In the US, adult family homes are the equivalent of Canadian family care homes. Adult family homes are privately owned, licensed, and regulated by the State. Medicaid or private pay will pay for the care.
Adult day-care programs
Adult day-care programs give respite to family caregivers. These programs usually operate from Monday to Friday and supply a hot noon meal, recreational activities, and social interaction for elders with physical or mental impairments. A few day-care programs can accommodate an elder overnight if the family is in crisis.
Special support services
Your regional health board may also supply meals, senior centers, adult day-care programs, and palliative and respite care.
Meal programs such as Meals on Wheels, Congregate Meals, or Wheels to Meals are run by volunteers but usually have a paid staff overseer. In the Meals on Wheels or Wheels to Meals programs, the hot and nutritious meals are provided for people who cannot do their own cooking. The client can purchase frozen meals for weekends. The food is usually prepared in a facility or government-inspected catering establishment where meals are wrapped, and volunteers deliver them to homes. The cost of meals is on a sliding scale depending on the client’s income. Congregate Meals is a program where clients gather to eat in a common place. The food is prepared off-site, and is brought and served by volunteers.
Many senior centers have preventive and supportive health programs for elders, such as friendly visiting, free transportation, help with shopping, and help with legal questions, bill paying, or other financial matters.
Palliative care provides support for people who are dying. Usually, the elder will get an increase in the number of hours of care in the home so he or she may die at home. Respite care is provided to the family to relieve them of their responsibilities for a while so that they can continue with some of their day-to-day activities. Family members can book their elder into an intermediate care facility if they are going on holiday. Respite can also take place in the home, and workers will be provided on a 24-hour basis to take care of the client at home while the family has a break. The continuing care division of the health department usually pays respite care.
In the US, it depends on what medical insurance or Medicaid to which the person qualifies. Often respite care is private pay.
An Encounter with the Quick-Response Program
One morning, at age 82, Mrs. Martino was going to feed her fish in the half-barrel when she slipped on the icy patio. She managed to crawl to the phone and call 911. The ambulance arrived and took her to the nearest hospital emergency that had a quick-response program.
To reduce the use of expensive acute-care hospital beds, some hmos and regional health boards have introduced programs that supply home care to clients on a short-term basis. A social worker usually arranges through a contracted agency to provide homemakers on a short-term basis of one to five days. Depending on an individual’s situation and whether or not the health board has previously assessed him or her, the service may be free or based on the person’s income.
Mrs. Martino was assessed by a physician, who determined that the only care she needed was bed rest while the vertebrae she broke during her fall healed. The emergency ward social worker called her son and told him that his mother could be discharged home, and she would receive home care for 16 hours a day for three days.
Unfortunately, it took longer than three days for her broken vertebrae to heal, so Mrs. Martino and her son needed to look beyond the quick-response program for help. If she had had no family, and if no interim rehabilitative places existed in her community, the hospital would have admitted her for a few weeks until she was sufficiently mobile to look after herself with some home care. Keeping her in the acute care hospital would have been a waste of those resources, however, because she really had no need for 24-hour care from registered nurses.
Luckily, Mrs. Martino had the support of her family, and her son arranged for a homemaker to help her while she recovered.
Assistive devices
During her recovery, Mrs. Martino was in a lot of pain. Her physician changed the type of painkillers she was on and also suggested she use some assistive devices. An assistive (or adaptive) device is a piece of equipment that assists the user in the operation of self-care, work, or leisure activities. Eyeglasses can be considered an assistive device. If an assistive device is deemed medically necessary, some insurers will cover the cost. For example, Medicare will pay for some medical equipment as long as the equipment —
• can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• is generally not useful to a person in the absence of an illness or injury, and
• is appropriate for use in the home (e.g., wheelchairs, hospital beds, walkers).
Mrs. Martino purchased a tens (transcutaneous electro nerve stimulator) machine. This machine reduced the need for medication by using an electrical current to cut the nerve pathways for pain. With the pain under control, she could lie on her side for short periods and eat comfortably.
However, she could not raise her head to watch tv, nor could she hold a book. So, for entertainment, the library provided “talking books” that kept her occupied when visitors were not there.
As time passed, Mrs. Martino became troubled by her loss of sight. She could not play Scrabble anymore because she could not keep score. Her son bought her a large-tiled Scrabble board, but not being able to keep score or read the dictionary made playing too difficult. Her son also bought her a large tv, and she learned the remote control buttons by experimenting and just turned the volume up until she could hear. Bridge was becoming a problem, even with the large playing cards. Usually one of the four could see well enough to score, but even using the big cards were getting difficult.
Transportation
She was still driving her car but not during the evening, because she knew she could not see at night. She did not want to give up driving because it gave her so much independence. Actually, Mrs. Martino was a menace on the road. Many jurisdictions require people over the age of 65 or those with a medical condition to take a driver’s re-examination every couple of years. If you have trouble checking over your shoulder, or seeing at night or in poor weather, you may be putting yourself and others at risk.
It was past time for her to give up driving, but she had to make the decision herself. After an incident where she ended up driving on the sidewalk, she reluctantly stopped. It was one of the more difficult decisions for Mrs. Martino to make, and she was not used to spending money on taxis. However, over time she realized that there were some benefits to not driving. She could sit back and relax as a passenger, and she could save money by not having to maintain a car. Also, she learned that she could take her disabled parking permit with her to use for any vehicle in which she was a passenger.
Mrs. Martino was getting lonely and loathed cooking and eating by herself. Her son suggested that she contact her local health board and sign up for congregate meals. This would prevent her from being tied at home every day at noon to receive the volunteer and would also put her in contact with other people. Volunteers served the meals in an apartment common room a few blocks away from her apartment.
Because her blindness and chronic congestive heart failure prevented her from driving, Mrs. Martino qualified to use the local elder transportation service run by her health board. By making a phone call, she could book the minibus to pick her up and deliver her