Survey: Too little thought given to senior care

This makes discharge planning harder

When discharge planners identify potential options for hospitalized, frail seniors who are stable but no longer can fully care for themselves at home, they face a huge obstacle in the emotions and family conflicts that come into play at discharge.

Families might not have considered that their mother's fall and resulting broken hip would mean that she cannot return to her formerly independent lifestyle. Or they might have thought that Medicare home health services would be provided, only to learn that the patient does not qualify for these.

The problem is that Americans give too little individual thought and planning for senior care, a new survey finds.

"About 73% of adult children have not done any planning for senior care," says Paul Hogan, co-founder and chief executive officer of Home Instead Senior Care of Omaha, NE. The senior care company, which has more than 550 offices in the United States and now is in 15 countries, sponsored a survey on how well families are planning for senior care.

Hogan also is a co-author of Stages of Senior Care: Your Step-by-Step Guide to Making the Best Decisions, a book published in late 2009 by McGraw Hill.

"Over 70% of seniors and adult children still think Medicare or Medicaid or their parent's pension will be enough to cover the cost of senior care," Hogan says. "We know that Social Security and Medicare will not cover it, and pension and savings are pretty bleak, too."

About 41% of seniors live on less than $12,000 a year in income, he adds.

"So, there are some dangerous misconceptions out there about who is going to be paying for their senior care and how much it costs," Hogan says.

The lack of funds for private-paid home and health services compounds the discharge problem, limiting options.

Discharge planners could improve the transition to home or another provider if they focused on starting the discharge process earlier, got the family involved sooner, and helped patients and families discover all of their options, Hogan suggests.

"One thing that's evolved over the past 10 to 15 years is that the number of options for senior care have grown, but the vast majority of seniors and families don't know what these are," Hogan says.

The Home Instead Senior Care survey also found that 71% of adult children could name only two non-family care options, and 66% of seniors also could name only two options. And the two options they most often cited were skilled nursing homes and assisted-living centers.

Some of the options that are overlooked include a family's personal resources, including neighbors, friends, a church outreach ministry, and Meals on Wheels. These are free resources that can provide visits to a senior, transportation, and assistance with meals.

There also are senior centers, adult day care centers, retirement communities, hospice care, and centers that specialize in care of dementia and Alzheimer's disease patients, Hogan says.

"One of the things that struck me about our survey is that when asked to name their options, people defaulted to saying, 'nursing home,' overlooking a lot of resources at their disposal," he adds. "This results in a lot of fear and anxiety."

For instance, perhaps a senior has watched over a neighbor's dog for years. So, now when the senior needs help getting to the grocery store, wouldn't the neighbor be willing to help? he says.

These are the kinds of things that discharge planners could ask patients about and have families look into, particularly when they are anxious about what will happen to their parent when they return home from the hospital with no in-home medical care.

Hospital discharge planners who wait until their elderly patients are about to leave the hospital to discuss their transition options probably will see readmission rates rise as the patient returns home only to have further problems requiring a rehospitalization.

"Hospitals need to do more to identify the next provider for patients before they're discharged," Hogan says.

One option is for discharge planners to use an Internet search to find low-cost options and services available in the patient's home town, he suggests.

Social workers can tap into this resource, as well, when they have patients who have limited social support and little funding for in-home assistance.

Plan in advance

Discharge planners should encourage families to think about what provider they'll want to use before the patient leaves the hospital, Hogan says.

"Talk about it in advance, so it doesn't come down to the last hour, or when the daughter is driving mom home and hasn't given this much thought," he says.

Hogan's company provides in-home assistance for seniors worldwide, including companionship, light housekeeping, medication reminders, errand assistance, and personal care. There is no medical care, and it's all paid through private funding.

"Hospital discharge planners call us quite often, and it's usually at 11 a.m., and they say, 'Mrs. Johnson is going to get out of the hospital today, and we need help,'" Hogan says.

Based on Hogan's experience, the four chief things patients need when they're discharged from the hospital are as follows:

• good nutrition and assistance with meals;

• assistance with taking medications on time;

• a good night's sleep;

• and reminders and transportation to make their medical appointments.

"If those four things do not exist, the likelihood of their being readmitted in 30 to 60 days is very high," Hogan says.


For more information, contact:

• Paul Hogan, Co-Founder, Chief Executive Officer, Home Instead Senior Care, 13323 California St., Omaha, NE. Telephone: (402) 498-4466. Email: Web site: