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Showing posts with label in-home care. Show all posts
Showing posts with label in-home care. Show all posts

Portland Oregon Support Network

Aging, End-of-Life and Bereavement resources in and around the Portland Metro area.

In-Home Hospice
  • Southwest Home Care and Hospice
    100 E 33rd Street, Suite 201 Vancouver, WA 98663
    360-696-5100
  • Serenity Palliative Care and Hospice
    6975 SW Sandburg St., Ste. 190 Portland, Oregon 97223
    503-639-0600
  • Specialty Comfort Care
    503-747-3021
  • Community Home Health and Hospice
    "Keeping pets and Families together during Hospice"
    14508 NE 20th Ave #201, Vancouver, WA 98686
    360-253-4626


    • In-Home Health Care


    In-Home Medical Equipment

    • Long Term Loan Program
      104 SW Clay St, Portland, 97201
      503-233-9511
    • All in One Mobility Home Medical Equipment
      12833 NE Airport Way, Portland, OR 97230
      503-255-5005
    • Adventist Health Home Medical Equipment
      5835 NE 122nd Ave, #105, Portland, OR 97230
      503-261-6070


    Food Delivery


    Family Caregiver Daytime Respite Care

    • Lambert House
      2600 S.E. 170th Ave., Portland OR 97236
      503-760-2075
    • Marie Smith Health & Social Center
      4616 N. Albina Ave. Portland, OR
      503-335-9980


    PERS - Home Medical Alert Services

    • Columbia Medical Alarm Inc.
      Offering Philips Lifeline service to the Portland / Vancouver Areas
      503-644-4736

    Mobile Medical Services

    • American Medical Response
      503-231-6300


    Advanced Directives


    Bereavement Support and Classes

    • Portland Adventist Medical Center Grief Classes/Support Meetings
      10123 S.E. Market St. Portland, Oregon 97216
      503-251-6105
    • Providence St. Vincent Hospital Medical Ctr.
    • 10 to 11:30 a.m., first and third Tuesdays, Pastoral Care Conference Room
      7 to 8:30 p.m., second and fourth Tuesdays, Conference Room 3
      9205 S.W. Barnes Rd., Portland, Oregon 97225
      503-291-2261
    • Tuality Community Hospital
      Surviving the Loss
      335 S.E. 8th, Hillsboro, Oregon 97123
      503-681-1700
    • Health & Lifestyle Center
      1885 NW 185th Ave, Aloha, OR 97006
      503-215-6595
    • SW Washington Medical Center
      Grief and Bereavement Support Group
      P.O. Box 1600
      Vancouver, Washington 98668
    • Providence Portland Medical Center
      11 a.m. to 12:30 p.m., first and third Tuesdays, Pastoral Care Conference Room
      4:30 to 6 p.m., second and fourth Tuesdays, Pastoral Care Conference Room
      4805 NE Glisan St., Portland, OR 97213
      503-215-1111
    • Providence Willamette Falls Medical Center
      1:30 to 3 p.m., second and fourth Tuesdays, Providence Willamette Falls Community Center
      1500 Division St., Oregon City, OR 97045
      503-656-1631


    Children's Grief and Bereavement Care

    • Legacy Hospice
      2275 NE McDaniel Lane McMinnville, OR 97128
      503-220-1000
    • Camp Erin - Grief Support for Kids
      6410 NE Halsey St., Suite 300 Portland, OR 97213
      503-215-2273
    • Me, Too. and Company Children's Grief Support Group
      P. O. Box 10796, Portland, OR 97296
      503-228-2104



    Physician Aid in Dying - Resources and Information

    Dying with Dignity


    Blogs



    News and Magazine Articles

    Other Refences


     If you know of or offer other resources you feel would be helpful for folks, please let us know so we can add them to this page.  We thank you for your input.
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    Case Study - Caregiver Burnout


