Wise people, how does one go about finding a private duty nurse?
I will call my dad’s doctor to see if he will order nursing care, but in case he won’t, I am not sure where to go.
My dad is Type 1 diabetic with a brain injury and he can no longer manage his diabetes, which means my mom has to be with him 24/7 practically. He has been having some low blood sugar readings which is puzzling his endocrinologist who is trying to figure out why. In the meantime, my mom has been having to stay with him and help him check his sugar often and then fight with him to take a glucose tablet if it is low (he gets cranky when it is low).
My mom is feeling the stress of all this and I would really like to have a nurse there for 4 hours or so a couple of times a week to give her a break and to let the nurse observe dad, help him eat lunch and take his insulin and keep checking his glucose.
I called the Visiting Nurse Assn we used for PT and they said the dreaded words “it all depends on what the insurance will pay for.” Plus the MD has to refer dad. The home health agency who provided unskilled aides does not have nurses.
I realize I will probably have to pay out of pocket. We are researching senior homes for my folks but that will take a while before anything is decided. In the meantime I need some help for mom ASAP. Thanks
Ask at church - ministers often know many very sick people at home and hear about good care agencies. Do you have a senior center, senior agency; companies like visiting angels.
When you pay out of pocket, you are paying the agency overhead. You may have a local agency that can refer a home care person and set up billing.
The RN or LPN will add costs. Your mom needs a break with the physical aspects (how is he on bathing, dressing?) How much is his brain injury affecting him? Maybe your mom could benefit better with light housekeeping (or even a weekly housekeeping service).
Some churches have volunteer nurses helping with helping keep their aging population healthy. Maybe she can network and find some volunteer help in addition to paid help.
intparent - I’m so glad the addition is off the table. The problem with our elderly is they want to wait until they need it to find a retirement or assisted living community. By then, it’s too late.
surfcity - I don’t see why your doctor would not refer for home nursing. But, that is just for the skilled needs such as helping monitor BS and help with an action plan. It seems you need a sitter to allow your mom to get some rest. Here is an example of a group that specializes in respite care https://www.homeinstead.com/. Often, the hospital or community have lots of information on a web site. Google county name and elder care. Here is an example: http://www.alamanceeldercare.com/
Surfcity-that is a lot to manage- for you and your folks. I can’t remember if they are nearby or if you are helping from a distance. It does sound like time for added support and assistance at home, as well as considering next steps.
If you don’t have local contacts and think it would be helpful to have professional input to make home care arrangements or assess care facility options, it may be worthwhile to consider consulting with a geriatric care manager, who can assess needs of one or both parents, make connections to care providers and help walk everyone through the next steps.
There is a charge for services, and yet it can be cost effective to find the shortest distance between two points. Nursing care is pricier than home health aides, for example, and a combination may work best. I paid for a consult before my folks signed up for a care facilty near me- they were moving from out of state and I just wanted confirmation that our assessment of the community was accurate. When the GCM said it was the best and most responsive place any of her clients had been, there was great peace of mind.
Geriatric care managers can be searched for online and frequently have social work credentials. Our estate attorney referred us to the one we used and Councils on Aging could also be a resource with care providers and care managers. It is a matter of how much you can navigate and how resources are allocated.
Thank you - I will look into a geriatric case manager, that may be very helpful.
We had had an aide in which was of limited help. The issue now is dad’s blood sugars are becoming less stable, so we really can’t leave him with someone who does not have diabetes experience. For 90% of the time it would be overkill to have an RN there, but one is needed during meal times and in the case of a real low blood reading.
I should still see about an aide too, for things like light housekeeping (although she has a cleaner). I really see the need to get them into senior housing now. Just have to crunch some numbers to make sure they can afford it and figure out if dad can actually qualify to live independently with mom or if they would have to be separated. All this is such a shock since they were both so independent before the car hit him.
I live about an hour away and am the only child so it’s on me to do everything. On the plus side, I don’t have any siblings to screw up the process
The most helpful resources for us have been a geriatric care manager and Jewish Family Services (you don’t have to be Jewish to benefit from their services).
surfcity, in some regions Craigslist is where caregivers search for jobs. In my mom’s city all of the major assisted living facilities post their job openings on Craigslist under the healthcare section. The agencies pay workers about half of what they collect from clients but they also do background checks and pay employment taxes. I think you do need someone with medical training if blood monitoring is done. The regular caregivers won’t do anything invasive, not even trim toenails. Your situation might be a good opportunity for a new nursing graduate to gain experience, but you’ll need to be vigilant about checking references and qualifications.
surfcity – regarding crunching numbers, just keep in mind that home help, even low order home help, can get really expensive really fast. Whereas if they move into a facility of some kind, a certain level of help will be built into the cost, so add-ons wouldn’t be nearly as pricey, if they’re even needed at all. It might be worthwhile to talk with a couple of facilities in the area to see how they’d handle someone like your dad.
