“It was pretty evident that my father-in-law wasn’t taking care of himself,” recalled Susan Ward. “We didn’t know what doctors he was going to or not, and what they were saying.”

After spending a week caring for her father-in-law, Susan quickly realized how bad the situation had become. “I started to call different agencies to see what could be done,” she said.

Susan’s frantic phone calls eventually led her to Vikki Dargenio and her medical case management company, A Nurse in the Family. “Vikki really came right at the nick of time,” Susan said. “When we hired Vikki, she knew immediately what needed to be done, and she was able to talk to the doctors and get the right care for Frank.”

Vikki started accompanying Frank to all his doctor’s appointments, helping to eliminate any confusion and ensure that he always had an advocate present. “When I take a patient on, I really become part of their family,” Vikki explained. “I am the quarterback of the healthcare team and my goals are to keep people at home and make sure they get the medical care they need.”

After caring for four of her own family members, Vikki realized that every patient needs an advocate, especially senior patients who are often referred to multiple specialists with limited explanations. “Dr. John Sabatini actually recommended that I start this business after seeing what I had done for my family. He told me that it was amazing and that there was really a need for this,” Vikki recalled.

As a registered nurse with a background in long-term care, Vikki is uniquely positioned to help ailing seniors receive better medical care and remain in their homes longer. Since the initial recommendation that started her business, she has had several medical professionals acknowledge the importance of her services.

“It is very helpful that you come to these appointments. And on top of that, I can tell you really care,” Dr. Daniel LeBovic, a hematologist, told Vikki during one of her many visits to his office with a patient.

For Frank and his family, Vikki’s care and compassion changed everything. The family no longer had to worry about whether Frank was receiving the best possible medical treatment or if he was correctly following the doctor’s orders. By managing all of Frank’s medical appointments and helping the in-home companion caregivers better serve his needs, Vikki made it possible for Frank to continue living at home until he passed away in May of 2012.

“Frank remained in his home, and Vikki was with him until the very end,” Susan remembered. “She was very competent and always knew what needed to be done. She was there whenever we needed her, and she was so good to him.”

After he served in the war, Bob and his brother decided to get involved in the printing business. Five years later, however, his brother decided he had had enough, so Bob bought his share and continued what was a very successful business. Eventually he sold it and pursed his passion as an antiques dealer.

Bob met his wife Mary Susan (Sue) after the war. “I saw her across the room at a party and I told the guy standing next to me, ‘I want to marry that girl,’” he said. After a brief courtship, the two married and raised four children while pursuing their love of traveling. When their house was becoming difficult to manage, their daughter Mary discovered Friendship Terrace, an independent living community in Washington, D.C. near her home.

While everyone was on board with the idea, Sue began developing health problems and needed the care of a nursing and rehabilitation center. The couple had fortunately been prepared and purchased a long-term care insurance policy which helps pay for her specialized care. “I go back and forth to see her everyday,” said Bob.

In his three years at Friendship Terrace, Bob has made several friends and also speaks very highly of its staff and management. “I was a businessman and I like being in a well-run business,” he said.

The location of the community also gives him access to everything he needs. “I walk down to the McDonalds every morning for a cup of coffee,” he said. “It’s good exercise and it keeps me going.”

While Bob often dines in the community’s dining room, he enjoys eating his lunch when exploring the galleries and museums throughout D.C.. He is also known to hop a bus to pursue a favorite pastime of collecting antique cigar boxes.

There is even more in store for Bob as the community begins its capital improvement project including apartment upgrades as well as public area and general building renovations.

From business principles to valuable antiques, Bob is full of sage advice. When it comes to making a life transition he said, “Stay loose and relax, this might be a little different from the life you were living, but take advantage of what it offers for you.”

The biggest difference between a traditional hospital and a LTACH is in the specialization. LTACH’s specialize in Long Term Acute Care services, while a traditional hospital offers many general services such as emergency rooms, maternity wards, and other services.

