Until recently, few alternatives to nursing homes existed for people who could no longer take care of themselves. Even today, some people are placed in nursing homes simply because neither they nor their family know about the alternatives to nursing homes. Today, people who cannot live completely independently may choose from a variety of living arrangements that offer different levels of care. For many, these alternatives are preferable to nursing homes.

• Home and Community Care
• Lifeline/Personal Response Systems
• Meals on Wheels
• Senior Congregate Dining
• Senior Community Centers
• Adult Day Programs
• Home Health Care
• Geriatric Care Managers/Care Managers
• Housing

Home and Community Care

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Lifeline/Personal Response Systems:

Lifelineâ and other similar personal response systems link customers to 24-hour assistance at the push of a button. It allows you to move freely around your home or yard with the confidence of knowing that if you need help - help is there!

If you need help, push your personal help button. Your communicator is activated and automatically dials the response center you are connected to. Highly trained staff are alerted, and they call your home to see what kind of help you need. If you cannot be reached, a responder will be sent.

Who is a responder?

A responder is someone you have chosen to be alerted if your button has been pressed and you are unable to be reached by the response center. Neighbors, family members and friends are usually chosen to be responders. If your designated responders are not available, community emergency personnel (paramedics, fire, police) will be contacted.

Who uses personal response systems?

These systems are used by people who live alone, experience chronic health conditions, heart patients, the elderly, the disabled, post-operative patients and anyone who needs or desires the added peace of mind.

Is it difficult to use?

No, it is not. For most personal response systems if you can press a button, you can use the system.

Is the service expensive?

Many of these programs can be activated for less than a one time fee of $30 and maintained on a monthly basis for about $30. Check each agreement carefully to ensure you do not have any long-term commitments.

Most community hospitals offer a personal response system through their community health department. If the community hospital is unable to assist you, contact Senior Linkage Line at 1-800-333-2433.

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Meals on Wheels:

Good nutrition is an important factor in keeping seniors healthy and independent. Many meals on wheels programs have been in effect since the 1960's. Meals on wheels assists seniors (and some disabled individuals) at all income levels, who are unable to prepare meals for themselves. Meals on wheels menus are planned by Registered Dieticians. When necessary, meals can be prepared for people with special dietary needs. Meals on wheels is available on both a short-term and continuing basis.

Eligibility:

Eligibility for participation in a home delivered program is for people age 60 or older who have a permanent or temporary illness, injury, or disability. People age 18-60 who are unable to prepare their own meals may be eligible under other funding programs.

Cost:

The cost of meals varies from one program to another. Many programs receive financial support to subsidize the cost of meals for those people unable to pay full cost.

Diets:

Most programs offer recipients a range of dietary choices: salt restricted, restricted calories and restricted calorie dessert.

How to access home delivered meals:

For a person to begin receiving meals, a phone call must be made to the Senior Nutrition program in the person's neighborhood. It is important to have specific information available concerning special dietary needs, how soon service can start, delivery address, name, address and phone number of the client. If you cannot locate the neighborhood Senior Nutrition program, call the Senior Linkage Line at 1-800-333-2433.

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Senior Congregate Dining

In addition to home delivered meals, seniors also have access to dining programs located in community centers, churches, schools and in apartment complexes throughout the State. Many of these programs offer a nutritious noon meal five days a week with the added benefit of socialization and community relations.

As with the home delivered meals programs you can located the Senior Nutrition program in your region by calling the Senior Linkage Line at 1-800-333-2433.

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Senior Community Centers

Senior centers are usually sponsored by city governments, school districts or nonprofit organizations. Many receive grants and contributions which enable them to provide services. Senior centers can be a lifeline for many older adults who are living alone in the community.

Senior centers offer a range of services both at the center itself or within the area it serves. Services may include: health screenings, senior dining, educational and recreational programming, chore services, assistance with tax or insurance forms, support groups and transportation.

For more information about senior centers in your community contact the Senior Linkage Line at 612-333-2433.

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Adult Day Programs

What do they do?

At these centers you can find a large variety of activities and services. Participants enjoy music, discussion, reminiscing, entertainment, cards and games, exercise groups, outings, crafts and more. They also receive a nutritious meal, snacks and assistance with medications and personal care. Transportation is often provided or arranged at approximately 9:00 am and arrivals at home may be near 4:00 p.m. Many programs offer tremendous flexibility, provide a range of hours earlier and later, and offer Saturday service.

How do seniors benefit?

The health and personal care services available at day centers allow many seniors to continue to live in their own homes instead of moving to boarding care or nursing homes. Seniors can receive health monitoring, skilled nursing care, physical therapy and even a whirlpool bath. All of these services can improve or help to maintain health, independence and, ultimately, community living.

Other seniors enjoy the activities, community, mental stimulation and spiritual care they receive at adult day centers. A sense of purpose and friendship take the place of what might otherwise turn into loneliness, boredom and depression.

Adult day programs also provide some "time off" for a caregiving friend or relative. Many adult day programs specialize in care for those with Alzheimer's disease, Parkinson's disease, stroke survivors and other limitations. Caregivers maintain their own well being while knowing their loved one is safe and well cared for.

Adult day program fees average $40 a day. The cost is a bargain - much less than one-third the cost of a home health aide or homemaker. Most day programs have agreements with county social service programs, which cover the costs. In addition, most long-term care insurance policies also authorize payment.

More than 30 adult day centers serve the Twin Cities; 92 are in greater Minnesota.

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Home Health Care

What is Home Care:

Home care encompasses a wide variety of services from intravenous therapy to snow shoveling provided to individuals in their own homes. Home care services are intended to promote, maintain, or restore health or to minimize the effects of illness or disability.

