Paid In-Home Care: MORE CARE & BETTER CARE FOR SENIORS

Transcription

1 Paid In-Hme Care: MORE CARE & BETTER CARE FOR SENIORS A W H I T E PA P E R F RO M

2 Sectin I ABOUT HOME INSTEAD SENIOR CARE Hme Instead Senir Care is a U.S.-based internatinal franchise netwrk that prvides high quality, nn-medical hme care fr lder adults. The Hme Instead Senir Care netwrk cnsists f mre than 900 independently wned and perated franchise ffices that help senirs and their families thrugh the hme-care stage f aging. Franchise ffices are lcated thrughut the United States and in Canada, Australia, Austria, Finland, Germany, Ireland, Japan, New Zealand, Prtugal, Puert Ric, Suth Krea, Switzerland, Taiwan and the United Kingdm. Hme Instead franchise ffices emply mre than 65,000 prfessinal, trained CAREGivers SM wh, in 2010, prvided mre than 40 millin hurs f elder care services thrugh mre than 60 hme-care activities. In situatins in which a client has aging-related medical needs beynd the capabilities f nn-medical hme-care wrkers, referrals can be made t Hme Instead s partners in the healthcare industry. Hme Instead was funded by Paul and Lri Hgan in 1994 in Omaha, Nebraska, and began franchising in June It was Paul s wn family experience caring fr his grandmther fr 12 years that influenced his realizatin f the need fr nn-medical hme-care and elder-cmpaninship services t help senirs live independently at hme. By 1998, the Hme Instead Senir Care netwrk had grwn t 99 franchises ffices and was recgnized by Entrepreneur magazine as ne f the 100 fastest-grwing franchise cmpanies in the United States. In 2000, Hme Instead began internatinal expansin by establishing a partner relatinship with Duskin C. in Osaka, Japan. The Hme Instead Senir Care Fundatin was created in 2003 t further the philanthrpic missin f franchisees. The fundatin s bjective is t prvide financial assistance t nn-prfit rganizatins specializing in prjects that imprve the quality f life fr senirs. Hme Instead has been cited fr its business success by the Internatinal Franchise Assciatin and by several publicatins including TIME, The Wall Street Jurnal, The New Yrk Times, Entrepreneur and Franchise Times. Cmpany Funder and Chairman Paul Hgan has als taken n several advisry rles n aging issues, including serving as an at-large delegate t the White Huse Cnference n Aging. 2

3 Sectin II METHODOLOGY This Hme Instead Senir Care-cmmissined research prject entitled the Value f Caregiving at Hme study examined the perceptins and experiences f U.S. caregivers fr senirs by cnducting a survey amng adults (aged 18 and lder) wh were prviding and/r arranging care fr an lder adult (aged 65 r lder). T ensure the integrity, independence and validity f this paper, an expert panel cmpsed f medical prfessinals and academics, as well as senir-care and research experts, guided and apprved bth the methdlgy and survey instruments. Additinally, bth methdlgy and survey instruments were reviewed and apprved by the Western Institutinal Review Bard, a fully-accredited cmmercial institutinal review bard that reviews health and healthcare-related research prjects accrding t FDA regulatins and ICH guidelines. Tw separate samples were used: ne invlving caregivers whse care recipients were receiving paid in-hme nn-medical care; and a secnd grup f caregivers whse care recipients were nt receiving this care. The data was cllected using a natinal panel f mre than three millin cnsumers wh have agreed t take part in surveys cnducted by prfessinal researchers. A detailed screening prcedure identified qualified respndents, wh then participated in this survey vluntarily. T be eligible, respndents had t be respnsible fr prviding and/r arranging care (either ttally r partially) fr smene aged 65 r lder wh was nt capable f cmplete self-care; and wh was nt living in a nursing hme, assisted-living facility, r grup hme. After qualifying as a caregiver, respndents were then apprpriately classified int paid in-hme nn-medical care r nn-paid in-hme nn-medical care grups. The definitin f nn-medical care was stringent, t include n registered r certified medical prfessinals whatsever. Fr the purpses f this reprt, medical prfessinals will be thus defined as physicians; physicians assistants (PAs); nurse practitiners (NPs) registered nurses (RNs); licensed practical nurses (LPNs); licensed vcatinal nurses (LVNs); physical therapists (PTs); ccupatinal therapists; r any ther registered therapists. Sme respndents were using bth medical and prfessinal, in-hme nn-medical care; hwever, thse relying slely upn prfessinal medical care were excluded frm this study. The nline survey instrument cnsisted f three cmpnent questinnaires designed t be administered sequentially. These questinnaires cntained sectins that allwed the fllwing: demgraphic prfiling f care recipients and caregivers; identificatin f the types f care prvided; detailed descriptin f the health status f the care recipient and the caregiver; assessment f the quality f life f bth the care recipient and caregiver; and the cllectin f data related t caregiver emplyment. Six-hundred and ninety-seven caregivers with paid in-hme nn-medical care cmpleted all three surveys, alng with 934 caregivers wh were nt using paid in-hme nn-medical care yielding a ttal f 1,631 study respndents. Only thse participants wh cmpleted all three surveys were retained in the survey-analysis prcess. Data cllectin ccurred thrughut January