The second difference is that LTACH’s may offer better care for patients that fit their specialization. The LTACH can focus very high standards on just a relatively small list of ailments, whereas the traditional hospital is more “spread-out” across a wide range of medical specialties. This is not to say that you cannot receive good acute care in a traditional hospital; it is just that the LTACH is set up to specialize in that care.

Across the nation there are close to 400 LTAC facilities. In the Washington, D.C. metro area, however, there are only three of these designated facilities which are operated by The Specialty Hospital of Washington. The following offers a glimpse into the services provided by Long Term Acute Care Hospitals.

*Ventilator Program*
With a Ventilator Program, many patients with respiratory failure or mechanical ventilation will be able to be successfully weaned from ventilator dependence and achieve their highest functioning level. The program is led by experts in pulmonary medicine and dedicated respiratory therapists whose only responsibilities are the active weaning of patients. The program also provides treatment to patients who require significant respiratory care who are not mechanically ventilated.

*Wound Care*
Patients with complex wounds, including pressure ulcers, serious wound complications or those who are recovering from extensive surgery, should receive care through a Wound Care Program. Visited daily by wound care specialists, these patients are given the time and optimal environment to heal with careful attention placed on the management of other complicating conditions, such as diabetes and vascular disease.

*Medically Complex*
Patients with complex medical conditions that require extended care in a hospital setting benefit from a Medically Complex Program’s integrated treatment regimen, which includes daily visits by medical and surgical subspecialists. Each unit should be equipped with life-support services that include telemetry, parenteral nutrition support, cardiac and respiratory monitoring, and dialysis.

Information for this article provided by David DeClark with The Specialty Hospital of Washington.

Dr. Bill Thomas argues that this archetype is severely flawed. Joining a strong support network and becoming interdependent, he says, will help seniors live longer, healthier lives and is the answer to the impending eldercare crisis.

“We all have to accept the idea that aging is developmental. We have to understand that people grow old-and that growth is an important part of the process,” says Thomas. An international authority on geriatric medicine and eldercare, Dr. Thomas founded The Eden Alternative, a non-profit organization committed to improving the care received in institutional facilities. The Eden Alternative was born of necessity.

Thomas recalls, “My wife, Jude, and I were working in a nursing home in the early 1990s. Our first-hand experience led to the reform strategy that is the heart of the Eden Alternative.” Years later, Thomas took the strategy one step further. He explains, “We thought, ‘what if we could build a facility from the ground up, instead of trying to work with what was in place?’”

Dr. Thomas started over. He created a new model for nursing homes, and with a team of experts, prepared to build his village. Their efforts resulted in the Green House Project, a philosophy for designing, constructing, and operating long-term care facilities that is a dramatic departure from current standards.

Facility size, interior design and layout, staffing patterns, and the methods for delivering skilled services were all altered in the Green House plans. Homes will be much smaller than the average nursing home, housing only 15-20 residents, and will be more user friendly for both residents and staff members. Green Houses will be licensed as nursing homes, so that residents can receive care regardless of their physical condition, and services will be covered by Medicare.

The Green House Project even redefined staffing procedures for long-term care facilities. Green House staff members are trained shabazi, professionals who work to enhance the lives of the elders they serve. Thomas points out, “Our Shabazim are unique. They are trained in nursing, housekeeping, culinary arts, shared decision making, and teamwork.”

Dr. Thomas goes on to explain how the Green House Project did away with the departmental model so prevalent in nursing homes, in favor of an environment that fosters team work. “There is no boss or administrator in a Green House. R.N.s visit with patients on a regular basis to meet their medical needs, but the Shabazim take care of creating and maintaining a healthy ‘rhythm of daily life.’ They work as a team, and they feel like a team, and they really know the residents,” he says.

The pilot Green House was opened in Tupelo, MS in 2003. The home, called Green Houses at Traceway, has been deemed a success by its residents, staff members, and by industry professionals. Rosalie Kane, of the University of Minnesota, did a two year study on the Green House. Thomas notes, “Her evaluation showed better clinical outcomes, better staff and elder satisfaction, and proved that the Green Houses were financially viable, that they can be operated with the same amount it takes to run a nursing home in Mississippi.”

