When you want to bring Mom or Dad home to live with you: What you need to know.

Millions of adult children each year are faced with having to choose whether to care for a parent at home or send them to a facility for care. Whether you are an only child or have siblings, the solution is never an easy one. Being educated before that time comes can make that decision easier during a time of crisis.

The first thing you need to know is your parent’s ability to care for themselves at home alone. Here are some questions you need to answer right away:

1. Can they safely get in and out of the house alone?
2. If there are stairs, can they safely negotiate alone or do they need help?
3. Can they walk to the bathroom alone safely and clean themselves?
4. Can they change their clothes safely by themselves?
5. Can they safely drive a car?
6. Are they alert and oriented all the time?
7. Can they prepare their own meals? If they cannot, can they reheat or prepare simple microwave meals or sandwiches?
8. Can they feed themselves?

If you answered “no” to one or more of these questions, then your parent will need some sort of assistance after their facility discharge. You may have always promised Mom or Dad that you would never put them in a nursing home, but are you ready for the financial, time, and emotional investment associated with caring for a parent at home?

According to a 2011 market survey completed by Met Life, financial costs are listed below.

	Nursing Homes		Assisted Living Communities	Home Health Care		Adult Day Care
	Semi-Private Room	Private Room		Home Health Aide	Homemaker
Rate Type	Daily		Monthly	Hourly		Daily
2011 Average Rate	$214	$249	$3,477	$21	$19	$79
2010 Average Rate	$205	$229	$3,293	$21	$19	$67
$/% increase from 2010	$9 (4.4%)	$10 (4.4%)	$184 (5.6%)	$0	$0	$3 (4.5%)
2011 Median Rate	$199	$224	$3,243	$20	$19	$65
2011 Annual Rate	$78,110	$87,235	$41,724	$21,840	$19,760	$18,200
The 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and
Home Care Costs October 2011

If you choose to bring your parent home, be prepared to need some training to learn how to safely assist them. Toileting, diapering, cleaning, and dressing an adult are much different than a child. Home health nurses and therapists under the Medicare benefit can educate you. Just do not expect that Medicare will pay to have a nurse, therapist, or aide in your home around the clock or even daily. Most home health plans of care call for one to three times a week visits for four to nine weeks. Depending on your parent’s status, home health may be able to stay in longer to assist with complicated care plans that may include wound care or urinary catheter changes. Just do not expect to have a nurse or an aide providing custodial or maintenance care as Medicare does pay for those services.

If your parent qualifies for Medicaid, they may also be eligible for extended home health aide services for custodial purposes. A Medicaid certified home health agency can submit a pre-authorization, otherwise known as a PA, for a specific number of hours. Be prepared to submit work schedules on company letterhead for any adults that live in the home or if you do not work outside the home, you will need a physician’s letter stating the reason why you cannot care for your parent twenty four hours a day seven days a week. You also need to be prepared for the Medicaid office to take two to four weeks to make a decision on approval. They may approve all hours submitted, some hours submitted, or they may deny the request.

If you need continued custodial assistance because mom or dad cannot stay safely at home alone and your parent does not qualify for Medicaid, you will need to pay privately. That means digging into your or your parent’s bank account. There are many private duty agencies providing this type of care. In Indiana they must now be licensed by the state. Get referrals from friends, neighbors or your physician. Make sure the agency is bonded and all the aides have had background checks. Aides are trained to keep patients clean and dry if incontinent, prepare and assist with meals, and perform light housekeeping (don’t expect them to wash your walls, floors, or do your laundry).

Remember, when you bring your parent home no matter whether you care for them alone or you have home health assisting, you are the primary caregiver and you are responsible for their safety and wellbeing. If something happens that the agency cannot staff hours because of an emergency, you will be required to care for mom or dad. That means an occasional day of missed work or an interruption in your day.

Caring for a parent at home can be very stressful.  There are support groups out there and good books to read. Most importantly, if you are not emotionally prepared to care for your parent at home, don’t do it. Stress can build up to a level that it may cause harm to you, your immediate family, and your frail parent. If you can’t handle it, get help. Most of all, if the new lifestyle is too emotionally stressful for you and/or your parent, it’s time to start thinking about finding a quality long term care facility.

Kim Krull is a Registered Nurse and the Director of Nursing for Allpoints Home Health Care located in Highland, Indiana. She has been a registered nurse for 25 years and has worked in the home care industry for over ten years.