4 Sectin III THE GRAYING OF THE BABY BOOMER The natin s ppulatin f senir citizens is abut t rise t histric levels. In 2011, the first f the Baby Bmers the 78 millin men and wmen brn between 1946 and 1964 will begin turning 65 at a rate f mre than 8,000 per day. By year s end, the natin s senir ppulatin will have increased by almst 3 millin, t nearly 49 millin. By 2025, the U.S. senir ppulatin, which was 35 millin in the year 2000, will have mre than dubled t 72 millin. As these lder adults cntinue t age, many will experience varius health prblems such as impaired mbility, strkes, Alzheimer s disease and ther dementias, t name just a few. Sme ailments will be lng lasting, and sme will ccur in cmbinatins. Indeed, 80 percent f the natin s current senirs have ne chrnic health cnditin, and 50 percent have at least tw. 1 The challenge cnfrnting the natin is hw t care fr these millins f senirs, many f them afflicted with chrnic cnditins. The challenge is cmplicated by the fact that the U.S. medical cmmunity is facing a serius shrtage f clinicians trained t wrk with lder adults. The situatin is cmplicated still further by the fact that in study after study, abut 90 percent f American senirs have said they want t remain in their wn hmes fr as lng as pssible. Their desire is bth sensible and understandable, but hw can s much care be delivered t s many individuals living in s many neighbrhds acrss the natin? Typically, abut 90% f American senirs say they want t remain in their wn hmes fr as lng as pssible. 4

5 Sectin IV PART OF THE SOLUTION: PAID IN-HOME NON-MEDICAL CARE One ptential slutin t this challenge is the use f paid in-hme nn-medical care. Recent academic research cmmissined by Hme Instead Senir Care indicates that paid nn-medical wrkers can be an integral part f the in-hme care cntinuum fr senirs, including thse wh als receive treatment frm medical prfessinals. This is especially true fr thse senirs wh are lder r need mre-intensive levels f care. In fact, the Hme Instead Senir Care research uncvered an assciatin between the use f paid in-hme nn-medical care and a lwer number f visits t dctrs by care recipients. The reasn fr this may be that the use f paid in-hme nn-medical care results in mre hurs f care and presumably better care fr lder adults. What s mre, the benefits f paid in-hme nn-medical care extend nt just t senirs, but als t the peple wh mst ften are caring fr them: their family members and friends. A Supplement t Medical Care This Hme Instead Senir Care study strngly suggests that fr senirs acrss the cuntry, paid nn-medical care is rapidly establishing itself as a supplement t the healthcare services they receive in their hmes. Thirty-five percent f the senirs studied were being cared fr nt nly by clinical prfessinals (physicians, registered nurses, licensed practical nurses, hme-health nurses, r physical r ccupatinal therapists), but als by nn-medical persnnel wh wrked in cllabratin with these prviders. The fllwing results reflect in-hme healthcare usage in this grup f senirs ver a 12-mnth perid: 60 percent used hme-health nurses. 59 percent used physical therapists. 32 percent used ccupatinal therapists. 37 percent had at least ne in-hme visit frm a physician s assistant r nurse practitiner. 17 percent had an in-hme visit frm a physician. 5

