Merrill and Judy Skolnik were overwhelmed by the thought of moving until they enlisted the help of a moving coordinator.

The Skolniks began looking at continuing care retirement communities (CCRC), and after a lengthy search, they selected Roland Park Place in Baltimore, Md. The two native Baltimoreans have a long history in the area and were relieved to find a place in the city and close to their children.

After raising their four children, Judy launched a career as an advisor at Towson University. An electrical engineer, Merrill earned his degree from Johns Hopkins University and worked for nearly 40 years for the U.S. government. When he retired, he was the Superintendent of the Radar Division of the Naval Research Laboratory in Washington, D.C., and a widely renowned author and expert in radar technology.

After living in the same home for decades, the Skolniks were overwhelmed by the thought of moving. Even after finding the right retirement community, they had no idea of where or how to start the transition.

The staff at Roland Park Place suggested that the Skolniks enlist the help of Senior Transitions, Inc., a moving coordinating company owned and operated by Charna Kinneberg, RN, MBA. Senior Transitions assists seniors and their families with every aspect of the moving process from planning and downsizing to packing and unpacking.

“We are not a one-size-fits-all company. Each client is unique,” Charna explained. “Our services are tailored to relieve the stress of moving, and our first goal is to determine the exact needs of the client.”

When Charna started helping the Skolniks, relocating began to seem manageable. “She just took the whole burden off; she was in charge,” recalled Judy. “Thank goodness for Charna.”

Instead of worrying about home maintenance or feeling isolated, the Skolniks now enjoy a wide range of activities with new friends and
neighbors.

Charna helped Judy and Merrill make key decisions about what to take with them and what to leave behind. “She’s very decisive,” Judy recalled of Charna. “She knows what should be done and just does it.” She also enlisted help to do the packing and unpacking, so the couple did not have to worry about the physical tasks of the move.

“They were just wonderful,” Judy said of Senior Transitions. “They pack you up, and they bring you here, and they unpack you. They even make up your bed, and you’re ready to begin your new life.”

In addition to being efficient and professional, Charna and her staff also formed a personal relationship with the Skolniks. It was almost a year after they moved that Judy recalled seeing some of Senior Transitions’ staff members in the lobby of Roland Park Place. “A new resident was moving in upstairs with Charna’s help. I recognized the movers, and, to my surprise, they greeted me by name. They remembered everything about us. I couldn’t believe it,” she said.

Since moving, the Skolniks have enjoyed a much-improved lifestyle. Merrill stopped driving and Judy only drives during the day, so the couple rarely ventured out in the evenings while living in their house. Now, they take the community bus to the opera, theater, concerts and dinners. “There’s something to do here all the time,” Judy said. “I try to take advantage of everything, and it’s been very stimulating.”

Finding a community close to home and the professionals to help them make the move has helped the Skolniks transition to their ideal retirement. From living an isolated life in their increasingly burdensome house to enjoying activities and events with new friends and neighbors, the Skolniks have certainly made a move in the right direction.

However, Florence recently faced a major challenge that has tested her emotionally. She made the transition from living alone in a large home in Pennsylvania to Sunrise Assisted Living of Leesburg to be closer to her family. “It has been difficult, it hasn’t been easy — but with help from everyone I will get through it,” she said.

Mary Ellen Knecht, RN and Nurse Liaison with The Medical Team refers to these challenges as “transitional trauma.”

Fortunately, the assisted living community where Florence resides utilizes a unique research-based program designed to assist families and individuals facing mental health and behavioral challenges. The Journey Behavioral Home Health Program was developed by The Medical Team with a leading expert on psychiatric home care.

Providing solutions to the transitional challenges like those Florence has faced is just one of many behavioral aspects that it addresses. “When I learned about the Journey program, I was very interested in offering it to our residents, staff and families,” said Susan Balinger of Sunrise Assisted Living of Leesburg.

The program addresses a critical concern, as statistics show that over six million Americans over the age of sixty-five have some form of this emotional disorder, with nearly two million being clinically depressed.

