six or eight people. Continuing Care Facilities are facilities that have a campus setting and have three levels of care available in one place. Continuing Care Retirement Facilities require that individuals meet specific financial criteria. Some facilities require non-refundable endowment fees. To be eligible for Continuing Care, residents need to usually, but not always, enter the facility when they are in reasonably good health. In California, consumers may contact their Department of Social Services for a listing of available licensed communities.
- Health Care Services--these services may include Health Maintenance Organizations, Social Health Maintenance Organizations, Adult Day Health Care Agencies, Home Health Care Agencies, and Skilled Nursing Care Facilities, as well as other local medical providers. For a listing of these providers consumers may contact the State Department of Health Services, responsible for licensing these entities. Social health maintenance organizations such as the Senior Community Action Network (SCAN) in southern California, are particularly unique as they are dedicated towards supporting family members in caring for aging relatives. In addition to paying for certain drugs, they also pay for social services such as home making services, respite care, and adult day care. There are only 4 SHMO's nationally. These include: Elderplan, (N.Y.) Kaiser Permanente Senior Advantage II (Oregon), SCAN (California), Sierra Health Service/Health Plan of Nevada.
- Home Care Agencies: There is a difference between Home Health Care and Home Care. Home Care Agencies are private organizations which require private pay payment for custodial care services. Home Health Care Agencies are based on a medical model and require that care be provided under a physician's plan of treatment, the individual is homebound, and skilled care is required. Certified Home Health Care Agencies receive Medicare Reimbursement. Home Care Agencies, on the other hand, are private businesses either privately owned or non-profit in nature. These agencies must have a business license and may or may not provide medical services depending upon state licensing requirements. Consumers can contact the State Association for Home Care to find a listing of members.
- Non-Profit Associations: Many states have non-profit associations dedicated towards providing support to individuals caring for the elderly. These can include the local Alzheimer's Association, Family Caregiver Resource Association, Arthritis Association, Diabetic Association, Parkinson's Association, etc. These associations provide educational information and are involved in legislative efforts on behalf of consumers.
- Geriatric Care Management Services: Consumers may also hire the services of private geriatric care managers who have been trained to navigate the health and community system. To find out about Geriatric Care Managers in your area contact the National Association of Professional Care Managers.
It is evident that several services to support caregivers are available. It is important for family members to realize that as a society, individuals spend greater time caring for their aging parents than they do raising their own children. Seeking outside help is not giving up one's moral obligation to care for our elders, but is providing relief and support to those who take on this very important job
pp. 253-305. Beckerman, Anita G. and Tappen, Ruth. M. 2000. It Takes More Than Love. Health Professions Press: Baltimore, MD.
- Indicate the web-sites you checked.
- List key points that you learned as a result of the web-site.
- Provide a brief paragraph on you thought was helpful or not helpful about the site.
- Indicate for whom the web-site would be helpful.
- Incorporate your findings into a paper.
- Forward your paper to instructor.
The following links are web-sties specifically available for consumers of services:
- This web-site provides information and resources to caregivers on a national basis. An excellent resource: http://www.aoa.dhhs.gov/default.htm
- Senior Options provides a nationwide directory of care-managers, adult day health services, home care, as well residential facilities and home care. The consumer should note however, that only those services that advertise are listed.. http://www.senioroptions.com/
To contact national centers that provide respite services based on a social model contact: http://www.ewol.com/brookdale/default.
For assisted living, residential care facilities, and continuing care facilities in your area contact: http://www.newlifestyles.com/
Caregivers interested in choosing a health plan should contact the American Association of Health Plans. This websites provides facts on what to look for when choosing a plan. www.aahp.org
