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The Breaking Point: Home Care or Managed Care

Do I Put Mom in an Assisted Living Facility?

The most difficult decision a child (or spouse) can make is whether to place mom or dad in a managed care facility or allow either to remain at home longer. Guilt, stress, love, failure, quality of care and social stigma play an important role in this decision.

Why the dilemma? Most studies have concluded that seniors want to stay at home as long as possible. Most payors (insurers or government) also agree that remaining at home is best. From a financial perspective, homecare costs a fraction of the alternatives, about 10%-30% of the cost of hospitalization or managed care facility, respectively. From a quality of life viewpoint, remaining at home is the path of least resistance for the senior. They are most comfortable in a known, safe environment. However, for caregivers, family and children of seniors, managed care may be the best option.

Some Aging Statistics

Our society is aging. This is the first time in history that the fastest growing segment of society is seniors. The are more seniors than children. The benefit of replenishment decreases as society ages. This is represented by a decreasing tax base and increased consumption. Seniors need more healthcare than younger folks, consuming more than 50% of the healthcare dollars available. In Canada, this gives rise to unpopular tax increases or the decision to reduce healthcare costs or benefits, equally unpopular. Recognizing this problem, the government of Canada has initiated new innovation programs, dedicated a minister to seniors and offers the most advantageous R&D programs that help businesses develop better ways of providing care.

In America, these decisions are carried out by private enterprises, HMOs and insurers. Pre-existing conditions, limited or refused coverage for new conditions, medication coverage and co-pay, skyrocketing hospitalization costs pose an even greater burden on the aging citizen. In recognition of these growing trends, American companies are developing and adopting new technologies at record speed. HMOs and insurers are recognizing this benefit and are adopting these technologies not only to provide better care, but to provide better care at lower cost. Imagine, with Telemedicine, the senior does not need to leave their home, a physician can see 10 times more patients in the course of a day. Pharmacists can automatically refill and deliver medications.

3 Point takeaway: 1) Our society is Aging; 2) Aging people have more sicknesses and chronic conditions; 3) Healthcare costs are increasing, almost accelerating.

Homecare – pros & cons

Everyone is comfortable in familiar surroundings. Home sweet home is always preferred by the resident. Let’s consider some of the benefits and difficulties with remaining at home.

The benefit of remaining at home include:

  • Reduced caregiver costs: many caregivers are unpaid family members
  • Comfort and consistency in daily activities. Familiar faces, family ties and pets are positive factors.

The difficulties of remaining at home include:

  • Lack of medical supervision
  • Medication adherence, complex doses, polypharmacy, complexity
  • Burden of care on caregiver, family or paid
  • Travel to medical appointments
  • Home maintenance – home need care too.

Managed care – pros and cons

Aside from the cost factor, managed care can provide around the clock support for those in need. Mild cognitive impairments, dementia or physical conditions all place enormous burden on family and caregivers. At an assisted living or managed care facility, experts may be on hand to professionally deal with these conditions.

Regular medication assistance keeps 30% of seniors out of the hospital. Daily assistance with bathing, travel and chores, food preparation and dressing are all provided, depending on the level of assistance selected, and paid, at each facility.

A managed care facility relieves the family member or caregiver of the stress of caring and worrying for their loved one.

Technology Can Help Too

Consider the state of technology today. Automated pill dispensers, cardiac and other wearable sensors, alarms, movement detectors, fall detectors and telemedicine are pretty amazing developments, available now.

The RxPense pill dispenser not only dispenses medications, along with instructions, it also collects vitals via third party wearables and maintains communication with caregivers, health care providers and loved ones.

The Apple watch started a smart watch revolution. It can now collect a variety of vital signs including heart rate monitoring though a single lead electrocardiogram that detects unusually high (or low) heartrates and arrhythmias, fall detection using advanced sensors and emergency 911 calling should you need it.

Wearable clothing, like Hexoskin, can continuously monitor, collect and store many health measurements.

Wireless scales, even ultrasound sensors plugged into a smart phone can be purchased off the shelf at local pharmacies.

Using these technologies perhaps can keep a senior at home longer. Remaining medication adherent and remotely monitored also reduces the stress on caregivers and patients, aside from the continual data stream provided to those who need to monitor.

Timing: When you need to decide

First question to ask: How do I feel? Are you stressed? Neglecting your own health and welfare? Do your own children miss or resent you for devoting all your time to the care of your parent?

Next, consider your efficacy. Are you really helping? Are medications always taken on time? Doctor appointment kept? Abnormalities or degraded performance in your parent reported immediately? Would your mom be better off with professional care?

Finally, are you financially stable or did you drain your savings or stop work to care for your mom?

While admirable and heart warming to be the primary caregiver for a loved one, sometimes better care can be provided by others. Better for your loved one and better for you.

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