    “Amy” is a sandwich generation caregiver who has reached a critical pointing her caregiving – “caregiver burnout” and has become short-tempered and desperate and misses many days from work trying to care for her mom, “Margaret.” The following information details how we could help support Amy and her family so Amy doesn’t lose her job, and Margaret continues to receive good care.
                On the Family Caregivers Alliance website, there is a page on working caregivers[1] with helpful questions we can ask Amy.
    1. Firstly, we have Amy consider what she needs help with and the times she needs the help. We know Amy has a job, and may benefit from being able to return to work, secure in knowing her mother will be well cared for, or able to attend doctor’s appointments in her absence.
    2. Second, we have Amy consider what level of care is needed for her mom, Margaret. Amy may like someone to prepare her mom meals, keep the house clean, or simply drive Margaret to and from appointments so Amy doesn’t have to miss work.
    3. Next, Amy needs to consider what type of in-home care Margaret’s Medicare or health insurance covers. For costs exceeding the insurance, we must consider how much Margaret can afford to pay, or perhaps how much her siblings are willing to split with her.
    4. Lastly, we need to help Amy to locate elder care resources near her home.
    In considering that Amy has used up most her sick leave, and may be in jeopardy of losing her job, we start focusing on bringing in help for Margaret so Amy can continue working. Amy decides against a full-time live-in caregiver; costs can range from $700 to $3,000 weekly[2].  Since cost is a concern, we have Amy consider hiring in-home day help for Margaret. We ask Amy to consider an agency like “Visiting Angels”[3] or “NW Senior Resources,[4]” where private caregivers can be hired to help out in the home. Amy will determine how long and for how many days of the week. We make a suggestion for Amy to start with hiring in help 2 to 3 days a week and that any and all appointments for Margaret will be scheduled to take place on those days so Amy does not miss work for them. The hired caregiver, will be given notes from Amy to take to the doctor, and a recording device to record the medical visits so Amy is able to catch up on what she misses.
                Next we help Amy look at Margaret’s Medicare benefits to determine coverage for in-home caregiving help. BenefitsCheckUp.org[5] is a good starting point for Amy. Here she can complete a questionnaire to find out what programs exist for assistance as well as benefits that may be covered for Margaret’s in-home care. We have Margaret complete the questionnaire entitled “For Older Adults and Families Raising Children”.[6] The questionnaire considers veteran status, abilities, housing, employment, programs of interest, finances (including monthly income for the household), assets, and the number of children in the household.
                Once Margaret’s Medicare benefit is confirmed. We help Amy consider how many days of care this will cover. Although we would ordinarily have a family consider the 50-50 rule, “the idea that adult siblings should divide caregiving responsibilities 50-50”[7], for Amy’s two siblings who live over 1,000 miles away, this is impractical. For the remaining caregiving costs, we suggest that Amy negotiate a payment plan with her siblings so they can instead equally share the financial burden. Another alternative would be to split caregiving costs and time based on what each sibling may have to give. “One sibling may have a good income but live at a distance. This sibling could contribute more financially, while another sibling who makes only enough money to get by on can help by providing hands-on parent care that may keep down some of the costs. A third sibling may do a little of each.”[8] If Amy and her siblings are unable to reach an agreement, we may need to connect them with a family mediator to negotiate a caregiving plan.[9] Together, in a family meeting the mediator may be able to help them make a written agenda, listen, get specific about needs, divide up tasks and not to expect total equality.[10]
                Once payment and Medicare coverage is ironed out, we have Amy interview and select an in-home caregiver. After this process is completed, we help Amy to locate a volunteer for respite care to give Amy a break at least once or twice a week so she can recover and feel renewed. If Amy is unable to secure a good in-home respite caregiver volunteer, we help her to locate Adult Day Care services for Margaret. Perhaps just on Saturdays, Amy will have Margaret attend a local Adult Day Care so she can have Saturdays off.  According to “Sarah Care” adult day care is the most affordable type of senior care.[11] With Margaret at day care, Amy would have a bit of respite to rest and have some personal time.
    We also want Amy to connect with other caregivers, and since she’s free in the evenings, we search support groups so she can share with others like her. Unfortunately the support groups we find in Portland, all run during Amy’s work hours. In Multnomah County, there are caregiver support groups that run from 2:00 – 3:30pm, 3:00 – 4:30pm.[12]  In Washington County, the caregiving support groups also run during business hours (2:00 – 3:30pm, 4:00 – 5:30pm, 3:30 – 5pm, and 10:30am – 12:00pm.)[13] We therefore help Amy decide that she may instead find a more convenient support network in a place like “Caregiver Village” online. “Caregiver Village members connect with friends, participate in book clubs with celebrity authors, journal, play mystery games, solve puzzles, and learn valuable information about caregiving.”[14] With an online support group, Amy can get started sharing with others right away, until she is able to locate a local support group that operates after business hours or on weekends.

