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How do we transition from institutionalized end of life care to a home care setting?

There is a way to create an Aging Foster Care system in the U.S..

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We are driven to work our entire lives to create a sense of security for ourselves, and our families, and in that life, not all of us are blessed enough to welcome death in our own homes, or with our own families by our sides.

The cost of living as we age is exacerbated by inundating health care costs and needs due to our body’s systems deteriorating whether it be our brain with dementia/alzheimer’s disease, diabetes, COPD, cancer, etc. In home support services not covered by Medicaid may range from $9.00-$30.00+ per hour, and is vastly paid as an out of pocket expense. IHHS is offered and the caregiver is paid through Medicaid, however not all who are aged 65+ are eligible to receive this benefit offered by the government. Medicare A covers inpatient services in a hospital, SNF, home health, hospice. Medicare B covers outpatient, preventative, doctors and additional health care specialists, with a limit, of course. Medicare D covers medications, and Medicare C is offered through private insurance companies, as equal to other additional “gap” coverage plans, which are mighty expensive, to which many of our budget’s cannot withhold.

According to the CDC, in 2014, there were 1.7 million licensed beds available in 15,400 nursing homes throughout the United States. Depending on insurance reimbursement, out of pocket expenses may range from $0.00 per day - $978.00 per day. Many people aged 65 and older end up in LTC facilities due to not having a family, or close support system willing or able to provide the necessary care for them to live out their final years comfortably and safe. There is a large percentage of people who live in LTC/SNF’s today, that would be able to maintain a healthy safe lifestyle for their final years in a home setting, if only funds or the support system were available.

I have worked in the healthcare setting, and with the elder population for 12+ years. I have seen the differences between, short term rehabilitation stays, long term stays, hospice, and home health. I have witnessed many people admitted to LTC solely due to the fact that their family is either nonexistent, the family is out of the area, or the family is unwilling, or just not ready to receive their family member in his/her home. Many of the people I have cared for and have observed over the years, are capable of completing tasks, and living a normally modified life at home with the support of others.

My grandmother suffered multiple TIAs, decreased strength, occasional confusion. She lived in a LTC facility until her passing as no family member knew how to care for her, or had the proper training to care for her in their homes. As a result, depression set in. She was confined to a crowded nursing home, with weekly activities, sub par meals, caregivers that are over-worked and underpaid, a physician who is way over his head in patient caseload, a room that barely fit two hospital beds, a roommate, two bedside tables, and two wheelchairs, which, when not occupied, littered the hallways, as the rooms were too crowded for the caregivers to actually provide care in a safe manner. The medication list grew. My once gleaming-eyed, rosy-cheeked grandmother had become a somber woman accustomed to mediocre care.

I have pondered for a long time, of how I can help to make the health care system, remarkedly for the elder population, more efficient, humane, and overall happy. I began to hypothesize, and question. How can I reduce the amount of psychotropic, pain management, antidepressant medications in this population? How can I help transition elder care from institutionalized to an in home setting?

I have begun a list of questions, thoughts, and ideas to research. All of which fall under my spark of an idea. How do I mimic the child foster care system that is already established in the US, and transition their structure to create a foster care system for the elderly?

Encouraging a system in the U.S. that is able to provide a home setting to elder individuals who are no longer safe or able to live in his/her home. Those who either do not have family, or who do, yet the family is not yet able to provide the necessary care required for reasons specific to each case.
The crazy idea is that there is a possibility to convince Medi-Care and insurance plans to pay for this care, for physicians to complete home visits, or for the foster families to provide transportation. There will be a set structure of guidelines that each applicant (foster family) must meet. There will be rules and regulations. Guidelines that each person must fall under to qualify for this program. I do think LTC facilities are a necessity to our health care system, however I think the population requiring the level of care provided by these facilities may be greatly reduced with the proper education, structure, and rules to create a foster system for the elderly.

This idea, is merely a zygote. It is so vast, and complex, and intimidating. I can barely wrap my mind around where this needs to go next, or what I need to think of; who do I need to speak to in order to make this me idea a "we". Am I crazy for thinking this could actually work?!

So, help me transform the end of life care for our elder population. Remove the fear of individuals being forced into welcoming death in LTCs/SNFs, and let us create an Aging Foster Care system. 

What is a provocation or insight that might inspire others during this challenge?

If you or your family members are unable to provide the necessary care for your elders, then feel grateful in knowing that there may be a way to give them the comfort of living in a home setting, with individual care, homecooked meals, with a better sense of autonomy and dignity than a LTC or SNF can provide. Feel grateful in knowing this is a generous possibility for those who have no family.

Tell us about your work experience:

I have been working with the geriatric population for 12 years.

If you participated in an End of Life Storytelling Event, tell us which Chapter or city you came from:

Eureka, CA

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