Getting treatment is extremely important for individuals and families. According to the National Institute of Mental Health, only about 10 percent of seniors suffering from depression receive treatment. When treated, however, studies show that older patients respond well. A Pittsburgh Medical Center study found that 80 percent of seniors treated over a three-year period didn’t suffer recurrent bouts, while only 10 percent of those without treatment avoided relapse.

Knecht advised, “If you suspect that a loved one has behavioral health issues, such as Alzheimer’s, depression or bipolar disorder, it’s important to talk with their physician as there are programs with proven outcomes available to help them.”

Balinger continued stating, “The Journey program has given us all support to help ease our residents through difficult situations.” The program has not only been instrumental in improving the lives of those living in senior care communities, but also homebound elders.

Based on her own experience, Florence offered up advice to others facing similar transitions saying, “Welcome all the help you can get, have an open mind, be courageous, and be thankful.”

With the help of an attorney and care management organization, Elizabeth Dusa found a homecare agency that has provided her with the support she needs.

Families are there for each other to celebrate the good times and help each other through the challenging times. Elizabeth Dusa had spent a lifetime caring for her son, but when her health began to turn, he became her loyal and compassionate caregiver in return. Unfortunately, he passed away suddenly, leaving Elizabeth alone with no remaining family or support.

Elizabeth grew up in Pennsylvania and is of Hungarian descent. When her son was diagnosed with juvenile diabetes, she was urged to institutionalize him. Although she was a single mother, she adamantly refused and took measures into her own hands. Elizabeth kept his health under control by monitoring his diet and keeping detailed journals of everything he ate. As a result, she was able to keep him healthy.

While maintaining this focus on her son, she led a frugal lifestyle in Annandale, Va. working as a secretary. In a true success story, her son eventually received a PhD in Physics, became an astronomer and had a celebrated career with the FBI.

With no one to care for her following her son’s death, Adult Protective Services (APS) was called in to help Elizabeth. They in turn contacted Elizabeth “Liz” Gray, an elder law attorney who now serves as the guardian for Ms. Dusa.

“I had to clean out the house, get her settled in Fairfax Nursing Center, and make sure she was well cared for,” said Ms. Gray. “She was losing weight, she wouldn’t let anyone touch her, she would scream and cry regularly, and at times was very combative.”

Ms. Gray then hired Elder Care Consultants, a geriatric care management firm to assist her in monitoring and coordinating Elizabeth’s care. Ms. Gray and Dia Loken, the RN and Care Manager assigned to Elizabeth’s case, observed that she was more comfortable around male caregivers, which they attributed to her strong relationship with her son.

They felt that finding a dedicated male caregiver that she could trust might enable them to reduce the medications Elizabeth was on to control her anxiety and combativeness. The search was more challenging than expected, so Dia connected with BestCare Home Care where she was introduced to Hugo Ruiz-Menandez, a trained physician in his native country of Bolivia.

“The care he provides to Elizabeth is extraordinary and the bond that the two of them have is exceptional. They are referred to as a little married couple at Fairfax Nursing Center because they are together always,” said Dia. “Her quality of life has been enhanced.”

Dia and the other professionals involved in Elizabeth’s case cannot emphasize enough the positive change they have seen in her.

“It was almost daily that she was getting into a physical altercation with another resident,” said Vanessa Bishop of ElderCare Consultants. “Now she is in love with her aide and has really calmed down.”

According to Dia, they have even been able to reduce Elizabeth’s medications as she has been consistently gaining weight and is rarely sick. Hugo also gives her fantastic skin care and the mere sound of his voice seems to calm Elizabeth down.

“I am very impressed with the responsiveness and work ethic of the caregivers and management at BestCare,” said Dia. “There are so many home care agencies to choose from, and it’s important not to tolerate substandard care. I don’t second guess their attention and care.”

She explained how important it is to have a team approach to care, especially in medically-complicated situations. The team is tuned into changes and is able to report to the physician in a timely and accurate manner.