     Have you ever experienced caregiver burnout? How did you overcome your stress and did you have support?


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    Selecting In-Home Caregivers

    Marion is in her 90’s. She lives alone, but is across the street from her son and his wife. Her children have hired many caregivers for Marion. However, Marion is never invited to interview or choose her caregivers. So, the result has been that Marion often goes without care because she frequently dislikes who has been selected to care for her and usually fires the person or drives them away with menial tasks unrelated to caregiving (i.e. pulling weeds). This has left Marion in an unsafe situation - without regular care.

    Once when Marion was chosen a caregiver she got along well with, the benefits of good communication were obvious. Because Marion was instructing the caregiver in what she wanted and needed done, Marion was happier and more responsive during visits. The caregiver made sure she got up and dressed every day (as opposed to sleeping in bed all day in pajamas). She helped Marion to look presentable, even helping her to dye her hair red. Marion was eating regular meals, looking healthier and feeling better. She boasted how good it felt to have her back scrubbed during her bath. She stopped falling trying to use the restroom during the night (perhaps because she did not sleep all day, she had more opportunities to go during the day.) This caregiver contentedly worked with Marion for over a year until Marion’s son cut her hours back and she was forced to move on.

    The lack of communication between Marion and her children has been a losing situation for Marion’s health and wellbeing. Marion does not communicate her wishes to her children because she feels they do not care (likely because she is never included in the decision making). Marion does communicate her concerns to her grandchildren, but they have no control over the finances, Medicaid, or care giving decisions.

    As in-home care is highly personalized, communication is key. If a senior is of mental clarity and can communicate for herself, this is ideal. This gives the senior a voice and a decision in the administering of her own care. However, when family members step in and make decisions without the senior’s input or consideration, as Marion’s family did, this is highly destructive to the senior’s sense of independence, as well as the quality of care she receives.

    A properly placed caregiver, sensitive to the client’s personal needs, would ensure better care and a greater longevity of caregivers. Simply working in firms that had high turnover rates, one gets a glimpse of the stress that training new people or adjusting to changes in staff creates. I cannot begin to imagine how just how stressful it would be to add a turnover in caregivers to dealing with one’s own personal disabilities or unattended needs. It cannot be healthy for seniors to deal with such turnover, which makes the initial proper placement such a vital step in the care giving process.

    Benefits of In-Home Care
    • Significant financial savings to seniors and Medicaid
    • Staying in one’s own home is generally preferable to entering a retirement community.
    • People tend not feel sick if they are cared for at home.
    • People are able to maintain some forms of independence, as they address some of their own needs themselves or by delegating difficult tasks to an in-home caregiver.
    • Seniors do not have to lose the community they have grown comfortable with.


    All content © Village Memorial. 2009-2010.
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    APS, Family Rights & Challenges

    The recent hospitalization of my grandfather led me to make an emergency trip to San Diego to check on his well-being. When I arrived I found my grandfather unable to walk, eat or swallow. He was somewhat confused, though he did say he had not seen my grandmother for several days. I tried to locate my grandmother, but could not find her. After checking with the charge nurse at her nursing home facility, I was informed that my grandfather’s power of attorney, filed eight years ago, gave him legal rights to authorize a dubious caregiver to remove my grandmother from the retirement facility and relocate her to the caregiver’s home. Apparently despite the recent decline in my grandfather’s physical and mental health, the power of attorney still held legal precedence. My lack of power of attorney or a conservatorship over my grandparents, restricted the police from acting on my request to remove my grandmother from the caregiver’s custody or terminate the caregiver. The police could only perform a “welfare check” and recommend that I contact Adult Protective Services (APS) for further assistance.

