Most people would agree that there’s no place like home. And most people would prefer to age right there. So allowing older folks to stay in their own homes is a priority for many families.
Independence often goes hand-in-hand with health and happiness. Fortunately, there are many local programs, organizations and agencies that make it possible for seniors to remain relatively independent in their own homes.

Types of in-home assistance:

• Case (care) management workers are discussed in the “Caregiving Information and Support” section.
• Chore workers provide one-time heavy cleaning (scrubbing walls, floors, windows, carpets, etc.), perhaps in anticipation of a homemaker service. Handyman services perform minor home repairs and yard work, install safety devices and winterize homes.
• Companions or sitters provide social stimulation, run personal errands and, sometimes, help with toileting or feeding.
• Emergency response systems are electronic alert systems used to summon assistance by seniors and those who live alone. See “Security” in the “Elder-proofing a home” chapter.
• Escort services and private drivers for the elderly accompany clients to doctor appointments and help with other errands.
• Friendly visitors are volunteers who visit on a regular basis (usually once a week) for social stimulation and checkup.
• Home care or medical services help with medical needs such as catheter and dressing changes and IV and nasogastric feeding maintenance.
• Home-delivered meals and personal chefs are covered in the “Nutrition Services” chapter.
• Home modification is discussed in the “Elder-proofing a home” chapter.
• Homemaker services might include light housekeeping, shopping, meal preparation and, sometimes, escort service on public transportation.
• Home-care non-medical services include help with the activities of daily living (ADL), such as bathing and grooming and sometimes transportation.
• Shared housing involves sharing one’s home in exchange for rent or services. See the “Housing alternatives” chapter for list of programs.
• Telephone reassurance is a telephone version of the friendly visitor, with volunteers phoning daily at a predetermined time. This might be coordinated with reminders to take medication or to eat.
• Transportation services are covered in the “Transportation services” chapter.

Project CARE
Project CARE is a community effort that enables seniors and people with disabilities to remain in their homes safely. Private businesses, service organizations, nonprofits and public agencies collaborate to develop each community’s Project CARE program, based on the area’s specific needs and resources.

You Are Not Alone: Senior Volunteer Patrol members either call or visit those at risk. This service is available through law-enforcement agencies.

Are You OK? A computer makes regularly scheduled checkup calls each day to those feeling alone and at risk. If the call is unanswered, a volunteer checks to see if the individual is OK.
Gate Keeper: Utility and refuse-collection companies train their meter readers and refuse collectors to recognize and report signs that their customers might be in trouble.
Postal Alert: Letter carriers keep a watchful eye on mailboxes of the elderly and disabled. If mail has not been picked up after two days, the letter carrier will check to see if the individual is all right.

Vial of Life: Those signing up for this program place a small plastic holder on their refrigerator door. Within the holder is medical information. In the event of an emergency, paramedics can use this information and save precious time in providing assistance.
Safe Return: This program, run by the Alzheimer’s Association, aids those with dementia and other cognitive impairments. Through a system of identification products (including wallet cards, ID bracelets, clothing labels, lapel pins and bag tags), and a national photo/information database, individuals who wander off and get lost may be found and assisted.

Minor Home Repairs: Sometimes, getting a handle on independence is as simple as installing a handle, grab bar, ramp, handrails, security lighting, etc. Volunteers and local business groups often are happy to make repairs that help maintain seniors safely in their homes.
Neighbors helping neighbors: There are some easy-to-recognize signs that your neighbor might be in trouble:

• Newspapers and mail are piling up at the residence of someone you know is home all the time.
• Refuse is not being set out for collection.
• Property that used to be maintained is falling into disrepair.
• The neighbor’s regular routine is not being followed. (For instance, a weekly trip to the grocery or bank has not been made in many weeks.)
  To get help, contact your community’s Project CARE program or call Aging & Independence Services at (800) 510-2020.

Finding care
For medical-related services, contact one of the home healthcare agencies (Home Care/Medical) listed in this section or ask advice from your parish nurse. Home healthcare agencies provide registered nurses, licensed practical nurses, home health aides, social workers and therapists (physical, speech and occupational).
Medical services might include routine physical checks, blood tests, administration of special medications, catheter and dressing changes, wound care, and intravenous and nasogastric feeding maintenance.

Non-medical homecare agencies, on the other hand, assist with such things as eating, dressing, oral hygiene, bathing, and light household tasks.
In addition to the homecare agencies, there are a number of private individuals who work in medical and non-medical capacities. This might be a more affordable option and can work well. But be very careful whom you hire. You must interview extensively and check references thoroughly. Before taking this route, check your insurance coverage; these people are seldom insured or bonded. Also, brush up on federal and state laws and tax provisions regarding the hiring of home help.

When you interview potential in-home care providers, ask how they would handle specific tasks and emergency situations. Ask about prior experience and formal training. Also consider their appearance, alertness, friendliness, physical ability, judgment, training and lifestyle. Alarm bells should sound if the person has a lack of work references, employment gaps, frequent state-to-state moves, no driver’s license or phone number, residency in the area for less than a year, or is overqualified. Get references and check them carefully, asking about the applicant’s strengths and weaknesses. Once you have selected someone, draw up a contract for the required services. Continue to supervise the worker closely.

Paying for in-home care
Medical care: Medicare, MediCal and private insurance might cover the cost of visits from a physician, registered nurse or a therapist (if prescribed by a physician). Medicare requires that a patient be homebound and in need of skilled-nursing care or physical or speech therapy. Services must be provided by a Medicare-certified home health agency. But don’t feel obligated by your physician’s preference. Shop around.

Non-medical care: These services are defined as assistance with the activities of daily living, which require no medical intervention and are noninvasive. These activities include (but are not limited to) companionship and supervision and assistance with feeding, dressing or bathing. Workers in this category typically include personal attendants, home-care aides, companions, respite workers and homemakers. Medicare and most private insurance do not pay for non-medical home care, unless they are also covering some type of medical home care.