The positive outcome of the study led to the decision of the Robert Wood Johnson Foundation to provide an endowment for the program. The ten million dollar grant will result in the creation of Green Houses in all fifty states.

“America is loaded with nursing homes that are aging faster than the people in them. We have to decide whether or not we are going to rebuild them-or if we are going to choose to build something different in their place,” Thomas says. He feels confident that America is prepared for a change. He states, “I’ll make a bold prediction: Someday America will have 100,000 Green Houses, and there will be one million Shabazim.”

Not satisfied to focus only on seniors in need of high levels of assistance, Dr. Thomas has recently shifted his attention to active adults and independent seniors. He is attempting to create the interdependent environment fostered in Green Houses in communities that are mixed-use and made up of mixed-age residents. He calls these communities EldershiresT. EldershireT communities promote the idea that health and well-being are tied closely to the nature and quality of the community that surrounds us. Better communities are the surest path to a better quality of life.

EldershireT is based loosely on the Danish concept of co-housing. In the 1950s, the Danish government began to construct co-housing communities, developments of small homes built close together with several common areas among them. These planned communities foster connections among neighbors and offer distinct environmental and social benefits. In recent years, co-housing developments have begun to catch on in America.

Playing off the uniqueness and success of co-housing communities, Dr. Thomas and his team began planning EldershireT communities. EldershiresT are unique in their “focus on the value and worth of aging citizens as an important building block of a healthy community,” according to Thomas. He continues, “So much of what we hear about aging revolves around how awful it is and how terribly expensive it can be. We are saying that aging is an importation cornerstone of any community and that elders are a vital resource.” Dr. Thomas and his wife are in the process of planning the pilot community in Upstate New York.

The inspiration for EldershireT was to create a viable alternative to what Dr. Thomas terms the “aging in place paradigm.” He explains, “Today, aging in place is the Holy Grail; it is perfection. Seniors strive to remain independent in their own homes even if it means being lonely, isolated, or possibly in danger.”

Anything less than living independently, he says, “is seen as a defeat.” While remaining in a long-time home or a familiar environment is the first choice for most seniors, it may be a choice that is detrimental to their health-and the health of their communities. “Where do you think the term ‘shut-in’ came from?,” asks Thomas.

Isolated seniors are robbed of the opportunity to contribute to their community, and their communities, likewise, are denied their knowledge and expertise. EldershireT communities will tap into this resource by allowing seniors to “age in community,” instead of aging in place.

Dr. Thomas firmly believes that living in a supportive community can give individuals the opportunity to remain involved, engaged, and most importantly, interdependent. He concludes, “The number one reason people end up in long-term care facilities is social, not medical. I would argue that every nursing home resident in America has an exact clinical double living at home. It is the social network they have in place, whether that is children, friends, or an entire community, that allows them to live at home.”

If Dr. Thomas’s EldershiresT come to fruition individuals will age in communities and receive necessary support from their friends and neighbors. If care needs become great, residents will turn to home health providers, but until then, they will take care of their own-regardless of their age. They will be caregivers, and they will receive care. They will be comfortable in their dependence on each other. They will grow old, and they will continue to grow. They will be a village.

Dr. Thomas is the author of two books, the critically-acclaimed, What are Old People For? How Elders Will Save the World, and the soon to be released, In the Arms of Elders.

The Older Americans Act (OAA) of 1965 created the Administration on Aging (AoA), an agency of the U.S. Department of Health and Human Services, and a national network of agencies that promote and protect the health and well-being of older adults. Federal, state, and local agencies now work together to serve the needs of the diverse senior population. Amendments to the OAA provided grants to Area Agencies on Aging (AAAs), giving them the resources to identify local needs and plan and fund local programs. Later changes to the act created the National Family Caregiver Support Program, which offers assistance to family caregivers.