6 Sectin IV Part f the Slutin: Paid In-Hme Nn-Medical Care (Cntinued) In additin, 17 percent f thse with paid in-hme nn-medical care had used adult day-care, as ppsed t just 4 percent f thse withut such services. (Adult day-care centers are similar t senir centers in that they are designed t help keep senirs in their hmes by prviding them with a wide range f day-time activities. But unlike senir centers, they have the staff and equipment t serve senirs wh have greater needs, including thse suffering frm dementia.) The remaining 65 percent f the lder adults in the study were using nly paid in-hme nn-medical services t meet all their care needs. This suggests that paid in-hme nn-medical care is increasingly functining as a jumping-ff pint frm which senirs access mre frmal medical care as the need develps. Help fr Thse with Intensive Needs This Hme Instead Senir Care study fund that the U.S. senirs with the greatest need fr medical care are als making extensive use f paid in-hme nn-medical care. The recipients f this cmbinatin f nn-medical and medical in-hme care tended t be lder. Accrding t the research, 75 percent were at least 80 years f age. And these care recipients were ften sicker r therwise mre limited in their daily rutines: 61% 29% 43% 22% 48% had mbility prblems. had Alzheimer s disease. were suffering frm ther types f dementia. were cntending with the after-effects f strke. were dealing with frailty, which is defined by the American Geriatrics Sciety as a cnditin characterized by three r mre f the fllwing: muscle weakness; slw walking speed; exhaustin; lw physical-activity levels, r unintentinal weight lss. 2 Bth the senirs wh use paid in-hme nn-medical care, and their families and friends, recgnized it as a vital supplement t clinical medical care fr thse wh wanted t stay in their hmes but had chrnic health prblems, r wh presented demanding caregiving challenges. 6

7 Fewer Dctr Visits The Hme Instead Senir Care research fund that the use f paid in-hme nn-medical care is assciated with a lwer rate f in-ffice dctr visits, thus helping t imprve senirs quality f life while helping them save n healthcare expenditures. Overall, the study fund that n average, caregivers fr senirs in the grup using paid in-hme nn-medical care reprted that thse senirs had abut 25 percent fewer dctr visits each year (12.5) than the lder adults wh did nt have such care (16.6 visits). The fllwing results, which cver a 12-mnth perid, are fr less-healthy senirs whse caregivers rated their cnditins as wrse than [thse f] thers f the same age : Amng care recipients with heart disease, caregivers tld us that thse with paid in-hme nn-medical care hadd 18.5 visits t a dctr cmpared with 23.5 visits fr thse withut such care. Fr thse with arthritis, the numbers were 19.7 dctr visits fr thse in the first grup versus 22.2 fr thse in the secnd grup. Amng thse with Alzheimer s r ther dementias, the difference was 10.2 dctr visits fr thse with paid in-hme nn-medical care versus 19.2 visits fr thse withut. Thus, it appears that having paid in-hme nn-medical care helps reduce the need t make incnvenient and ptentially expensive visits t a dctr s ffice. 25% fewer dctr visits 7

8 Mre Care, Better Care The Hme Instead Senir Care research fund that per week, recipients f paid in-hme nn-medical care typically receive mre verall hurs f care (bth paid and unpaid, medical and nn-medical) than lder adults wh d nt use such services. In fact, the cmparisn is startling. The senirs in the study with paid in-hme nn-medical care received an average f 87.9 hurs f care per week, cmpared with 35 hurs fr thse withut. Put anther way, in any given week, lder adults wh use paid in-hme nn-medical care will receive abut tw-and-a-half times as much ttal care as the senirs wh d nt. Hurs f care per week Senirs Using Paid In-hme Nn-medical Care Senirs Nt Using Paid In-hme Nn-medical Care Interestingly, while the first ttal includes an average f almst 48 hurs f paid in-hme nn-medical care delivered ver the last week, it als reflects the fact that senirs in this grup are likely t receive care frm family and friends first, and then frm paid prfessinal in-hme nn-medical care. What were the mst imprtant services ffered by paid in-hme nn-medical care prviders? Accrding t the research, the senirs wh had such care made extensive use f it in transprtatin (ften a prblem fr lder adults) and husewrk. In additin, paid in-hme nn-medical care prved useful in grcery shpping and meal preparatin, bth critical activities in helping lder adults remain healthy and independent. Thus, paid in-hme nn-medical services are able t cmplement the care prvided t senirs by their medical prfessinals and their family and friends resulting in mre care, and mre diverse care. Caregivers Recgnize This The caregivers wh participated in the study supprted this cnclusin when they were asked t use a 1-t-5 scale t rate the verall quality f in-hme care being received by their senirs. Seventy-eight percent f the caregivers fr lder adults whse bundles incrprated paid in-hme nn-medical services rated the verall quality f care as a 4 r 5 very gd r excellent. In cntrast, 70 percent caregivers fr senirs nt using paid in-hme nn-medical services assigned a 4 r 5 t the quality f care. In summary, mre care appears t als mean better care fr senirs wh, as a result, shuld remain healthier and happier in their wn hmes, and in the cmpany f family and friends. 8