    Adult Protective Services, in California, is an agency that helps seniors of 65 years and older and dependent or disabled adults between the ages of 18 to 64. On the California Department of Social Services it breaks down the assistance provided by each agency: APS assists when seniors or disabled adults are “unable to meet their own needs, or are victims of abuse, neglect or exploitation”. APS investigates abuse of elders or dependent adults in “private homes and hotels or hospitals and health clinics when the abuser is not a staff member”. The California Department of Aging is responsible for investigating abuse that takes place in nursing homes, board and care homes, residential and long term care facilities. The California Department of Health Services “handles cases of abuse by a member of a hospital or health clinic.” The APS evaluates “abuse cases and arranges for services such as advocacy, counseling, money management, out-of-home placement, or conservatorship” as well as providing information, referrals to other agencies and public education of “Elder and Dependent Adult Abuse Reporting laws.” The services of APS are available to all regardless of income level (CDSS, 2007).

    When I called the San Diego County APS on Saturday, I was dismayed to get their answering service, which informed me that their business hours were weekdays only from 8am to 5pm. I did however find a form on their website called “SOC 341,” a “Report of Suspected Dependent Adult/Elder Abuse.” The “SOC 341” form has sections to be filled out for information on the victim, suspected abuser, and reporting party (along with an option to waive confidentiality to specific parties or all). The form asks for incident information and designates two types of abuse categories. The category “Perpetrated by Others” offers a checklist for abuses of assault/battery, constraint or deprivation, sexual assault, chemical restraint, over/under medication, neglect, financial, abandonment, isolation, abduction or other. The category “Self-Neglect” offers a checklist for abuses of physical care, medical care, health and safety hazards, malnutrition/dehydration and other. The next section, “Abuse Resulted in”, has check box options for physical injury, death, mental suffering, minor medical care, hospitalization, care provider required or other. The last five sections ask about the reporter’s observations, targeted accounts, other people believed to have knowledge of abuse, others responsible for victim’s care, and report information.

    While I was impressed with the depth of information that the APS form requires, I was displeased with the inability to contact APS on the weekend. The fact that my grandmother was in the custody of an untrustworthy caretaker, who was responsible for the disappearance of my grandfather’s car and miscellaneous valuables from their home including jewelry, antiques and furniture, led me to investigate a conservatorship further. Similar to guardianship of a minor, “a person under conservatorship is…a protected person” (Wikimedia, 2009). “A conservatorship can be set up after a judge decides that a person (called the "conservatee") can't take care of themselves or their finances. Then the judge chooses another person or organization (called the "conservator") to be in charge of the conservatee's care or finances, or both” (California Courts, 2009). My mother, now seeking a conservatorship of my grandparents, has to submit addresses of several relatives for notification. Both my grandfather and grandmother will be interviewed by social workers and my mother’s background will be investigated to consider her for the conservatorship.

    At present financial abuse of the elderly is on the rise since the economy has collapsed. As seniors “usually have steady income -- Social Security and sometimes pension checks”, they are targeted in turbulent economic times. Although people generally consider “financial abuse…[as] phony investment schemes or Internet scams…attorneys say just as common are instances of exploitation perpetrated by a loved one or friend”. The most usual suspects of financial abuse are “in this order -- family, caretakers and new best friends”. Protecting seniors proves difficult if they have given authorization to bank accounts or signed over a power of attorney to the abuser. Without a power of attorney or conservatorship held by a trusted family member or friend, seniors continue to remain at risk.

    While it is commendable to have an agency devoted specifically to the protection of seniors and disabled adults, APS needs to be available like other emergency services – 24 hours a day. APS should also work to make the public fully aware that without the legal action of a power of attorney or conservatorship, families will not be able to protect their loved ones.


    References

    Adult Protective services (APS). (2007). California Department of Social Services (CDSS). Retrieved from: http://www.cdss.ca.gov/agedblinddisabled/PG1298.htm

    Conservatorship. (2009). Wikimedia Foundation Inc. Retrieved from: http://en.wikipedia.org/wiki/Conservatorship

    Duties of a Conservator. (2009). California Courts Self-Help Center. Retrieved from:
    http://www.courtinfo.ca.gov/selfhelp/seniors/duties.htm

    Jun, C. (2009, July 27). Financial abuse of elderly rises as economy sinks. The Detroit News. Retrieved from: http://www.detnews.com/article/20090727/METRO/907270338/1409/METRO

    SOC 341. (2006). Report of Suspected Dependent Adult/Elder Abuse. State of California. Health and Human Services Agency. Retrieved from: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/SOC341.pdf

    All content © Village Memorial. 2009-2010.
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