The Department of Health & Human Services describes this comprehensive network as the National Aging Network. The Department notes that the Network “includes 56 State Agencies on Aging, 655 Area Agencies on Aging, 243 Native American aging programs, over 29,000 service providers, and thousands of volunteers.” It is the goal of the Network to offer opportunities and services that will allow older adults to “lead independent and dignified lives at home and in their communities.” Seven million Americans age 60 and over and over 325,000 caregivers are served by this network. The key components of the network include the Administration on Aging, the State Units of Aging, and the Area Agencies on Aging.

Administration on Aging (AoA)
As the leader of the Network, AoA works primarily to increase awareness among government agencies, organizations, and the general public in regards to the needs of the older American population. In addition to recommending policy and developing regulations, AoA is also responsible for providing grants to worthwhile projects. The AoA can be reached at www.aoa.gov or 202-619-0724.

Eldercare Locator
In an effort to provide nationwide, information assistance to the general public, the AoA developed the Eldercare Locator in 1991. Eldercare Locator is a public service that connects older Americans and their caregivers with critical information about local senior services. Through a website and an 800 number, the program puts seniors and their families in touch with local AAAs and other community-based organizations that can provide assistance. With the number of senior resources growing in every community, this important service can eliminate hours of research by providing direct contact with trustworthy resources.
The information provided by the Eldercare Locator is available nationwide and is comprehensive. From assistance with meals and transportation to caregiver education and training, the Eldercare Locator can provide referrals and contact information for agencies and organizations that can help. To contact the Eldercare Locator, call 1-800-677-1116 or visit www.eldercare.gov.

State Units on Aging
The State Units on Aging (SUA) serve as the state arm of the AoA. SUAs coordinate services in their states by working with a variety of state agencies and other public and private organizations. The Units support community-based programs and services including legal services, long-term care ombudsmen programs, and many others. State Units also award grants to AAAs in order to help create community specific programs. See Local Resources for contact information.

Area Agencies on Aging
On the local level, Area Agencies on Aging (AAAs) coordinate and provide services to meet the needs and concerns of residents who are 60 years of age and older. The Department of Health and Human Services defines an AAA as a “public or private non-profit agency, designated by the state to address the needs and concerns of all older persons at the regional and local levels.” It is important to note that AAAs go by a variety of different titles and may be organized in different ways.

Because of the many services and programs they offer, AAAs are one of the single most important resources for seniors. Available services vary by locale, and the services below are just a sampling of many of the services that are routinely offered by AAAs. In order to qualify for an assistance program, individuals may have to meet certain criteria. To find out more about the specific services that are available and how to obtain those services, contact the local AAA. See Local Resources for contact information.

Services Provided by Most AAAs:
Adult Day Care is available for individuals who need daytime supervision.
Caregiver Programs help family members who are caring for an older adult.
Case Management Services are conducted by professionals who can assess needs and arrange for services to encourage continued independence.
Elder Abuse Prevention Programs provide investigative services and intervention in cases of abuse.
Financial Assistance and benefit counseling is conducted by professionals.
Home Health Services provide needed care in the home environment.
Home Repair Programs help older adults complete needed repairs to avoid major problems.
Home Modification Programs provide renovations to make the home safer and more secure for individuals who choose to age in place.
Information and Referral Services offer a vital connection to available resources throughout the community.
Legal Assistance is available for individuals aged 60 and over with legal problems involving government benefits, tenant rights, and consumer issues.
Nutrition Services Programs provide home delivered meals to homebound individuals and congregate meals in specified locations for other seniors in the community.
Personal Care Services can help those with functional impairments with some of the activities of daily living.
Respite Care provides caregivers with a much needed break from the constant care and supervision of their elderly loved one.
Senior Centers offer educational, recreational, and social activities for older adults.
Telephone Reassurance provides regular contact and a safety check for homebound senior citizens.
Transportation Programs can provide door-to-door transit for individuals who do not have private transportation and/or cannot use public transportation.
Volunteer Programs connect interested older adults with fulfilling volunteer positions in the community.

