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Question re: Home Health Care with home health aides versus assisted living

by Jenny
(Woodbridge, VA)

I'm hoping to get some advice from this forum. I'll start off by saying that I'm an ICU nurse.

My grandmother (76 yrs old) recently had a debilitating stroke that left her with hemiparesis (one-sided paralysis) and global aphasia (inability to comprehend/express language).

While she may have suffered some cognitive decline, she is very alert and attempts to be interactive. She was living independently in a rural area away from all family members. After the stroke, we moved her to Miami to be closer to my dad.

She is currently in a nursing home in Miami. This is essentially her "nightmare scenario" as she never wanted to be in a nursing home. She built up significant financial resources to avoid this.

While I don't think it's realistic for her to live in rural Pennsylvania again, I wonder if she would be happier in a condo/apartment with round-the-clock nursing aides?

How do I even go about this? Her nursing home is highly rated by Medicare but I'm not sure that their criteria means anything to a patient.

Thanks for your help!


I am assuming that you are asking what is the best living arrangement for your grandmother. You may consider assisted living instead of independent living with 24 hour care. It can be cost more effective and less worrisome,to a point.

Assisted living is a more home like environment promotes socialization and allows an individual to be as independent for as long as possible.

Because I am a nurse, I will make you aware that I believe that assisted living gives families a false sense of security.

Many times things are missed because the staff may not have regular contact with a resident.

Because the resident is independent, there are different levels of care. If you need to have someone give you medications, then you will pay for that service.
At the present time, many AL's have staff that are not certifed nursing assistents, just aides with little to no training.

The individual giving medications can be an individual that is just a med tech or aide.

I am making you aware of this, as it is very important that she be close to family and family stay involved in her care and progress.

She will have the ability to come and go as she pleases and have overnight company,as if she was in an independent living situation.

There are some AL facilities that will allow hospice to come in when a person begins to deteriorate and allow them to pass in their own home.

You can find some AL listings at www.ourparents.com.
Ask to see their state survey and stop in several times before making a decision.

Having her close to family is the key to successful placement and peace of mind. Please feel free to contact me if you have any further questions.

Your Life Care Advocate

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Question re: Home Health Care with home health aides versus assisted living

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thanks Diane
by: Anonymous

Thank you ,Diane,

That is just the sort of info I needed. I will share that with her children.
I think they will be relieved to see that she is still doing well at home and other than getting checked up on daily and of course more social visits from them, they shouldnt have to "do anything with her" for now.

Your advice is always great, thanks again!

Signs When it is Time need to Increase the Level of Care
by: Diane Carbo RN and Your Life Care Advocate


Here is a list of things that you may want to observe to identify that more help is needed.

1. There will be some difficulty with walking. May start to hold onto furniture or walls when ambulating.

2. Experiencing frequently falls or unsteadiness. You may see the presence of bruises.

3. Decline in personal hygiene or grooming.May start to wear stained clothes,have body odor, infrequently bathes or washes hair. May wear the same clothes day after day.

4 Experiences changes in eating habits. May only snack, have a decreased appetite, eat one meal a day, forget to eat,makes poor food choices,or has a refrigerator of expired food or no food in the refrigerator.

5. Starts having problems with incontinence.

6. The home environment is unsafe. Maybe it is unclean, has cluttered walkways or poor lighting. The home may need repairs. There are broken or missing smoke detectors, lack of security, may leave doors unlocked or the stove or oven on.

7. Experiences significant weight loss or gain.

8. Lives in chronic pain

9.Abuses alcohol or prescription drugs.

