The Third Third

A New Take on Caretaking

Once upon a time I read wedding announcements in the *New York Times* to find a job (back when you could assume the bride was leaving hers); more recently, when my father-in-law was ill, I read the obituaries in our local newspaper -- to find a caregiver. Yes, I read obituaries, and I made cold calls. I called the bereaved if they mentioned a loving caregiver. I called people they thought might know someone, and then I called others who said they thought they knew someone who ran a group of caregivers, and I called that someone, then the person she recommended who ran another group in the next town, then the person she recommended, and then two or three more generations of phone calls later, I called a person who might be available. (And by that time, I would have taken *anyone*.) There existed then – and there does, still – a vital underground network of women who provide caregiving services in Dallas. They live an hour away, sometimes two or more, in small communities where they say they can’t make as much money doing anything as they make taking care of the elderly and infirm 24 hours a day, seven days a week, one week on, one week off. They don’t earn that much (though together they cost you about $4000 a month) and they are usually compelled to give 10 percent of it to the woman who placed them in the job, but it works for them and, when you’re lucky, it works for you and the person for whom you need care. Still, desperate as you may be to find someone – anyone - to be a companion, cook, driver, bather, safe-guarder, diaper-changer and heavy-lifter to an aged loved one, finding that someone (actually two someones – remember, one week on, one week off) doesn’t solve all the problems. Their main qualifications are necessarily going to be “Caring” and “Honest”. Particular skills, training and intelligence will be a bonus. So who is going to talk with the doctor(s)? Who can dispense the prescription medicines? Who can help you file the insurance claims? Who’s paying the bills? Who takes care of appliance repairs, yard work, the new roof? And what if your aging parent needs home health care, a physical therapist, a wheel chair? Answers to all these questions have been hard to find. And good answers have been even harder. Once again, an enterprising, experienced woman– someone our age – has turned the challenge into an opportunity by creating a company offering one-stop shopping for caregiving needs. Janet Houston has been through it all – the anxiety, the guilt, the frustration, the stress, the financial toll, and the emotional toll of caring for an aging parent. In fact, she’s been through it twice – once for her mother and once for her husband’s father. And she did it for ten years – with a full-time job and five children of her own, one of them an infant. Now she’s launched AssuraSource, – a clearing house of sorts for any service you can imagine related to caring for the elderly. It’s exactly what she wished for when she and her husband were struggling to figure out what they should do for their parents. Now the rest of us can make just one call -- and find a bill payer, a nursing home, a home health aide, a social worker, or that wheel chair. Even someone to fix the roof. AssuraSource has five full-time staff members including a registered nurse and a clinical social worker trained in geriatric care, and a rolodex full of service providers. It’s quick. It’s easy. And Houston knows the business both inside and out -- because she also worked five years with one of the country’s largest skilled nursing center providers. But her market isn’t quite ready for all that AssuraSource offers. Despite studies that show quality, coordinated care of the elderly improves quality of life and reduces hospitalizations, neither Medicare nor private insurance companies will pay for what AssuraSource provides, not even consultations about home health care, or coordinating a client’s multiple prescription drugs and dispensing and monitoring them. And if Medicare and insurance companies won’t pay, the target population – men and women around 80 – don’t think they should pay either, especially for something most of them don’t think (and won’t admit) they really need. The patient’s children are more likely to call – these days for their parents – and then eventually for themselves. Baby boomers, Houston notes, are used to paying for services, for convenience, for peace-of-mind. And in a few years she’ll be serving a generation that purchased Long Term Care Insurance. For now, AssuraSource offers a smorgasbord of options, most often to a family in crisis after a loved one falls, has a stroke, doesn’t recover fully from major surgery, or is discovered to be making dangerously faulty judgments. The commodity most in demand is their professional assessment of what is required, and their ability to communicate those needs objectively to patient and family alike. They can offer simple solutions, like grab bars in bathrooms and removing clutter, radical change such as a move to assisted living or a skilled nursing unit, or more sophisticated approaches, including tele-monitoring a patient’s prescription drug intake or vital signs. They will meet with physicians, secure physical therapists and home health aides, hire and pay caregivers, or, sometimes, simply provide respite care. What does it cost? Consultations cost $75 an hour. Ongoing case management and medical oversight is also $75 an hour. The machine that reminds you when to take your medication and dispenses the prescribed dosage and alerts someone if you fail to take it rents for $79 a month, $149 a month if AssuraSource monitors your prescriptions and fills the machine. Caregivers are paid $17 an hour. AssuraSource is aggressively competitive – but not inexpensive. Still, Janet Houston wouldn’t change a thing. “This is very rewarding work,” she says. “Very rewarding. I help people improve the quality of their lives – and not just the patient’s life, the family’s life as well.” AssuraSource has fielded calls and designed caretaking plans for families as far away from Dallas as North Carolina and Indiana by contracting with caretakers and registered nurses across the country. And the telemonitoring, Houston adds, can be accomplished from anywhere. Resources: AssuraSource: (8770573-1010) Caregiver Alliance: (800-445-8106) National Alliance for Caregiving: National Association of Professional Geriatric Care Managers:
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