9 Sectin V CONCLUSION The Hme Instead Senir Care research fund that in-hme nn-medical care fr senirs is frequently part f a larger prtcl f care invlving medical prfessinals and family members and friends a cmbinatin designed t help lder adults remain in their hmes as lng as pssible. And the use f paid in-hme nn-medical care can help families prvide mre and better care fr their senirs. As the number f lder Americans rapidly expands, paid in-hme nn-medical care can play a vital rle in ensuring that senirs receive necessary and apprpriate care even thugh the U.S. healthcare system is stretched thin in funding and staffing a prblem that likely will becme mre prnunced in the cming decades. In an especially significant finding, the study indicates that n average, senirs receiving paid in-hme nn-medical care experience fewer dctr visits each year. This has majr financial implicatins fr senirs and their families, the healthcare system, and the federal budget. The use f paid in-hme nn-medical prfessinals has a majr impact nt nly n the quality f care that senirs receive, but als n the number f hurs per week f care that they receive. Finally, the use f prfessinal in-hme nn-medical care may help delay r even prevent the need fr mre frmal medical care, thus, taking significant pressure ff the cuntry s resurce-strapped healthcare system especially hspitals and nursing hmes. The cntributins f paid in-hme nn-medical wrkers becme even mre significant in light f sciety s mve away frm institutinalizing senirs in favr f helping them remain healthy and independent in their wn hmes. Cnsequently, it will be an imprtant plicy-level imperative t determine at which pints n the evlving senir-care cntinuum that paid in-hme nn-medical care can best augment clinical care r in sme instances, delay r even prevent the need fr it. 9

10 Sectin VI RECOMMENDATIONS Given the grwing imprtance f paid in-hme nn-medical services and their ptential t imprve the quality f senir care while saving the natin significant sums, a series f steps t encurage their grwth and develpment is in rder: Natinal Senir-Care Plicy Establish a cmprehensive natinal senir-care plicy t prvide ptimal care fr senirs and ensure gd stewardship f the limited human and financial resurces available t prvide care t an aging ppulatin. An Educatinal Campaign Develp a cntinuing natinwide prgram t educate senirs and their families abut the chices that are available alng the healthcare cntinuum, and hw t g abut making the best decisins at each stage f the aging prcess fr example, prviding nn-medical care in the senir s hme rather than institutinalizing him r her in a nursing hme. The campaign culd be munted by a calitin invlving public senir-service agencies and the private-healthcare cmmunity. Tax-Plicy Changes Create a natinal study cmmissin t review the impact f the current tax cde n senir-care decisin-making and recmmend adjustments t the cde which wuld encurage hme care and persnal respnsibility fr senir care. A Yuth Crps Create a crps f yung vlunteers wh wuld be trained t wrk fr, say, three years as in-hme nn-medical wrkers, perhaps using reductins in cllege-lan debts as an incentive. A Senir Crps Often, sme f the best in-hme nn-medical wrkers are senirs themselves. Scial plicies shuld be develped t encurage this trend. New Senir-Care Optins Offer federal grants t test innvative new prgrams in senir care, especially prgrams that will enable lder adults t age at hme, a chice nearly 90 percent say they prefer. Surces: 1. Online at 2. Online at 10

11 NOTES 11

12 hmeinstead.cm Califrnia Street Omaha, NE Each Hme Instead Senir Care franchise ffice is independently wned and perated Hme Instead, Inc. 12