10. There are unpaid or past due bills.

11. Unopened piles of mail.

12. Becomes unable to manage their checkbook.

13. Difficulty dealing with money properly.

14. May be a victim of scams or financial abuse.

15. Experiences poor or decreased judgment.

16. Has difficulty coordinating or monitoring and being compliant with different medications.

17. May experience paranoia, forgetfulness or memory loss.

18. Gets lost and can?t find their way back home, in familiar surroundings.

19. Leaves stove on, unplugs the refrigerator.

20. Has difficulty recognizing friends or family members. May not remember them at all.

21. Forgets to take medications, or taking it improperly.

22. Becomes increasingly forgetful. Misses doctor's appointments, family events. May forget names of individuals or objects.Frequently looses things or places things in unusual places.

23. May start to be repetitive in questions or stories.

24.May become physically or verbally abusive.

25. May start to experience delusions or hallucinations. This may exhibit as a different perspective of objects or events that others don?t see or developing false beliefs.

26. May start to call adult children or friends repeatedly at inappropriate hours of day or night.


27. Social Isolation

28. Experiences mood changes such as anger, suspicion, paranoia,or agitation.

29. Becomes depressed or feels lonely. May exhibit this by crying, feelings of sadness or have lack of energy or feelings of hopelessness. May experience an increase or decrease in sleeping and/or appetite.

30 Exhibits a lack of interest in formerly enjoyable activities.may stop participating in social, church or volunteer activities.

These are just a few indicators that you may want to get help or increase help in the home.

As a care giver, when do you know when you will need to increase the level of care?
by: Anonymous

Hi Diane,
I am currently helping a neighbor by just checking in on her twice a day, am and pm. Her family was concerned that she might be getting too weak/feable etc. to be on her own all the time. She is healthy, had a non reoccuring health issue a little over a year ago, recovered from that but was left with anxiety. She started taking Ativan but then her family thought that she should get off of it as she was getting lethargic, and not wanting to continue doing out of the house activities. Now she is doing fairly well, she is taking less meds and will be off them hopefully soon. She does still get panic/anxiety attacks a couple of times a day.
I think she is anxious about her living siuation and who will care for her when she needs more care. I wonder do you have any guidlines, that would be good to give her family, to help them decide at what point she might need more help, like 24/7 in home or a AL apartment. Her family are all in a uproar about what to do with her when it comes to that time. I have told them, that I dont think she is ready for more care, she seems to do well alone and is not a fall risk at this time. I take her to curves 2x a week and visit am and pm 1/2 hr and she goes out with someone (family or friend) to do shopping a couple of times a week. She is able to fix her own food, and other ADL's. She keeps her home neet pays her bills and manages her money well. She ,reads and watches tv etc...

I guess my question really is, How can you judge when a person is needing more care?
Thank you Diane! Great web site. Nancy


This is a great question. There is no time like the present to start planning for future care needs. If your neighbor is suffering from anxiety or panic attacks, then it is important that she start to look into a companion or a home health aide for a few hours a week. That way she can start to develop relationships and trust with several individuals. This may also decrease her anxiety.

This is the perfect time for the aging senior and her family to sit down and put short term and long term goals into place.

Right now, she just needs someone to monitor her. Adult day care or the local senior center may offer her socialization.

It is very important for your neighbor to get important medical, legal and financial papers in order, as well.

Power of attorney for health and finances, as well as advanced directives should be done while she is able to make her wishes and needs known.

I do not know the financial situation of your neighbor, but, she may want to contact the local Department on Aging and see if she qualifies for any services.

the most important thing
by: Anonymous

No matter where your loved one is, nursing home, assisted living or at home. The most important thing will be to have one family member or friend visit them preferibly daily and at a minimum weekly. You might be able to catch neglect and other problems that the overly busy nursing and aides can catch. Question medications and their side effects. Be sure your loved on is treated with love and respect, show up at different hours of the day. Be there at shower time, dinner time, bed time.. what are the routines and can you help with any of these chores? Is the place clean and safe? Make sure all injuries are documented and precautions are taken to prevent them occuring in the future.
Bottom line, be there for them, I have seen too many seniors abandoned at nursing homes but also in their own homes. The most important thing is for the ones that love them to be active voices for them, help them get the care they deserve.

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