“I want to go home.” A hospital patient’s universal plea is also a caregiver’s dilemma. For someone managing a serious illness, going home may be the best option or a very poor option. There is no one template for remaining in one’s home while coping with a long term illness. Some of the factors that come into play include: having a family member caregiver who possesses enough dexterity to juggle multiple responsibilities, a caring and supportive spouse, a home or apartment that has a layout that does not inhibit caregiving or prevent mobility and geography that is favorable for home health care workers to service the home.
The most important factor in keeping someone at home for the duration of a long term illness is a dynamic caregiver. Having someone in your corner who can make sure meals are eaten, medications are taken and schedules are followed is a necessity. Even after home health aides are hired, a primary caregiver coordinates doctor visits, daily concerns and general comfort. If a supportive spouse is part of the caregiving team then there is the added luxury of continuity and security. Without the right caregiver, isolation coupled with a lack of oversight can nullify any advantages of remaining at home.
In many cases, a home’s layout and condition will be a determining factor. Sometimes a home’s design does not mesh well with recovery. The raised ranch homes that are plentiful in the Hudson Valley have multiple sets of stairs that are difficult for mobility challenged people to navigate. In these situations, repurposing the garage and wreck rooms into first floor living spaces may be the best solution. The construction of ramps, lifts and wheelchair access points can make a huge difference for mobility in homes that can accommodate such changes.
Hoarding and neglect can make a home not the ideal place for long term recovery. Even if trash is removed, a home’s poor condition may not be suitable for both the recovering patient and the home health aides as a work environment.
One of the least discussed factors regarding recovery at home is the proximity of home health aides to the patient’s home. The Hudson Valley’s many communities are spread over a vast distance, often geographically difficult to service for those aides without automobiles. Even when private insurance or Medicaid is in place finding a home health aide can be daunting when geography is the issue. New York’s Consumer Directed Program under Medicaid does allow for certain family members, friends and neighbors to become paid home health aides. But, for those that are ill, live deep in the Hudson Valley and do not have a strong support system this combination can thwart any possibility of remaining at home.
Bringing a loved one home to recover often appears as a triumph. Keeping that loved one at home for the long term requires a three-dimensional understanding of care needs, housing realties, family dynamics and staffing.