Also keep in mind all the costs your parents will be shedding if they leave and sell their home – mortgage if any, property taxes, groceries & household supplies, homeowners insurance, cleaning & lawncare, maintenance & repair, etc. Once all of that it taken into account, it may still be more expensive at a facility, but the differential might be a lot less than you’d think.
Until someone needs an extensive amount of outside care, living in own home is going to outweigh a facility when it comes to costs and for some quality of life - however if being at home no longer is looked as a positive but a burden; sometimes people don’t realize what a burden until they are free of the responsibilities and enjoy the benefits of senior living.
I agree about having protocol for diabetes - many, many people deal with diabetes and I can bet you can find an aide that is familiar and can learn dad’s diabetes sign/symptoms/needs.
One assisted living that may work out (if there is one in your area) is Morningside - they charge the same for the room/services for one person as for a married couple (don’t think that has changed). Ours stays at near 100% occupancy.
If you find a facility that will be a ‘fit’ for your parents, have them at least give it a try, like a ‘vacation’.
We averted a family scare. MIL had heart arrhythmia and other issues and had two day hospitalization. FIL cannot manage at home for long w/o her. She is now back home. However it helped plant the seed with H that we also need to consider them as ‘dependents’ in the event that they need care coming in that is beyond their budget. Two other brothers can be counted on for this financial help. ‘The baby’ is married to an oldest, and she rules their expense appropriations; therefore we can’t count on their participation in cost sharing.
An LPN may be certified to administer medications. Most aides are CNAs, in my area. My experience with doctor approved home visits by RNs is that they come with specific tasks to manage. They usually don’t spend, say, four hours. And any “homemaker” services (dishes, laundry, etc) are a different category.
Thank you all. The agencies I have talked to do not let their aides administer insulin. I agree that we could find our own person or friend and train them, but I don’t know if that is feasible. His dose changes meal to meal based on his pre-meal numbers. And he has been having precipitous drops (like to 40!) in the afternoons, one time my mom work up fro ma nap just in time to shove some glucose tablets in his mouth.
I will call the doctor today to see if he will order a nurse for this. Then I can use the VNA services.
We are definitely looking into senior living places but I know realistically that that move cannot happen overnight.
@surfcity My husband has Type 1 diabetes, and his disease management as we age is a concern of mine. In your father’s case, two questions come to mind
Would a continuous glucose monitor (CGM) be beneficial? While it doesn’t eliminate all of the need for finger stick testing, it can be set to alarm when certain levels are detected so that action can be taken to address low or high blood sugars BEFORE they are at a dangerous level. One problem is that I don’t think Medicare covers CGMs or the supplies needed. Supplemental insurance might cover. Another thought is one of the newer insulin pumps (Minimed and Animas) which are linked with a CGM, and the insulin administration will be halted if the blood glucose reading gets too low (a point that the user sets).
Depending on your father’s age, is it really necessary to maintain such tight blood sugar control? It is the striving for such tight control that results in more low blood sugar incidences. If your father is complication free at this point, less tight control could result in easier day to day living and any complications from higher blood sugar levels could be years off, maybe not in his remaining lifetime.
Many places will allow you to have a sample week or month at their facility to “try it out.” Perhaps that would be a good way for folks to see what it is like and how many cares it may relieve. They provide a unit with a bed and meals for a payment, like a hotel with meals! One place that I visited says they rent by the month and have a couple that comes for month every winter to HI and stays with them in a furnished unit.
LF - this is why I am calling around to places. I would feel better if I could set up a schedule where a nurse (or someone) can come up to check him 2 hours after a meal, etc. And in the meantime, if I can get a private duty nurse in for a few hours, she may be able to see a pattern that my mom cannot at this time.
Cincy gal - I sent you a PM! Him - that sounds like a great idea
I agree with Cincy gal, I would see if your dad’s doctor can keep him under less tight control. Studies show our seniors benefit with the length and quality of life with less stringent control.
All this is such a shock since they were both so independent before the car hit him.