Local Resources

Maryland Department of Aging
410-767-1100
1-800-243-3425

Area Agencies on Aging
Allegany………….301-777-5970
Anne Arundel………410-222-4464
Baltimore City…….410-396-2273
Baltimore…………410-887-2594
Calvert…………..410-535-4606
Caroline………….410-479-2093
Carroll…………..410-876-3363
Cecil…………….410-996-5295
Charles…………..301-934-9305
Dorchester………..410-221-1930
Frederick…………301-694-1604
Garrett…………..301-334-9431
Harford…………..410-638-3025
Howard……………410-313-5980
Kent……………..410-778-2564
Montgomery………..240-777-3000
Prince George’s……301-265-8450
Queen Anne’s………410-758-0848
Somerset………….410-651-0020
St. Mary’s………..301-475-4200
Talbot……………410-822-2869
Washington………..301-790-0275
Wicomico………….410-543-0388
Worcester…………410-632-1289

What to look for in a Nursing Care Facility
Before choosing a facility, contact the long-term Care Ombudsman Program of your Area Agency on Aging. Ombudsman programs promote the highest quality of life and care for residents of nursing facilities and can help families and staff with inquiries and complaints.

Tell the ombudsman which facilities you are considering and request any information they have about the facility. Visit prospective facilities at different times of day. Talk with residents and staff members. Be persistent about getting your questions answered.

Entering and Adjusting to Nursing Home Life
Although some people enter a nursing home temporarily for a short-term stay, it is still a sad day for most people and sad feelings are normal. Reassurance from family and friends that love and contact will be maintained can ease the transition. In addition, there are steps to take that may help lessen the trauma of the change:

–Talk about the admission in advance
–Visit the home with the prospective resident beforehand, if possible
–Involve the prospective resident as much as possible in the decision-making
–Describe the home in detail before moving there
–Decide together what items to bring to the nursing home
–Get to know the administration of the nursing home
–Maintain contact with the resident after admission
–Maintain contact with the home after admission
–On the day of admission, be available the entire day to help settle the resident and provide emotional support.

Paying for a Nursing Care Facility
Medicare, Medicaid, private insurance, and personal assets are all used under various circumstances to pay for services in a nursing care facility. If a facility is not certified by Medicare and Medicaid, the care will have to be paid for entirely with personal funds.

In general, Medicare pays for skilled nursing care following hospitalization for the same illness or condition at 100% of the cost for days 1 – 20. However, on days 21 – 100 the Medicare subscriber is responsible for a co-pay. Medicaid, a government program for the indigent, covers nursing home care for individuals who meet strict medical and financial eligibility requirements. Some long-term care insurance pays for nursing home care; insurance payments are usually a fixed amount for a specified number of qualified days. On the subject of buying long-term health care insurance, the National Council on Aging can be helpful, providing practical, objective information on what to look for. Call 1-800-373-4906 and request the “Long-Term Care Insurance” booklet. The cost for the booklet is $14.95 for non-members. Information is also available online: www.ncoa.org.

The “Consumer’s Guide to Nursing Home Contracts,” published by Legal Services of Northern Virginia, Inc., provides additional information and advice on paying for nursing care services. Below is an excerpt from the guide.

What is the Basic Daily Rate?
The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping, meals, and general nursing care.

It is important to understand all the services and amenities that are not included in the basic daily rate. The fees and charges for “supplemental services” often increase the expense of the nursing home bill dramatically, to the surprise and dismay of the recipient of the bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs, and telephone services are extra charges.

Does the basic daily rate include all the nursing care I will need? Probably not. The basic daily rate includes “basic” or “general” nursing services. What is provided with basic or general nursing care may vary from nursing home to nursing home.

But the basic daily rate often does not include many common nursing services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc. might each involve extra fees. In addition, prescription and non-prescription medicines are not included in the basic daily rate.

How can I avoid being surprised by added costs?
To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident Assessment. This assessment is required by law and analyzes what kind of nursing and other care the resident needs. For example, if the new resident is incontinent, the assessment should indicate this fact.

To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the nursing home representative to discuss the resident assessment and to explain to you what additional nursing and services, beyond what is covered by the basic daily rate, are necessary. The nursing home should give you an itemized list of supplemental services and the costs above the basic daily rate.

