Bullock’s Nursing Bullock’s Nursing ServiceService

Home Healthcare and skilled Home Healthcare and skilled nursing since 1978nursing since 1978

Welcome to the Sandwich Welcome to the Sandwich GenerationGeneration

More than 65 million Americans More than 65 million Americans provide care to a disabled or aged provide care to a disabled or aged friend or family member.friend or family member.

The cast majority of caregivers – The cast majority of caregivers – nearly 90% - are family members.nearly 90% - are family members.

30% of caregivers care for more than 30% of caregivers care for more than one person.one person.

The average duration of caregiving is The average duration of caregiving is more than 4 years.more than 4 years.

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The Sandwich GenerationThe Sandwich Generation The proportion of adult children providing personal care The proportion of adult children providing personal care

and/or financial assistance to a parent has and/or financial assistance to a parent has more than more than tripled over the past 15 yearstripled over the past 15 years. .

The total estimated aggregate lost wages, pension, and The total estimated aggregate lost wages, pension, and Social Security benefits of these caregivers of parents is Social Security benefits of these caregivers of parents is nearly nearly $3 trillion$3 trillion..

For women the total individual amount of lost wages due to For women the total individual amount of lost wages due to leaving the labor force early and/or reduced hours of work leaving the labor force early and/or reduced hours of work because of caregiving responsibilities equals $142,693. The because of caregiving responsibilities equals $142,693. The estimated impact of caregiving on lost Social Security estimated impact of caregiving on lost Social Security benefits is $131,351. A very conservative estimated impact benefits is $131,351. A very conservative estimated impact on pensions is approximately $50,000. on pensions is approximately $50,000. Thus, in total, the Thus, in total, the cost impact of caregiving on the individual female caregiver cost impact of caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals in terms of lost wages and Social Security benefits equals $324,044.$324,044.

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Facts and StatisticsFacts and Statistics

According to AARP, the value of According to AARP, the value of unpaid hours for all family caregivers unpaid hours for all family caregivers is $375B annually.is $375B annually.

23M households are currently 23M households are currently providing eldercare for aging family providing eldercare for aging family members. members.

37% of caregivers had to reduce their 37% of caregivers had to reduce their work hours or quit their jobs to handle work hours or quit their jobs to handle their care responsibilities.their care responsibilities.

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5 Considerations for in-home 5 Considerations for in-home carecare

1.1. Independence. In-home care allows your loved one to stay in their home and to remain Independence. In-home care allows your loved one to stay in their home and to remain as independent as possible.as independent as possible.

2.2. Family involvement in care. Those who are cared for at home have the advantage of Family involvement in care. Those who are cared for at home have the advantage of open visiting hours. Family members can help out as necessary without concerns open visiting hours. Family members can help out as necessary without concerns about intruding in the care of others.about intruding in the care of others.

3.3. Continuity of care. Because your loved one is able to stay at home, they can continue Continuity of care. Because your loved one is able to stay at home, they can continue to see the same doctor, so the continuity of their care remains intact.to see the same doctor, so the continuity of their care remains intact.

4.4. A personal environment. Of course, moving to an assisted living facility or nursing A personal environment. Of course, moving to an assisted living facility or nursing home can be quite difficult for an elder. In-home care keeps your loved one in an home can be quite difficult for an elder. In-home care keeps your loved one in an environment they know and trust.environment they know and trust.

5.5. Lower costs. Traditionally, in-home care costs are lower than those found in assisted Lower costs. Traditionally, in-home care costs are lower than those found in assisted living facilities or nursing homes. You and your elder get to select the hours of service, living facilities or nursing homes. You and your elder get to select the hours of service, only using it when your loved one needs the help the most.only using it when your loved one needs the help the most.

Take time to research the various options for elder care, so Take time to research the various options for elder care, so when you do make the decision, you'll know the choice was when you do make the decision, you'll know the choice was the right one. the right one.

