Help for the Sandwich Generation. (An Advertising Supplement to the San Fernando Valley Business Journal).

If you are tired of being called a "Baby Boomer," take heart, you may now fall into the "Sandwich Generation." The Family Caregiver Alliance estimates that between 20% and 40% of caregivers have children under age 18 to care for in addition to an aging relative. If you are female, you are 72% more likely than a male to be the one responsible.

The one arena of the health care field that continues to grow is home health care, and yet it continues to be the least understood. Home health care can be divided into three major categories: intermittent home health visits, private duty nursing, and home hospice care.

Virtually any service that can be provided to a patient in a hospital can be provided in the home utilizing intermittent home health visits. This evolution of Intermittent Home Health Visits has kept pace with the shorter and shorter hospital stays. In addition to skilled nursing visits and rehabilitation therapies (physical, occupational, and speech), a patient can have an I.V. at home, oxygen, and even an X-ray. These services are ordered by a physician as dictated by the diagnosis, typically following a 3-day hospital stay. A patient does not always need a new diagnosis or in-patient stay, however, to qualify. An exacerbation of an existing illness, such as diabetes or multiple sclerosis makes a person eligible for home nursing or therapy. The only stipulation is that the patient be home bound. Home health visits are covered by Medicare, Medi-Cal, or private insurance.

The second type of care that can be provided in the home is Home Hospice Care. Hospice is a special way of caring for terminally ill patients, providing compassionate end of life care to patients and their families through a team of hospice professionals. The care that hospice provides is meant to help make the most of the last months of life by giving comfort and relief from pain. The focus is on care, not cure. Hospice benefits are covered through Medicare, Medi-Cal and most private insurance companies.

The third type of care found in the home is Private Duty Nursing. The predicament that many primary caregivers find themselves in is they don't have the luxury of being able to stay at home. The FCA fact sheet reveals that nearly two-thirds of family caregivers are employed outside the home. It can become a real necessity for families to rely upon private duty nursing services.

There are two types of private duty care skilled and non-skilled. Skilled private duty care is provided by Licensed Vocational Nurses (LVN's) and is utilized in cases such as ventilator dependent patients, spinal cord injury patients, or medically fragile children. This type of care is typically reimbursed by private insurance or Medi-Cal. Non-skilled private duty care is known in insurance company lingo as "custodial" care. This is the most frequently needed category of private duty care. This type of care, unfortunately, is not covered by most insurance companies and definitely not by Medicare or Medi-Cal.

Too often we see members of our family obligated to move into nursing or retirement homes because their frailty or other medical condition would make it unsafe for them to be at home alone. They are not necessarily sick, they just have difficulty performing activities of daily living, such as bathing, grooming, eating properly, toileting, etc. It may not be possible for them to be completely independent because they cannot do their own grocery shopping or meal preparation. They may be forgetful about taking their medications, or be at risk for falling down.

When utilizing an agency to provide your caregiver, be sure to review all of the expectations of care and work with the agency to determine the appropriate level of care to meet your needs.

Sherry Netherland, MA, is the Director of Special Projects for Assisted, a full-service home health care agency. For more information, call [phone].