If in-home care is appealing but the costs are too high, consider shared care. It may provide you with just the services you are looking for. Many parents prefer to have their children cared for in a home environment. However, for some the cost of private, in-home care is too burdensome. The perfect alternative for these parents may be shared care.
In a shared care setting, several families work together to hire a nanny or other caregiver who usually rotates between the families’ homes. This option allows families to have the personalized services of in-home care, while keeping the cost down. Parents who hire shared-care help often feel they have more control over the kind of care their children receive, and the size and makeup of the group. They also have the ability to design their own program and include the activities which are important to them.
As you start investigating shared care alternatives, here are a few things to keep in mind:
- How many kids do you want in the group?
- Do you want all of the other children to be your child’s age?
- Is it more convenient for you to seek out parents near your work or your home?
- Do you prefer a caregiver who has been formally trained or one who has a good deal of practical experience?
- Are similar religious and philosophical views important or do you prefer your child to be exposed to a variety of views?
- Is your family vegetarian, or do you have other preferences for your child’s diet?
- Is it important to you to have more of a structured program for your child or do you prefer spontaneous activities?
- Do you prefer that your children are not exposed to certain things like too much TV or toy guns?
- Does your child have special needs that would require specific care?
You can find other parents who are interested in setting up a shared care arrangement by checking local referral services, putting an ad in the paper, or posting a notice at your local grocery store, church or synagogue.Tags: Home care, Family, new born, Geriatrics, Shared care, Social work
Many kinds of help are available for people who have had strokes and their families and caregivers. Some of the most important are:
- Information about stroke: A good place to start is with the books and pamphlets available from national organizations that provide information on this subject. Many of their materials are available free of charge. A list of these organizations are under Additional Resources.
- Local stroke clubs or other support groups: These are groups where strokesurvivors and family members can share their experiences, help each other solve problems, and expand their social lives.
- Home health services: These are available from the Visiting Nurses Association (VNA), public health departments, hospital home care departments, and private home health agencies. Services may include nursing care, rehabilitation therapies, personal care (for example, help with bathing or dressing), respite care (staying with the stroke survivor so that the caregiver can take a vacation or short break), homemaker services, and other kinds of help.
- Meals on Wheels: Hot meals are delivered to the homes of people who cannot easily shop and cook.
- Adult day care: People who cannot be completely independent sometimes spend the day at an adult day care center. There they get meals, participate in social activities, and may also get some health care and rehabilitation services.
- Friendly Visitor (or other companion services): A paid or volunteer companion makes regular visits or phone calls to a person with disabilities.
- Transportation services: Most public transportation systems have buses that a person in a wheelchair can board. Some organizations and communities provide vans to take wheelchair users and others on errands such as shopping or doctor’s visits.
Many communities have service organizations that can help. Some free services may be available or fees may be on a “sliding scale” based on income. It takes some work to find out what services and payment arrangements are available. A good way to start is to ask the social workers in the hospital or rehabilitation program where the stroke survivor was treated. Also, talk to the local United Way or places of worship. Another good place to look is the Yellow Pages of the telephone book, under “Health Services,” “Home Health Care,” “Senior Citizen Services,” or “Social Service Organizations.” Just asking friends may turn up useful information. The more you ask, the more you will learn.Tags: Stroke, Sliding scale fees, Social Issues, Home care, Caregiver, Geriatrics
The doctor and other hospital staff will provide information and advice about rehabilitation programs, but the patient and family make the final choice. Hospital staff know the patient’s disabilities and medical condition.
They should also be familiar with the rehabilitation programs in the community and should be able to answer questions about them. The patient and family may have a preference about whether the patient lives at home or at a rehabilitation facility. They may have reasons for preferring one program over another. Their concerns are important and should be discussed with hospital staff.
Things To Consider When Choosing a Rehabilitation Program
- Does the program provide the services the patient needs?
- Does it match the patient’s abilities or is it too demanding or not demanding enough?
- What kind of standing does it have in the community for the quality of the program?
- Is it certified and does its staff have good credentials?
- Is it located where family members can easily visit?