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4 Reasons to choose in-home 4 Reasons to choose in-home carecare

Home care promotes freedom. Individuals receiving home care Home care promotes freedom. Individuals receiving home care can engage in their traditional day-to-day activities as their can engage in their traditional day-to-day activities as their health dictates, while getting the care and support they need. health dictates, while getting the care and support they need.

Home care provides for control. Home care allows your loved Home care provides for control. Home care allows your loved one to remain a participant in their own care. one to remain a participant in their own care.

Home care is flexible and personalized. Home care can be Home care is flexible and personalized. Home care can be tailored to the needs of each individual. You and your loved tailored to the needs of each individual. You and your loved one can dictate the type of care needed and when that care one can dictate the type of care needed and when that care should be provided. should be provided.

Home care relieves the caregiving burden. In-home care Home care relieves the caregiving burden. In-home care services reduce the day-to-day caregiving responsibilities. services reduce the day-to-day caregiving responsibilities. Instead of being heaped upon a single family member, those Instead of being heaped upon a single family member, those duties can be shared as needed with a professional caregiver.duties can be shared as needed with a professional caregiver.

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4 Considerations for assisted 4 Considerations for assisted livingliving

1.1. Facility size - Facility size - Would your elder prefer to live in a large complex with Would your elder prefer to live in a large complex with amenities such as a gym? Or, would they like to live in a smaller amenities such as a gym? Or, would they like to live in a smaller residential home with only a few other elders?residential home with only a few other elders?

2.2. Social activities. Does the assisted living facility offer recreational Social activities. Does the assisted living facility offer recreational activities?activities?Menu - What type of food does the assisted living facility provide? If your Menu - What type of food does the assisted living facility provide? If your loved one has special dietary needs, can the facility meet those needs?loved one has special dietary needs, can the facility meet those needs?

3.3. Transportation - Does the facility provide transportation services for its Transportation - Does the facility provide transportation services for its residents?residents?

4.4. Cost - What is the base monthly fee for living at the facility? Are there Cost - What is the base monthly fee for living at the facility? Are there other costs for additional services or amenities?other costs for additional services or amenities?

To find the right fit for your loved one, tour the different facilities To find the right fit for your loved one, tour the different facilities you're interested in (with your loved one, if possible). Put together a you're interested in (with your loved one, if possible). Put together a checklist of questions to ask and find out if the facility offers the staff, checklist of questions to ask and find out if the facility offers the staff, environment, cost, and amenities that can help your loved one environment, cost, and amenities that can help your loved one transition to their new phase of life. transition to their new phase of life.

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Questions to ask before Questions to ask before becoming your parent’s becoming your parent’s

caregivercaregiver What are the personal sacrifices I will have to make in order to properly look What are the personal sacrifices I will have to make in order to properly look after my parent?after my parent?

What are the sacrifices my spouse and children will have to make in order for What are the sacrifices my spouse and children will have to make in order for me to look after my parent?me to look after my parent?

Will there be financial burden?Will there be financial burden? Will my employer notice and object to my devoting time each day to my Will my employer notice and object to my devoting time each day to my

parent’s welfare?parent’s welfare? Will too much time away from work cost me my job?Will too much time away from work cost me my job? How much do I know about care giving?How much do I know about care giving? Do I have the time to do this properly?Do I have the time to do this properly? Will I be able to do enough, or will I always feel professional caregivers would Will I be able to do enough, or will I always feel professional caregivers would

have done a better job?have done a better job? Will I be offended or become resentful if my care giving efforts are taken for Will I be offended or become resentful if my care giving efforts are taken for

granted?granted? Is there any way in which my being my parent’s caregiver could damage my Is there any way in which my being my parent’s caregiver could damage my

relationship with that person?relationship with that person? Will my spouse and/or children object to my devoting time each day to my Will my spouse and/or children object to my devoting time each day to my

parent’s welfare?parent’s welfare? Will my parent accept me as their homemaker/caregiver? Is this what they Will my parent accept me as their homemaker/caregiver? Is this what they

want?want? Can I integrate some professional care along with my own services to allow Can I integrate some professional care along with my own services to allow

myself a break now and again?myself a break now and again?

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Long-term care costsLong-term care costsServiceService MonthlyMonthly AnnuallyAnnually

24 x 7 Home Care24 x 7 Home Care $18,720$18,720 $224,640$224,640

12 x 7 Home Care12 x 7 Home Care $9,360$9,360 $112,320$112,320

8 x 7 Home Care8 x 7 Home Care $6,420$6,420 $74,880$74,880

Assisted LivingAssisted Living $4,645$4,645 $55,740$55,740

Nursing Home/RehabNursing Home/Rehab $10,500$10,500 $126,000$126,000

Adult Day Care (8 x 5)Adult Day Care (8 x 5) $2,200$2,200 $26,400$26,400

Home care costs assume a nurse’s aide at $26 per hour. Adult day care assumes $100 per day including meals. Assisted living and nursing home costs taken from averages of the MetLife Market Survey of Long Term Care Costs.

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Long Term Care Costs - MALong Term Care Costs - MA

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Long Term Care Costs - RILong Term Care Costs - RI

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Helpful ResourcesHelpful Resources MetLife Mature Market Institute MetLife Mature Market Institute metlife.com/mmi/ AARP AARP aarp.org/home-family/caregiving/ Genworth Genworth caregiving.genworth.comcaregiving.genworth.com Your local Council on Aging (MA) or DEA (RI) Your local Council on Aging (MA) or DEA (RI)

http://www.eldercare.gov/ National Family Caregivers AssociationNational Family Caregivers Association Family Caregiver Alliance Family Caregiver Alliance caregiver.orgcaregiver.org Mindingyourelders.comMindingyourelders.com http://www.caremanager.org/http://www.caremanager.org/ Agingcare.comAgingcare.com Caring.comCaring.com Ourparents.comOurparents.com Children of Aging Parents (CAPS)Children of Aging Parents (CAPS) National Institute on AgingNational Institute on Aging National Aging in Place CoalitionNational Aging in Place Coalition 1212

The Sandwich GenerationThe Sandwich Generation

The "Sandwich Generation" is dealing with The "Sandwich Generation" is dealing with one of the most elaborate juggling acts – one of the most elaborate juggling acts – caring for an elderly parent, parenting their caring for an elderly parent, parenting their own children while working a full time job. own children while working a full time job. Nearly 66 million Americans are care givers Nearly 66 million Americans are care givers and the average care giver is 49 year old and the average care giver is 49 year old woman who not only holds down a job but woman who not only holds down a job but also spends about 19 hours a week also spends about 19 hours a week providing care to a loved one.  providing care to a loved one. 

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Sandwich Generation StatsSandwich Generation Stats 89% percent of all women over age 18 will be caregivers to children, parents or 89% percent of all women over age 18 will be caregivers to children, parents or Most women will spend 17 years caring for children and 18 years helping an elderly Most women will spend 17 years caring for children and 18 years helping an elderly

parent. parent. 44% of Americans between the ages of 45 and 55 have aging parents or in-laws as 44% of Americans between the ages of 45 and 55 have aging parents or in-laws as

well as children under 21. well as children under 21. The Sandwich Generation phenomenon.The Sandwich Generation phenomenon. 59%-75% of family or informal caregivers are women. 59%-75% of family or informal caregivers are women. The average caregiver is age 46, female, married and working outside the home The average caregiver is age 46, female, married and working outside the home

earning an annual income of $35,000 per year. earning an annual income of $35,000 per year. Nearly half of all baby boomers aged 45-55 have children still living at home and Nearly half of all baby boomers aged 45-55 have children still living at home and

elder care responsibilities. elder care responsibilities. 64% of caregivers are employed full-time or part-time. 64% of caregivers are employed full-time or part-time. More than 14 million US workers care for aging family members. More than 14 million US workers care for aging family members. Fastest growing population group is older Americans. Fastest growing population group is older Americans. Most rapid population growth is among people 85+ with the majority being females. Most rapid population growth is among people 85+ with the majority being females. An estimated 7 to 10 million adult children are caring for their parents from a long An estimated 7 to 10 million adult children are caring for their parents from a long

distance. distance. Nearly two-thirds of Americans under age 60 think they will have elder care Nearly two-thirds of Americans under age 60 think they will have elder care

responsibilities in the next ten years. responsibilities in the next ten years.

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Caregiver ProfilesCaregiver Profiles 44% of Americans between the ages of 45 and 55 have aging 44% of Americans between the ages of 45 and 55 have aging

parents or in-laws as well as children under 21. parents or in-laws as well as children under 21. 59%-75% of family or informal caregivers are women. 59%-75% of family or informal caregivers are women. The average caregiver is age 46, female, married and working The average caregiver is age 46, female, married and working

outside the home earning an annual income of $35,000 per year. outside the home earning an annual income of $35,000 per year. Nearly half of all baby boomers aged 45-55 have children still Nearly half of all baby boomers aged 45-55 have children still

living at home living at home andand elder care responsibilities. elder care responsibilities. 64% of caregivers are employed full-time or part-time. 64% of caregivers are employed full-time or part-time. More than 14 million US workers care for aging family members. More than 14 million US workers care for aging family members. Fastest growing population group is older Americans. Fastest growing population group is older Americans. Most rapid population growth is among people 85+ with the Most rapid population growth is among people 85+ with the

majority being females. majority being females. An estimated 7 to 10 million adult children are caring for their An estimated 7 to 10 million adult children are caring for their

parents from a long distance. parents from a long distance. Nearly two-thirds of Americans under age 60 think they will have Nearly two-thirds of Americans under age 60 think they will have

elder care responsibilities in the next ten years.elder care responsibilities in the next ten years.1515

Caregiving Trends of the Caregiving Trends of the FutureFuture

Continued increase in prevalence of Continued increase in prevalence of caregiving for American families caregiving for American families

Increasing numbers of working Increasing numbers of working caregivers caregivers

Increase in male caregivers Increase in male caregivers Increase in long-distance caregivers Increase in long-distance caregivers

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Time and MoneyTime and Money

Time: Average length of time spent on Time: Average length of time spent on caregiving was about eight years, with about caregiving was about eight years, with about one-third of the respondents providing care one-third of the respondents providing care for 10 or more years. for 10 or more years.

Money: Almost all respondents reported Money: Almost all respondents reported helping the care recipient with some helping the care recipient with some expenses, most frequently with food, expenses, most frequently with food, transportation, or medications. On average, transportation, or medications. On average, caregivers helped with expenses for two to caregivers helped with expenses for two to six years and spent a total of $19,525 in out-six years and spent a total of $19,525 in out-of-pocket expenses. of-pocket expenses.

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Difficult Decisions to MakeDifficult Decisions to Make

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In Home care makes sense when....

•The person wants to remain in their home•They are uncomfortable in a group living situation•They find it difficult to meet new people•They require more care than is generally supplied by a facility•They need assistance with ambulating

Decisions Continued....Decisions Continued....

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Assisted Living facilities make sense when....

•The person needs more socialization•They need just basic personal care and assistance•They enjoy activity and meeting new people•They can adjust quickly to new surroundings•They can ambulate on their own

Home Care vs. Assisted Home Care vs. Assisted LivingLiving

Home Care Assisted Living

Advantages + Allows “aging in place” with family

+ Less disruption in lifestyle

+ Can attend adult day care if socialization is needed

+ Independence and control

+ Affordable+ 24 hour support and

supervision+ One monthly cost+ Facilities designed for

safety+ Nutritional and fitness

support+ Housekeeping+ Socialization

Disadvantages

− High cost− Can be burdensome

to family members− Supervision limited to

hours of care selected

− Separation from home and family

− Low independence and control

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Resistance to Care: Resistance to Care: SolutionsSolutions

Involve the elder in care decisions and Involve the elder in care decisions and discussionsdiscussions

Be honestBe honest Choose your battles wiselyChoose your battles wisely Check for troublesome environmental Check for troublesome environmental

factors (lighting , temperature, noise)factors (lighting , temperature, noise) Learn how to “redirect” to eliminate Learn how to “redirect” to eliminate

confrontationconfrontation Learn how to be comfortable with “fiblets”Learn how to be comfortable with “fiblets”

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A Geriatric Care Manager....A Geriatric Care Manager.... Is a health and human services specialist Is a health and human services specialist

who helps families who are caring for older who helps families who are caring for older relatives relatives

Is trained and experienced in any of several Is trained and experienced in any of several fields related to care management, fields related to care management, including, nursing, gerontology, social including, nursing, gerontology, social work, or psychology, with a specialized work, or psychology, with a specialized focus on issues related to aging and elder focus on issues related to aging and elder care care

Is an experienced guide and resource for Is an experienced guide and resource for families of older adults and others with families of older adults and others with chronic needs, including helping those chronic needs, including helping those suffering from Alzheimer’s Disease or suffering from Alzheimer’s Disease or Parkinson’s or exhibiting symptoms of Parkinson’s or exhibiting symptoms of dementiadementia

Long distance caregivingLong distance caregiving Plan a visit – check out:Plan a visit – check out:

– What is the food situation (contents of refrigerator)What is the food situation (contents of refrigerator)– Bills paid? Look at recent checks and bank statementsBills paid? Look at recent checks and bank statements– Bathing and grooming habitsBathing and grooming habits– Driving habitsDriving habits– Condition of the house (inside and out)Condition of the house (inside and out)

Make a list of nearby contacts (family, friends, doctors) with Make a list of nearby contacts (family, friends, doctors) with phone numbers. Call them periodically to check-in.phone numbers. Call them periodically to check-in.

Establish online back account accessEstablish online back account access Talk to a Geriatric Care Manager and visit: Talk to a Geriatric Care Manager and visit:

http://www.caremanager.org/ Aging agencies – every local area has one. Visit Aging agencies – every local area has one. Visit

http://www.eldercare.gov/

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Caregiving: Yes, There’s an Caregiving: Yes, There’s an App for ThatApp for That

Medicine Cabinet – lets you keep a list of medications for one or more individuals

iBiomed – an application for iPhone and iPad that allows the caregiver and the individual to synchronize information that’s being tracked

Elder 411Elder 411 – is specifically for caregivers of a senior – tips and – is specifically for caregivers of a senior – tips and adviceadvice

Elder 911 –includes valuable advice on how to navigate through a significant crisis or event in an elderly loved one’s life

Caregiver’s Touch – a powerful application that allows the user to sync the iPhone with the web and share vital information with others such as Doctors or family members

The AT Health Tracker – lets you monitor important health indicators such as weight, blood glucose levels, blood pressure

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Interviewing Home Care Interviewing Home Care AgenciesAgencies

How long has the agency been serving this community?How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how Does the agency have any printed brochures describing the services it offers and how

much they cost? If so, get one.much they cost? If so, get one. Does the agency have a current license to practice (if required in the state where you Does the agency have a current license to practice (if required in the state where you

live)?live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and

responsibilities of both the agency and the senior being cared for?responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her Does the agency write a plan of care for the patient (with input from the patient, his or her

doctor and family), and update the plan as necessary?doctor and family), and update the plan as necessary? How closely do supervisors oversee care to ensure quality?How closely do supervisors oversee care to ensure quality? Are agency staff members available around the clock, seven days a week, if necessary?Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 Does the agency have a nursing supervisor available to provide on-call assistance 24

hours a day?hours a day? How are agency caregivers hired and trained?How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with What is the procedure for resolving problems when they occur, and who can I call with

questions or complaints?questions or complaints? Will the agency provide a list of references for its caregivers?Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled?Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?What type of employee screening is done? Can the agency provide references from other existing clients?Can the agency provide references from other existing clients? Can I interview some of the caregivers?Can I interview some of the caregivers?

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