Patient Care & Assistance

Care for a dementia patient often involves a progression. Starting with some form of aide in the home. The lowest level is called companionship and typically costs about $24/hour through an agency on Cape Cod, or $15/hr by an untrained person. Think of care in terms of "shifts" with three 8-hour shifts in a day. If a patient sleeps through the night (without wandering) s/he may tolerate a social day program run by a local Council on Aging (e.g., Eastham and Orleans), VNA (Tradewinds in Sandwich), or private program provides transportation. Costs run around $60 per day, but Elder Services may assist. This could cover up to five day-time shifts weekly. Family may be able to manage the evening shifts and weekends.

For patient's with compromised Activities of Daily Living (ADL's) assistance usually starts in the home with increased family supervision and care. The next step usually involves hiring in-home care providers which include: companions, home health aides, certified nursing assistants (CNA), and nurses. A typical care Monday-Friday program for an elder living alone might include two hours of companionship morning and evening to help them arise, dress, remind them to take medication, prepare a meal, leave a sandwich for lunch, and prepare them for any scheduled events. This usually costs about $25/hour or $250 per week. A home health aid or CNA might come twice per week to help the senior shower, trim nails, etc. at about $30/hr. Only a nurse can "touch" the patient's medications, so s/he might arrive one weekly to set up a pill box, which the companion would remind the patient about at medication times. This program assumes the elder sleeps through the night without wandering. Family often cover the weekends, and might set up the pill box saving the cost of an RN which can run $90/hour.

The next level might add day programming (Day Care) through a private agency or nearby Council on Aging (COA). Such programs usually provide transportation for a low cost (e.g., $5/day) to pick up and drop of the senior from the day program which includes supervision, planned activities and a meal. Often there is a minimum of 2/3 days per week, with service up to 5 days per week. Costs run around $55-$70 per day. Another step up is Day Health Care which requires an RN onsite with a crash cart for medical emergencies. This program costs more (≥$75/day) but is reimbursed by Medicaid, whereas standard Day Care is not paid for by Medicaid. Financial help for companionship in the home and Day Care is available through Elder Services and programs like the VA's Aid in Attendance program.

Then we typically move on to residential settings.

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