Also, decide what additional amenities you want (telephone, beauty care, etc.) and add these costs in. Request an estimate of the total bill. You should have this estimate long before the end of the first month, so that you know exactly what to expect.

Since paying for care in a nursing care facility can be both expensive and confusing, it is a good idea to contact your local department of social services or Area Agency on Aging for more information.

Evaluating Nursing Homes

Use this checklist to judge and compare the nursing homes you call and/or visit.

– Is the facility accepting new patients?
– Does the facility offer skilled nursing care?
– Is the facility Medicare-certified and/or Medicaid-certified?
– Are the home and its current administrator licensed?
– What type of education and training do staff members have? How many Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) are on staff?
– Are background checks conducted on all staff members?
– Is there a care plan developed for every resident?
– Are care plans reviewed and updated by providers and family members?
– Is the interaction between residents and staff members warm and respectful?
– Are public areas and resident rooms clean and comfortable?
– Are there a variety of activities available for residents?
– What is the staff to patient ratio at night and on weekends?
– Do staff members respond to residents requests for assistance promptly?
– Are there enough staff members available to assist residents during meals?
– Does the food in the dining room look and smell appealing?
– Are there handrails in hallways and grab bars in bathrooms?
– Are exits clearly marked?
– Is the facility outfitted with smoke detectors and sprinklers?

Adapted from Medicare’s Nursing Home checklist. For more information, see www.medicare.gov.

While Sam and Peggy knew the coverage was important, it always seemed to come back to the cost and the fact that they could not afford it. Sam had seen his parents go through their life savings and go on Medicaid when his dad had a series of strokes back in the late 80s. He did not want that to happen to their life savings, but what could he do?

In his meetings with all of the insurance agents, it all seemed to go the same way: sales pitch, explain the policy, quote, it is too expensive, end of appointment. Sam could see that the agents knew the ins and outs of the policies, were acting in his best interest, and were trying to come up with viable solutions to his insurance needs. But something was just not right. None of them really took the time to understand Sam and Peggy’s finances and how long-term care insurance could fit in.

After a financial planning consultation with Colin Meeks, a Certified Financial Planner, Sam and Peggy were much more informed and educated about their complete financial well-being. Sam and Peggy were in a “gray area” for purchasing long-term care insurance. They had too many assets to rely on Medicaid, but they were not wealthy enough to self-insure the risk. They were also spending all of their income on necessities, so there was little left over for other expenses. It turns out that they were in the same boat as many other retirees.

After reviewing all of their assets, Sam and Peggy were able to rearrange some of their investments into higher paying accounts. These accounts would then generate enough additional income to pay for a good long-term care insurance policy from a solid company. During the process, they realized that they were too spread out, had too many accounts, were paying unnecessary taxes and fees on their investments, and were taking substantially more risk than they were comfortable with. With some slight adjustments, they made some sensible changes. They were able to increase their income, reduce their taxes, and insure they never run out of money.

In the end, Sam and Peggy were very happy with the outcome. Sam compared the experience with going to the doctor: “A doctor wouldn’t just write you a prescription without doing a complete examination, would he? Our financial planner did the same thing – He did a complete examination, evaluated our options, and presented several solutions that really made sense.”

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place-receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.

Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:

Is the provider Medicare/Medicaid certified?
If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).

How many years has the provider been in business?

Is the provider associated with a larger health care group or hospital?

Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?

Will the agency help you find the best homecare options for you?

Does the provider have a written policy describing the patient’s rights?

Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?

Will the provider give you written information describing how they commence and discontinue services to patients?

What backup does the patient have if their caregiver cannot show up at the scheduled time?

What are the internal complaint procedures?

Will the provider give a list of citations they have received from state surveyors over the past year?

Does the provider have a nursing supervisor on call and available 24 hours per day?

How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?

What types of reimbursements will the agency accept?

Will the provider give a list of references?

Article adapted and checklist borrowed from the Maryland-National Capital Homecare Association’s (MNCHA) and the National Association for Home Care’s (NAHC) websites. For more information, please visit their websites at www.mncha.org or www.nahc.org.

