By Alicia M. Colombo
“A caregiver assessment is administered to identify stressors, then an individualized action plan is created," Issenberg said. "This can include working on relaxation, developing communication techniques with family members, mobilizing social support networks, dealing with feelings of guilt and frustration, and accessing resources. It’s not psycho-therapy, or long-term counseling, but rather a collaborative effort to help the caregiver healthily adapt.”
Six counseling sessions are provided for the caregiver alone or in conjunction with family members and/or the care recipient. In addition, CARES also hosts support groups for caregivers of older adults that are free and open to the public. These take place at Northeast Regional Library, Cottman & Bustleton Aves., on the first Thursday of the month at 10:30 to noon; and at West Philadelphia Senior Community Center, 41st & Poplar Sts., on Wednesdays (except last in month) at 10:30 to 11:30 a.m. Alternate sites and times can be arranged by request.
Even if your income is above the guideline, Issenberg said she can connect you with resources. “I encourage all informal caregivers of older adults to call us for assistance. We keep an active, updated list of referral programs and caregiver resources,” she said. For information about CARES, call 215-426-8610, ext. 1207 or e-mail firstname.lastname@example.org.
Family Caregiver Support Program
Philadelphia Corporation for Aging’s (PCA) Family Caregiver Support Program (FCSP) provides caregivers who qualify with financial support, as well as education, training and resources. Caregivers may receive $200 to $500 a month in reimbursement for caregiving services and supplies, and may also receive up to $2,000 in housing modifications or assistive devices, such as stair glides and tub grab bars, to make caring for the loved one at home easier. The monthly reimbursement funds are most commonly used for “respite” care, where an in-home care aide comes in for a few hours to give the caregiver a needed break, and for personal or medical supplies. The caregiver may select a respite worker from personal contacts or a home care agency, but the worker cannot be the caregiver or a relative of the care recipient.
“Our goal is to reduce caregiver stress and provide support to maintain the caregiver-care recipient relationship,” said Cheryl Clark, FCSP director at PCA.
To be eligible, the caregiver must provide hands-on care and have primary responsibility for the physical and emotional well-being of the care recipient. The care recipient must be age 60-plus, or 19-plus with a diagnosis of dementia or a severe disability, and require assistance with an ADL. Information and benefits counseling is available to eligible caregivers, regardless of income. To receive reimbursement for services or supplies, the household income limit for FCSP is $44,347 for one person or $59,775 for two people.
“In a perfect world, older adults would be cared for by their children or closest relative. But children might live far away, or they might not be willing or able to provide care full-time,” said Clark, who added that caregivers do not have to be a relative as the program’s name suggests. Friends, neighbors or church members can be, and often are, caregivers.
FCSP currently has no waiting list, so applications and referrals are encouraged. For more information about FCSP and other caregiving programs, such as those assisting grandparents who are raising their grandchildren, call the PCA Helpline at 215-765-9040.
Temple Time Out
Caregivers for an elder with cognitive and/or physical challenges can benefit from Time Out, a program of Temple University’s Intergenerational Center. College students are trained to be respite care providers and act as companions for these older adults, providing socialization and stimulation; assistance with light meal preparation, laundry or changing bed linens; accompaniment on public transit for grocery shopping and other errands; and medical escorts. The program does not assist with personal care, medication administration or therapies.
“We are able to visit people who live in Philadelphia or the nearby suburbs. Our main goal is to provide the caregiver some ‘time out’ – a chance to take a deep breath,” said Mady Prowler, MSW, program manager of the Time Out Respite Program.
Time Out is unique because it serves multiple purposes – reducing isolation and promoting independence for the elder; lightening the caregiver’s load; and providing real-life experience for students interested in the helping professions, particularly those thinking about working with older adults.
“Ageism still exists, and we’re trying to change young people’s perceptions of an older person and what they can do,” said Prowler. “Students cater to the specific needs and tastes of the care recipient. They discuss shared interests, build a strong bond, and learn to respect the person they’re caring for. For elders who don’t have grandchildren to spend time with or children who live far away, it’s a very special gift.”
Student respite workers receive rigorous pre-service training and ongoing support related to aging and the needs of caregivers. Students are carefully screened through references and a criminal background check. “Time Out is very well-established with a 28-year history in Philadelphia. It’s a reputable, respected and needed program. We work with the students throughout their respite home care experience to help them develop the best approach for their particular individual or family,” said Prowler
The cost to receive services through Time Out is $8 an hour, plus a $25 annual registration fee. A limited number of no-cost student respite workers may be available through their college’s work study program.
For information or to apply, call 215-204-6540, e-mail email@example.com or go to www.timeoutprogram.org.
