Month: June 2018

What are the criteria for finding good in-home care services?

criteria for finding good in-home care servicesWhat is home health care?

Home health care is the process of providing health care to people in their homes. This could include post-trauma care, post-operative care and elder care, and may range from supporting daily living activities to complete at-home ICU setup.  In this article we will restrict ourselves to home healthcare for elders.

The need for home health care

Of late, India has woken up to the need for home health care.

Firstly, a burgeoning population is putting a lot of pressure on hospitals to treat and discharge patients as soon as possible.  This is extending the post-hospitalization and recovery period where people who have come back home continue to require a fair amount of health care in order to fully recover.

Secondly, the elder population in India is growing steadily and small families are finding it hard to look after the elders at home without professional help.  India today is home to over 120 Million people above the age of 60 and a good 10% require some health care and support at home.

These two together are creating a new market for professional home healthcare services.

Introduction to professional home healthcare services in India

“Home healthcare services” is still a nascent industry in India.  It is also a very challenging space because the requirements and conditions in India are very different from those in developed nations. Which means that we do not have a successful model to emulate or follow.

Currently, there is no regulatory body or umbrella organization for the home healthcare sector that could regulate and set up the rules of engagement.  So, we are pretty much bordering on what can be called an unorganized, unregulated sector.

Also, most home healthcare services organizations are independent organizations not affiliated to any hospital.  This means that, more often than not, the hospital is not aware of what specific services the home healthcare agency is providing for their discharged patient and whether it is in line with what they – the hospital –  has recommended. In fact, most often, the home healthcare services are provided without any supervision or monitoring by a doctor.  This means all the due diligence in the selection process and the supervision of their work with the patient rest solely on the shoulders of family members of the patient.

This is why it is essential to learn how to select the right service partner for you.

  1. Collect the list of service providers operating in your area.  These could be individuals (freelancers), general manpower agencies, local hospitals’ outreach business arm, or dedicated home healthcare providers.
  2. Select a service partner who meets your current requirements and be prepared to switch to a different partner if the needs become more complicated (or less complicated) as the case may be.  This will give you some flexibility in managing costs.
  3. If you are selecting a freelancer or individual, there are both advantages and disadvantages. The advantages and disadvantages are
  4. (A) The cost will be low.
  5. (A) If you have the space, you can find someone who is a live-in service agent.  This will prevent sudden “no-shows” and unexpected disappearances.
  6. (D) You will have to do all the due diligence starting from the security aspect onwards.  Is this person reliable?  Where do they live?  Do we need to get them to get a police clearance?  Should I get copies of their important documents?   These are all some of the questions you will need to grapple with.
  7. You will be responsible for their personal needs in terms of food, security and shelter (in the case of a live-in).
  8. When they leave for whatever reason, either permanently or for a short/long leave of absence, finding a replacement can be challenging.
  9. If you are selecting a general manpower agency, it should be only for a companion or a nursing assistant (untrained helper).   You should not rely on a general manpower agency for professionally qualified personnel such as nurses, physiotherapists, occupational therapists or doctors.  The advantages of going to a manpower agency over an individual is that you can expect the manpower agency to do some of the due diligence (though we would strongly recommend that you do your own due diligence).  Additionally, finding a replacement for a truant caretaker may be easier.  On the down side, expect “no-shows” and everyone involved, from the agency to the actual personnel, to be “unreachable” at such times.
  10. If your local hospital provides home healthcare services also, that is ideal.  Since all the services are provided by the same organization, one can hope that they all work in unison and provide you with the right level of support whatever your needs are.
  11. Finally, there are a number of independent professional home healthcare agencies that have come up in India recently.  They are expensive, but they provide a wide range of services from house calls by doctors to 24×7 intensive care.

Bottom Line

The bottom line in all this is that the quality of service received is, at the end of the day, dependent on the quality of the individual deputed to provide that service.  As a fledgling industry, training of personnel for home health care is still not very advanced and you can expect a lot of rough edges.  Be prepared to spend time on training the deputed personnel on matters such as hygiene, empathy, kindness, caring and pleasant bedside manners.  You will also have a tough time taking them away from their phones!

All the best!

 

 

How to handle a parent who has become, bitter, rude and even more stubborn as they have aged?

DementiaThough this may sound pithy, it is true that old people are like children. And sometimes, the older they get, the more child-like and/or childish they become. While this can be endearing at times, it can also be very frustrating and annoying. Not to mention, difficult to manage.

If you feel that your elder loved one is behaving badly, ask yourself this question.
Is this completely new, surprising behaviour or is this their usual inherent traits getting magnified a bit (or a lot)?

If you feel that there is a sudden and drastic change in the personality of the person, then this could be a symptom of dementia. Seek professional help. Take the loved one to a neurologist and have a proper assessment done.

Dementia is a generic term for decline in mental ability of a person. It is not a specific disease. Alzheimer’s is one of the common forms of dementia among elders. Dementia results in a loss of ability to perform even routine tasks properly and the person suffering from this may become frustrated and angry at their own inability which can then manifest itself in the form of bad behaviour.

If on the other hand, the traits exhibited have always been inherent in the person, except that it is coming to the fore more often and more forcefully, then it could be due to other factors.

In both cases, a lot of patience, tolerance, love and care are needed. Here are few tips for handling such situations:

1.Try and identify the cause(s) for their frustration.

2. Help them in tasks they are having difficulty with.

3. Where possible assist them in finding ways by which they can remain independent, rather than taking up those tasks yourself. For example,

– If they are constantly forgetting things, get them a board on which they can write things they need to remember and allow them to use it to supplement their memory.

-If they are forgetting dates and seasons, get them a big calendar that they can refer to regularly.

-Sometimes they are misplacing things, help declutter their living environment and designate places for the things they misplace. For example, a decorative and distinct keyholder can ensure that they hang all the keys there. A spectacle stand kept within ready reach can help them remember to leave their specs in the same place most of the time.

-If they are getting lost, buy them a wearable GPS tracker. This may not help them but will help you ensure that they don’t wander away and get lost.

If they are abusive or physically threatening, then get them to sit down and explain why such behaviour is disturbing to you and ask them how you can make them happier. If that does not work, you can switch to expressing your displeasure at being abused and take certain actions to ensure that they get the message that you will not tolerate bad behaviour. For example, you can move out of the room saying “I am not going to come back till you calm down and behave properly”. If they get physically violent, get support.

If they are suspicious of you, don’t take it personally. Many times, you are the only person they are interacting with and so you become the easiest target to vent out all their frustration, anger and suspicion. If they are worried about monetary issues, keep their bank passbooks and other asset related papers somewhere close to them, so they can go through them whenever they want and reassure themselves.

Each case is unique. The main thing to remember is that you don’t have to face it all alone. Get help. Talk to your friends and family. Enlist their support. Talk to fellow caregivers. Join a self-help group. Approach NGOs that are working with elders.

Above all, tell yourself that their behaviour is not a reflection of their opinion of you. Don’t let your self-esteem suffer. All the best!