- Does it actively involve the patient and family members in rehabilitation decisions?
- Does it encourage family members to participate in some rehabilitation sessions and practice with the patient?
- How well are its costs covered by insurance or Medicare?
- If it is an outpatient or home program, is there someone living at home who can provide care?
- If it is an outpatient program, is transportation available?
A person may start rehabilitation in one program and later transfer to another. For example, some patients who get tired quickly may start out in a less intense rehabilitation program. After they build up their strength, they are able to transfer to a more intense program.
When Rehabilitation Is Not Recommended
Some families and patients may be disappointed if the doctor does not recommend rehabilitation. However, a person may be unconscious or too disabled to benefit. For example, a person who is unable to learn may be better helped by maintenance care at home or in a nursing facility. A person who is, at first, too weak for rehabilitation may benefit from a gradual recovery period at home or in a nursing facility. This person can consider rehabilitation at a later time. It is important to remember that:
Hospital staff are responsible for helping plan the best way to care for the patient after discharge from acute care. They can also provide or arrange for needed social services and family education.
This is not the only chance to participate in rehabilitation. People who are too disabled at first may recover enough to enter rehabilitation later.Tags: Rehabilitation medicine, Geriatrics, Healthcare in the United States, Geriatric rehabilitation, Stroke recovery, Nursing home, Healthcare
Some people do not need rehabilitation after a stroke because the stroke was mild or they have fully recovered. Others may be too disabled to participate. However, many patients can be helped by rehabilitation. Hospital staff will help the patient and family decide about rehabilitation and choose the right services or program.
Types of Rehabilitation Programs
There are several kinds of rehabilitation programs:
- Hospital programs
- These programs can be provided by special rehabilitation hospitals or by rehabilitation units in acute care hospitals. Complete rehabilitation services are available. The patient stays in the hospital during rehabilitation. An organized team of specially trained professionals provides the therapy. Hospital programs are usually more intense than other programs and require more effort from the patient
- Nursing facility (nursing home) programs
- As in hospital programs, the person stays at the facility during rehabilitation. Nursing facility programs are very different from each other, so it is important to get specific information about each one. Some provide a complete range of rehabilitation services; others provide only limited services
- Outpatient programs
- Outpatient programs allow a patient who lives at home to get a full range of services by visiting a hospital outpatient department, outpatient rehabilitation facility, or day hospital program
- Home-based programs
- The patient can live at home and receive rehabilitation services from visiting professionals. An important advantage of home programs is that patients learn skills in the same place where they will use them
Individual Rehabilitation Services
Many stroke survivors do not need a complete range of rehabilitation services. Instead, they may need an individual type of service, such as regular physical therapy or speech therapy. These services are available from outpatient and home care programs.
Paying for Rehabilitation
Medicare and many health insurance policies will help pay for rehabilitation. Medicare is the Federal health insurance program for Americans 65 years of age or over and for certain Americans with disabilities. It has two parts: hospital insurance (known as Part A) and supplementary medical insurance (known as Part B). Part A helps pay for home health care, hospice care, inpatient hospital care, and inpatient care in a skilled nursing facility. Part B helps pay for doctors’ services, outpatient hospital services, durable medical equipment, and a number of other medical services and supplies not covered by Part A. Social Security Administration offices across the country take applications for Medicare and provide general information about the program.
In some cases, Medicare will help pay for outpatient services from a Medicare-participating comprehensive outpatient rehabilitation facility. Covered services include physicians’ services; physical, speech, occupational, and respiratory therapies; counseling; and other related services. A stroke survivor must be referred by a physician who certifies that skilled rehabilitation services are needed.
Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered. Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are older, blind, or disabled, or certain people in families with dependent children.
These programs have certain restrictions and limitations, and coverage may stop as soon as the patient stops making progress. Therefore, it is important for patients and families to find out exactly what their insurance will cover. The hospital’s social service department can answer questions about insurance coverage and can help with financial planning.Tags: health insurance policies, outpatient hospital services, Nursing, Nursing home, Geriatrics, hospital insurance, skilled rehabilitation services