Jefferson Elder Care
Caring for an older adult with dementia poses special challenges and stressors. According to the Alzheimer’s Association, nearly 15 million adults in the United States are caring for someone with dementia. Through Jefferson Elder Care, caregivers of someone with memory loss, Alzheimer’s disease or a condition that causes dementia, such as Parkinson’s disease, can receive occupational therapy (OT).
Unlike the other programs mentioned, the caregiver can be paid or informal.
“It’s so important for the person with dementia to have an educated caregiver. Caregivers are often not provided with training and education to meet needs of a person with dementia,” said Catherine Verrier Piersol, PhD, OTR/L, clinical director of Jefferson Elder Care. “We’ll work with any caregiver in the home. Sometimes, we’re helping the family caregiver by empowering them to teach skills to paid workers.”
When a person with dementia has trouble starting activities, such as getting dressed or taking a shower, occupational therapists teach caregivers to simplify what they say or use different types of cues to enhance participation. “We help the caregiver to ensure safety during daily activities and promote the person’s maximum level of capacity. This in-home OT service is meant to help give caregivers the skills to do their job better; caregivers are typically involved in the sessions, so it is not considered a respite program,” said Piersol.
This home-based clinical service is available to everyone with Medicare Part B, which covers outpatient services. Under standard Medicare Part B, there is a 20% co-pay for OT services, but most patients have a supplement that covers that. “The beauty of the program is that Medicare Part B provides reimbursement to enhance the skills of caregivers. It’s been our experience that most people are not taking advantage of this OT benefit. Each Medicare beneficiary can receive $1,920 of OT services per calendar year,” said Piersol.
Through a grant from The PEW Fund, Jefferson Elder Care is able to serve low-income elders and their caregivers who do not have Medicare Part B. To be eligible for no-cost services, the elder must meet Medicaid income guidelines of $2,400 a month for a single person or $3,400 a month for a married couple.
For more information, call 215-503-6791, e-mail firstname.lastname@example.org, or go to www.jefferson.edu/elder_care.
Older adult daily living services
For elders who need extended supervision or assistance while a caregiver is out during the day, adult day centers may be a viable option. Adult day centers are non-residential facilities that provide a safe environment for elders who cannot remain at home alone. Licensed by the Pennsylvania Department of Aging (PDA), these facilities provide a planned program of activities that promotes well-being and social interaction.
Adult day centers typically provide personal care, recreational activities, counseling and social services, medical support and monitoring, and transportation to/from the center. Some facilities may also offer dementia care and specialized health care services.
Adult day services can be provided in half- or full-day time increments, which offers caregivers flexibility.
“Adult day centers provide a dual benefit. The caregiver receives an extended break, while the care recipient receives stimulation and socialization through activities with others. It can be especially beneficially for people with dementia, by providing a structured routine,” said PCA’s Clark.
At an average cost of $75 a day, enhanced adult day centers licensed by PDA are a good alternative for extended daily care assistance. However, they are more expensive than an in-home care aide. Medicare and standard health care insurance do not cover adult day services, but some programs, such as Aging Waiver or Options, Veterans Administration or long-term care insurance may assist with the cost. For a list of adult day services in Philadelphia, call the PCA Helpline at 215-765-9040 or visit www.pcaCares.org; or www.portal.state.pa.us (type “Philadelphia Adult Day” in the search box).
Living Independently for Elders (LIFE) Programs
The LIFE program offers participants a comprehensive array of medical services, adult day services, meals, transportation and personal care, all provided and coordinated from a single location. The program is known in Pennsylvania as “LIFE” and nationally as the Program of All-Inclusive Care for the Elderly (PACE). It is designed to enable the elderly to live as independently as possible, in the community.
To be eligible, an individual must be 55 years of age or older and eligible for Medicare and/or Medicaid; require nursing facility level of care services; and live in one of the LIFE programs' service delivery areas. Participants must meet the financial requirements as determined by the Department of Public Welfare, or be able to privately pay.
There are currently three LIFE Programs in Philadelphia, which serve designated geographic areas. Following are the centers and service areas:
University of Pennsylvania School of Nursing LIFE Program
Areas served: zip codes 19103, 04, 21, 30, 31, 39, 42, 43, 51, 53
Mercy LIFE Program
Areas served: zip codes 19106, 07, 22, 23, 25, 33, 34, 37, 40, 45-48; and Delaware County
NewCourtland LIFE Program
Areas served: zip codes 19100-11, 14-16, 18-20, 24, 26-29, 32, 35, 36, 38, 41, 44, 49, 50, 52, 54