For some, home care is needed by individuals who are recovering from an acute illness, those recovering from surgery, or those with a chronic long-term health condition. Skilled care encompasses services prescribed by a physician and provided by a licensed professional. Registered nurses and licensed practical nurses may be needed to monitor medicines, help with wound or catheter care, teach the recipient or family member about medical devices or skilled services. Therapists may be employed to provide physical, speech, respiratory, and occupation therapies in the home.

Others may require ongoing support services for personal cares (bathing, dressing, grooming, eating); homemaker services (meal preparation, light housekeeping, errands); and or companion ("supervision") services.

Following a hospitalization, Medicare may pay for a limited number of physician-approved home care visits by a skilled professional. Medicaid coverage varies for home care services. Some private long-term health insurance policies cover in home health care. In many cases, home care is paid for privately by the client or family. The cost of services provided will vary according to the agency and the type of service requested. Home Health Aide visits average between $12-$18 an hour. Some agencies have contracts with a county and provide services on a sliding scale.

To locate home care agencies in your community you may want to consult with your doctor, hospital discharge planner, nursing home social worker, private geriatric care manager or county health department. You can also contact the Minnesota Department of Health (651-215-8700) for a list of licensed providers serving your county. You can also refer to the Minnesota County Intake Numbers listed in this site.

• Does Medicare certify the agency?
• Does the agency have a contract with your insurance/HMO?
• Does the agency bill Medicare/insurance provider or is family responsible?
• What type of training, supervision and monitoring does it provide its staff?
• Does the agency develop a plan of care - how often is it reviewed and by whom?
• Does a nurse conduct an initial assessment? Is there an additional cost for this?
• Does the agency provide family with training on high-tech equipment in the home?
• Is there a 24-hour emergency contact for questions or complaints?
• How does the agency assure that staff are available for the requested times?
• How does the agency insure consistency of care providers?
• Is there a charge for canceling a scheduled day?
• How does the agency screen their staff? Are criminal checks completed?

• Check references.
• Check with any State Licensing Boards (e.g. Board of Nursing).
• Complete a criminal background check (e.g. Local Police, Sheriff, Bureau of Criminal Apprehension, drivers license division).
• Check with the IRS about tax issues.
• Have a back-up plan for when the worker is sick or on vacation.

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Geriatric Care Managers/Care Managers

What does a geriatric care manager offer:

A geriatric care manager is a professional who specializes in assisting older people and their families in meeting their long-term care arrangements. GCM's have training in gerontology, social work, nursing, or counseling.

GCM members can help:

• Conduct care-planning assessments to identify problems, eligibility for assistance, and need for services;
• Screen, arrange and monitor in-home help or other services;
• Review financial, legal, or medical issues and offer referrals to geriatric specialists to avoid future problems and conserve assets;
• Provide crisis intervention;
• Act as a liaison to families at a distance, making sure things are going well and alerting families to problems;
• Assist with moving an older person to or from a retirement complex, care home, or nursing home;
• Provide consumer education and advocacy; and
• Offer counseling and support.

Some GCM's also provide family or individual therapy, money management, and conservatorship or guardianship assistance. GCM's have extensive knowledge about the costs, quality, and availability of services in their community. One call to a GCM will connect you with the services an older person may need.

Fees and Costs:

The fees for these services range from $30 to $150 an hour. (The cost of any resources recommended are not included.) Some public and nonprofit agencies use a sliding-scale system based on income to set fees for their assessment and monitoring services.

Locating a Geriatric Care Manager:

The Senior Linkage Line 1-800-333-2433 can provide you with information about care mangers in your area or the National Association of Professional Geriatric Care Managers can refer callers to managers who have the necessary professional credentials for membership and certification in the organization. The address is: NAPGCM, 655 N. Alvernon, Suite 108, Tucson, AZ 85711; (520) 881-8008. Their web site address is: www.caremanager.org.

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Housing

Community Housing

Many seniors require care services that are too cumbersome or too expensive to be provided for in the home setting. Still other seniors prefer to be living in a setting where they have daily contact with other active seniors who want a setting free from the worries and trouble of home maintenance.

There are many choices in living communities for older adults. It is important to consider your present needs as well as what type of services you may require or want in the future.

Subsidized Senior Housing

There are Federal and State programs that subsidize housing for older people with low to moderate incomes. A number of these facilities offer assistance to residents who need help with certain tasks, such as shopping and laundry, but residents generally live independently in an apartment within the senior housing complex. In this way, subsidized senior housing serves as a lower cost alternative to assisted living - though assisted living communities are frequently newer and more luxurious. For those who believe they may be eligible for subsidized housing programs, it is prudent to apply well in advance of the need due to waiting lists and cuts in subsidies.

Market Rate Senior Housing:

Senior buildings are often age restricted (to age 55 or age 62 and older), and must comply with federal housing guidelines to qualify for this restriction. While most of these buildings are similar in layout to other area apartment complexes, those with the senior housing designation may offer more community programs and dining opportunities.

Adult Foster Care:

Foster care settings are licensed by counties on behalf of the state. Due to license requirements, they tend to be limited to 5 or fewer residents, but may be clustered together to create communities of 20 to 50 tenants. These settings can provide a range of services, up to and including home care and memory loss services.

Assisted Living

Memory loss or dementia specific residences:

Recently there has been an influx of housing establishments that specialize in memory loss services. Some of these programs are housed within a larger complex that offers services to a range of populations, others are designed specifically for the person living with memory loss or dementia. Many of these facilities have incorporated the latest information and research in the design of their programming, staffing, and environmental layout. Some of these facilities can accommodate individuals with skilled physical needs as well as cognitive impairments.

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