Kelsy Johnson

As the baby boomer generation ages, more and more older Americans and their families find themselves looking for home health care and assistance. Health needs for aging adults often change without warning. Their spouses or children find themselves taking on new responsibilities in order to keep their loved one at home, and before they realize it, they have become caregivers.

This holiday season will be an eye opener for some family members returning home to their aging relatives. When they can actually see their loved ones at home, their health needs become more apparent.

For those who choose to age at home, finding the right support services can be difficult, but several options are available for families who face new health care needs for an aging relative.

Making care decisions

Judy Tschider, program administrator for the North Dakota Family Caregiver Support Program, a program of the DHS Aging Services Division, says most caregivers don't reach out for help until they're at the end of their rope.

The first step in dealing with a loved one's new needs is to call a resource like the Department of Human Services to determine what kind of services are needed.

When an individual contacts the Department of Human Services, a program coordinator will schedule an initial in-home assessment. They then sit down with the caregiver and their loved one and discuss the needs that they have.

Many support services are free to caregivers and their loved ones. The North Dakota Family Caregiver Support Program, for example, is funded by the Older Americans Act, a federal fund that doesn't require means testing to receive free services.

Demand for home healthcare services has increased in recent years, and it's expected to climb even more as the baby boomer generation ages. The perspective on care as people age has changed. Many families will do whatever they can to avoid placing their loved ones outside the home. Tschider sees this change in her work with the Family Caregiver Support Program.

"People want to keep their loved ones at home a whole lot longer than they used to," Tschider said.

The choice to age in place or move into residential facility is entirely personal, said Jan Engan, the director of the Aging Services Division at the Department of Human Services. The DHS provides case management for people who are considering their options.

After the in-home assessment, the program coordinator can refer families to the right resources and provide information to help them make their health care decisions.

Home health care

Tammy Theurer, director of Home Care and Hospice at St. Alexius, said people typically contact her department after a medical issue comes up. An aging adult may have had a recent hospital stay or emergency room visit that influenced the level of health care they now require. Or they have an exacerbating condition where they need someone to monitor them or provide education to manage their symptoms.

"If we can teach someone what symptoms to watch for and how to manage them, that gives them a sense of autonomy," Theurer said.

St. Alexius has adopted a new way to reach clients through telehealth monitoring, a system where patients check their own blood pressure, oxygen saturation levels, glucose and other vital signs and answer questions about their symptoms. The results are sent via phone to a clinician who can determine whether the patient needs additional care. Telehealth reduces hospital visits and allows patients to stay in their homes.

Home health care has its advantages. Theurer says this option can save families money if they can avoid hospital stays and visits to the emergency room. The telehealth monitoring program helps clinicians spot problems early on.

For medical issues, most home health care services are covered by insurance or Medicare. The Home Health Program at St. Alexius usually offers skilled nursing assistance or physical or occupational therapy. Patients may also need medication or disease process education in order to be more self-sufficient with their health.

"A very small population pays out of pocket," Theurer said.

Other nonessential services may be available to people through state funds. Clients can receive help with bathing, exercises, meal preparation, errands and grocery shopping. All of these options are designed to give aging adults some independence.

Assisting the caregiver

Reaching out for help with a family member's care needs can be difficult. Many people feel responsible for their burden as caregivers, which means they won't ask for assistance unless absolutely necessary.

"Most of our residents are very resilient," Tschider said. "People don't take advantage because they don't want to relinquish their role."

The emotional impact on caregivers is significant. As they adjust to their loved ones' new needs, they struggle with other they may also face a host of issues such as anger, resentment, and guilt. The Alzheimer's Association reports that one third of U.S. caregivers suffer from depression, and two thirds rate their stress level as high or very high. The Family Caregiver Support Program offers counseling services and support groups to people in these situations.

As health needs change, family caregivers may need education themselves in order to provide care to their loved ones. The Department of Human Services can educate family members on care tasks and specific issues related to loved ones who have dementia.

When caregivers face their own personal challenges, they can access respite care from the program for adult day care, foster care or other temporary arrangements.

The goal of the Family Caregiver Support and home health programs is to support families who choose to care for loved ones at home. While family caregivers may feel responsible for their aging relatives, support services can lighten their burdens and ensure that their loved ones receive adequate health care as they grow older.

Kelsy Johnson, a native of Bismarck, works as a freelance reporter and nonprofit writer in Fargo. She divides her time between her two passions: storytelling and martial arts.