Pieter spent a large portion of his career working for the Baltimore Friends School as its athletic director. He retired in 1997, but he fondly remembers how coaching on many different levels allowed him to watch “a kindergartener grow from an eager fledgling want-to-be to a mature, accomplished person living life with confidence as a 17 year old.” Phyllis also taught in Baltimore, at Bryn Mawr School, and retired in 1997. She thoroughly enjoyed her time at this girl’s school because of the diversity of the students’ individual personalities.

For these two devoted and inspired educators, retirement was not an ending, but rather, a new beginning. They are still actively involved in their community and look forward to continuing to foster their treasured relationships with their children and their spouses and their seven grandchildren. One of the primary reasons they decide to purchase long-term care insurance is because of their love for their family. The couple wanted to “be prepared for the future, physically and financially, and avoid being a burden to family.”

Before deciding which long-term care insurance plan to purchase, the two certainly did their research. They investigated plans with four difference companies and got a feel for the expected costs and the likelihood of need in the years ahead. While investigating these plans they specifically looked at the future viability of the policy and the company backing it, the personal services offered by the company, and the breadth of coverage provided by the policy. The couple quickly learned that many of the policies had similar features, but they found their perfect fit when they found Coventry Care Link, which “was unique in addressing our desire to maintain our lifestyle in our home environment as long as possible. This includes annual wellness assessment and follow up to encourage us to achieve and maintain our emotion, social, mental, and physical goals. Coventry also provides a directory for home maintenance, home repair, and personal services.”

They had found a company that provided long-term care insurance and a network of related services. The personal involvement of the company and their focus on enabling their clients to remain at home convinced Phyllis and Pieter that they had found a policy to fit their current lifestyles and their anticipated needs for the future.

The two are now secure in their future, and while they look forward to remaining in their home, they know that should a need arise they would be able to make a smooth transition to a retirement community. Long-Term care insurance has given them the security to live life to the fullest with the knowledge that the future is taken care of.

This accomplished couple continues to grow and prosper with confidence; Phyllis works as a Mission’s Coordinator for their local church, and Pieter works as a substitute teacher and a part-time Home Depot sales associate. The two also volunteer for Habitat for Humanity, play tennis, golf, travel, and get together with their family during their leisure hours. After facilitating the positive development of countless children in the Baltimore area, it is not surprising that the DeSmit’s have ensured that their own continued development is planned for.

John and Josephine Syres joined Friends Life Care At Home after living in a local retirement community. “We had known about Friends Life Care At Home since I had worked with the Department of Health & Human Services. It was my job to inspect nursing facilities. I became an expert,” Josephine says.

Always active, the couple participated in the local African-American community when they first moved to the Philadelphia area. As head of the Haddington Leadership Organization, Josephine led the drive to redevelop a section of West Philadelphia in the 1960s. John was a counselor in the Philadelphia School District’s pupil personnel department, and is an accomplished artist with 29 watercolors displayed in the Smithsonian National Gallery.

Having moved to Overbrook Park in 1985, Josephine continues her community activities as much as she can. “As John and I get older, we really value our time together, but I still have time for my community,” she proudly proclaims. Josephine serves on their condominium complex’s budget committee.

When they began thinking about long-term care, the Syres were concerned about spending their later years at home. With her husband seven years her senior, Josephine didn’t know if she was up to the challenge of caring for her husband at home as he grew older. “I thought that we might get better care if we were in a community where help was just a call away. We quickly realized that in-home care gives us exactly that service, yet we remain independent and in our own home.”

Josephine called on the services of her Care Coordinator when she had a couple of minor surgical procedures. “Friends Life Care At Home was my saving grace during my recent cataract surgery. It provided transportation to and from my surgery, and John and I had care at home while I was recovering.” She also was given peace of mind during a hospital stay knowing that the service was available for her husband. “In my absence, my husband was given the daily care that I usually provide him. I wasn’t worried about how he was doing at home because I knew he was in good hands,” she relates.