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HOMECARE A VIABLE ALTERNATIVE -
AND INCREASINGLY THE FIRST CHOICE
Sarah, who had married young and raised her family during the Depression,
was furious when her husband died and left her alone. She insisted that
she did not need any help, but a kind and compassionate live-in health
aide and the gentle encouragement of a sensitive case manager, brought
Sarah the help she truly did need, along with relationships that helped
to fill her home, and her heart, once again. When illness left her bed-bound,
Emma, who had never married nor had any other close relationships, needed
help for the first time in her life. In the home health aide who cared
for her, Emma found, in the final days of her life, the tenderness and
friendship she had never experienced. John, a retired attorney, was
lost when his wife died, leaving him to cope for the first time with
household chores he had never had to master. The part-time home health
aide who came daily to John's home tidied up, shopped, and prepared
his evening meal and his lunch for the following day. But she also spent
time with him, laughed at his jokes, exchanged family stories, and listened
as he talked about the wife he missed so much. She gave John companionship
as well as homemaking services, and she gave John's adult children,
who lived out of state, the assurance that there was someone keeping
a caring eye on their dad, who could help him and could tell them if
he needed help. This communication gave John's children the reassurance
they needed. These three individuals illustrate the range of challenges
all of us will face, either as elders, growing older ourselves, or as
children of parents for whom we must care as they age. In recent years,
a booming economy has made assisted living facilities, planned communities,
and other institutional or quasi-institutional arrangements the first
choice -or the presumed first choice - for elders who can no longer
live independently. But cost already puts this option beyond reach for
most middle-class families and a cooling economy will foreclose the
choice for many others. The aging baby boom generation, meanwhile, will
soon outstrip the already limited supply of institutional choices even
for those who can afford them. Cost and supply aren't the only issues,
or even the primary ones. For if the adult sons and daughters listen
-really listen - to their parents, they will hear that, given the option,
most elders want to remain in their homes. Sarah, Emma, and John received
a level of personalized attention and care that few institutional settings
could have duplicated. They received as much assistance as they needed
while continuing to live as independently as they could, in the communities
with which they were familiar and in the homes in which they felt comfortable
and secure. Flexibility, freedom, and dignity are the essential hallmarks
of home care. Home care gives elders and their families the flexibility
to: · Design a plan that provides as much or as little help as the individual
needs · Adjust the plan as those needs change · Add ancillary services
- physical therapy, yoga, weight training, art lessons or astrology
- all offered in the client's home at the client's convenience. Home
care gives elders the freedom to: · Remain in their homes and in their
communities · Keep their pets · Maintain long-standing relationships
- with friends, hairdressers, corner grocers, etc. · Play opera (or
reggae music or rock) at full blast · Wear their purple bunny slippers,
their favorite hat - or nothing at all · Eat what they want when they
want · Live as independently as they choose for as long as they are
able. Home care allows elders to hold on to a sense of self and a measure
of dignity that can be diminished or lost in an institutional setting.
An institution can provide high quality, comprehensive care, but in
a public setting that many elders may find uncomfortable, or certainly
less comfortable, than the privacy of their own homes. Privacy can ease
the humiliation many elders feel when coping with incontinence, paralysis
(from a stroke), or other age-related infirmities. Elders may respond
to the high technology of an institution, but they are more likely to
thrive given the one-on-one relationships and caring touch home health
aides can provide. In recent years, policy-makers have assumed that
institutional settings were more cost-effective than community-based
alternatives, and government funding has reflected that assumption.
But this pendulum will swing once again. As health care costs continue
to spiral upward and as the population of baby boomers explodes into
late middle age and beyond, government will discover that home care
is not only more humane but also more cost-effective than institutional
alternatives. Equally important, baby boomers, who have been vocal about
every other aspect of their lives, will be no less vocal about the aging
process. And the message from this generation will be clear: Their parents
want to age at home - and so do they. Karen Gould, MSW, MPA President,
Golden Care, Inc.
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