Caregiving

Understanding ADLs (Activities of Daily Living)

When discussing caregiving and assessing what level of help a person needs, healthcare professionals rely on a metric called Activities of Daily Living (ADLs). These are the fundamental skills required to independently care for oneself:

• Ambulating: This is the ability to move from one position to another.
• Feeding: The ability to feed oneself.
• Dressing: The ability to select appropriate clothes and put them on.
• Personal Hygiene: The ability to bathe and groom oneself.
• Continence: The ability to control bladder and bowel functions.
• Toileting: The ability to get to and from the toilet and clean oneself.

Note: As the ability to perform these tasks declines, it can be helpful to use these terms to help describe what a person needs to a professional like a doctor, a geriatric care manager, a home health nurse, or a long-term care facility.

The Crucial Role of Self-Care

The phrase "you cannot pour from an empty cup" is very apt. Caregiver burnout is a real, measurable condition with negative health outcomes—one of the most widely cited studies (published in JAMA in 1999) found that elderly spousal caregivers had a 63% higher risk of mortality than their peers. With the aging population, it's imperative that caregivers take steps to protect their own well-being. Here are a couple of tips that can help protect your own well-being.

• Re-Evaluate the Environment: Oftentimes, ADL needs change as a person's condition changes. As a result, it is important to re-evaluate the help you need and ask for what you need. This could be a physical change in the home, bringing in caregiver help to the home, or even a change in the care plan like moving to a long-term care facility.
• Keep a "Help List": Family and friends often want to help but don't know how - it can also be tempting to just say "no, I'm fine" because you don't want to think about what you really need. It can help to keep a list of specific, tangible things you need like picking up groceries, cooking meals, or providing two hours of respite care while you go to a doctor's appointment.
• Acknowledge Losses Along the Path: Recognize that losses begin as physical and cognitive abilities decline: going on date nights, going to a grandkid's soccer game, participating in trivia, and the ability to do things that were once easy. Finding a therapist or someone that understands your experience firsthand, via a caregiver support group or other peer support network, allows you to process without judgment. Noticing and calling out what's emotionally happening can help you be more present in yourself.

Understanding Insurance Coverage

A common misconception is that Medicare will pay for full-time, at-home caregivers. It is vital to understand the difference between skilled care (medical) and personal care (often called "custodial care" by insurance).

• Medicare Home Health Services: If a doctor certifies that your loved one is "homebound" and requires intermittent skilled care, Medicare covers 100% of eligible services like part-time nursing or physical therapy. Medicare also pays 80% for Durable Medical Equipment (DME) like wheelchairs or hospital beds. However, Medicare does not cover the cost of 24-hour care, meal delivery, or homemaker services like cleaning.
• CNAs and Home Health Aides: A Certified Nursing Assistant (CNA) or Home Health Aide is a trained professional who helps patients with Activities of Daily Living (bathing, dressing, toileting). Medicare will cover home health aide services at no cost only if they are required alongside intermittent skilled nursing or therapy. Some examples of conditions needing skilled nursing or therapy are: hypertension, wound care for an ulcer, heart conditions, or physical therapy after a surgery.
• Hospice Respite Benefit: If your loved one is on Hospice, the Medicare hospice benefit includes a respite care benefit, which covers the cost of transferring the patient to a Medicare-approved facility (like a nursing home, assisted living, or inpatient hospice center) for up to 5 days at a time, specifically to give the family caregiver a period of rest.
• Long-Term Care (LTC) Facilities: Generally, Medicare does not pay for long-term room and board in a nursing home, assisted living, or memory care facility. Medicare does cover short-term rehabilitation stays. An example of that would be a skilled nursing rehabilitation after a hip replacement surgery because there is a need for physical therapy and skilled nursing care. Medicare will also cover the short-term hospice respite benefit mentioned above. Medicaid does cover long-term care in a facility, but it often is very hard to get access to beds.