This is a big concern in South Carolina, as overnight crisis respite is virtually impossible to arrange except at home with private providers.  Here a major complication is that T.B. testing is required for admission to all communal care facilities, except hospitals.  Because more virulent T.B. strains have emerged, some skilled nursing facilities require a "two tier reading" which means a full week of testing and reading before an admission.  I have compared notes with a nursing home staffer in my home state of Oregon, and they do not seem to have the issue with T.B. testing at all. 

Of course, a chest x-ray can be substituted, but then we have to arrange to have the requirement waived that patient must also have a History and Physical done within 5 days prior to admission.  Our Respite for the Lifespan Statewide Committee will make a recommendation in its report to our legislature, as follows:

Within 3-5 years encourage development of emergency respite options in existing skilled nursing and assisted living facilities, hospitals, respite homes, or among private providers OR develop plan to create a statewide system or build facilities to meet family respite needs at time of crisis.

I do recall an excellent workshop I attended at the ARCH national conference in 2003 or 04 - Pittsburg, I think.  One presenter was from a large city and had developed overnight respite options within a larger facility that also provides day respite.  The other was from a smaller community where they started their overnight respite program in an old parsonage donated by a church.  Eventually they raised funds for a new state-of-the-art, accessible Lifespan facility for day and overnight respite.  Somewhere I probably have the notes, but Jill may have an old agenda in her computer.  I can not recall a particular emphasis on crisis care, but simply having 2-3 overnight beds available impressed me greatly, coming from a state in which there was none.

Susan Robinson, Director

South Carolina Respite Coalition

screspitecoalition@yahoo.com

I, too, am beginning to look into emergency respite options here in DE and find there are really very few, if any….

This is the scenario that I proposed to our APS agency as well as to several home health agencies:  I am a caregiver for an adult with significant disabilities.  At 4:00 am I need to call 911 for emergency medical treatment.  As I am taken away in the ambulance, I am able to tell the paramedics that there is another family member in the house who cannot be left alone as he cannot get out of bed without assistance.  I wanted to know what would happen next and the answers I got are not good ones:

• -they may take my loved one to the hospital with me and then social workers and APS will figure out what to do next
• -they can call APS who will not respond until morning
• -they can call the local police agency (unsure of what they would do)

So this galvanized me into action.  Several parents and I approached a home health agency to actually ‘register” with the agency so they would be familiar with the client.  If they were regularly receiving services from the agency, they would be in a position to respond to that phone call at 4:00 am and get a home health worker to the home as soon as possible and they would remain in the home for as long as it took to make better arrangements.  This is, of course, available to people who can pay privately for the services (which we would do) so I am scheduling the intake for my brother so we can be on their rolls and start using the service at least a few times monthly so they would be familiar with him and his needs.

But this does beg the question:  if clients are supposed to have an “emergency back-up plan” in place, who is checking that there is, indeed, a viable plan in place?  And how often is the plan reviewed?  I think we have a lot of work to do….if people have large families then they might have an easier time of it but we don’t have any family available to us in the local area and none who would take the responsibility for daily care of my brother so I will work through local agencies to make sure he is supported if I am not available to do so.  Yet another issue to get families to confront…..

Question:  Can anyone direct me to resources where I can learn more about emergency respite – both in general but also specific to older adults?  Are other states providing or  developing emergency respite programs? Is so, for any specific age groups or conditions? What criteria or assessments, if any, are you using for use and eligibility? 

Note from ARCH:  ARCH will also be preparing a fact sheet on this topic over the next few months and may use this information for that purpose with your permission.

From: Emily Farah-Miller with the Minnesota Lifespan Respite Program