Now Elizabeth, who once seemed alone, has quite the caring support network and essentially a different kind of family that will continually be there for her.

“I fell in love with her when I met her because she was so feisty,” said Dia. “In fact I have a picture of her on my refrigerator. My family refers to her affectionately as ‘The Duce.’”

The holidays are supposed to be a joyful time of good cheer, parties and family gatherings, but it is not unusual for many of us to feel sad, lonely or even anxious during the holidays. This condition, which has come to be called “holiday blues,” can occur with any holiday or vacation time. It commonly happens at the end of the year when it can seem that just about everyone is celebrating in some way, while those with the holiday blues feel pressured with the high expectations of the season.

Why are seniors susceptible?

“Many factors can contribute to feelings of sadness that seniors may feel around the holidays. The holidays can heighten feelings of grief and loss for seniors adjusting to changes related to the process of aging, such as life without a loved one or close friends, ill health, or a move from a lifelong family home into a retirement home or senior community. They may feel guilty about having feelings of sadness which may in turn intensify those feelings of sadness,” says Karen A. Briskie, RN, MSN, Director of THE MEDICAL TEAM’s Journey Behavioral Health Program.

How to manage the holiday blues?

The holiday blues can be a normal response to a stress-filled time of the year, but seniors don’t have to suffer unnecessarily. Mental Health America, a non-profit dedicated to helping Americans lead mentally healthier lives, offers the following tips for coping with stress:

• Keep expectations for the holiday season manageable. Try to set realistic goals. Make a list and prioritize the important activities.
• Remember the holiday season does not banish reasons for feeling sad or lonely; there is room for these feelings to be present, even if the person chooses not to express them.
• Leave “yesteryear” in the past and look toward to the future. Life brings changes. Don’t set yourself up in comparing today with the “good ol’ days.”
• Do something for someone else. Try volunteering some of your time to help others.
• Enjoy activities that are free, such as taking a drive to look at holiday decorations.
• Be aware that excessive drinking will only increase your feelings of depression.
• Try something new. Celebrate the holidays in a new way.
• Spend time with supportive and caring people. Reach out and make new friends, or contact someone you haven’t heard from in a while.
• Find a family member, friend, member of the clergy, or a physician or professional counselor you can talk with who can help you through this difficult time.

When is it more serious than just the holiday blues?

While they may be intense and unsettling, holiday blues are usually short-lived, lasting for a few days to a few weeks prior to or just after the holiday. “However, it is important for family members, physicians and other caregivers to be alert to signs of something more serious than just seasonal sadness. Many elderly individuals may feel that depression is a natural part of aging and may not seek treatment on their own,” says Karen Briskie, RN, MSN.

Depression is a very real and serious disease that can be treated and managed, but can be life-threatening if left untreated. The signs of depression include: sadness that won’t lift; loss of interest or pleasure; changes in appetite and weight; thoughts of death or suicide. If you notice that a loved one seems depressed, encourage them to talk to their healthcare provider.

How can home care help?

If diagnosed with depression, elderly patients may respond more readily when receiving psychiatric care in the comfort of home, surrounded by their family and possessions. THE MEDICAL TEAM offers an in-home care program to assist patients, families and caregivers affected by depression and other behavioral health disorders to journey towards wholeness. Services include crisis stabilization, medication management, family interventions and long-term management. The program is based on established research outcomes and meets all Medicare standards.

Source: Mental Health America, www.nmha.org

• Difficulty adapting to reduced mobility
• Frustration with lifestyle changes such as moving from a family home to a retirement home
• Sadness due to changes in family structure, such as loss of a spouse
• A reaction to chronic pain or illnesses and their side effects which can be more prevalent among seniors: strokes, respiratory problems, diabetes, and neurological disorders like Parkinson’s and Alzheimer’s disease
• Side effects of the commonly prescribed medications for these illnesses

Recognizing the difference between sadness and depression can help you identify when your loved one may need help. Everyone experiences “life’s ups and downs” or the “blues” during their lifetime. Feeling sad, disappointed, or experiencing grief after the death of a loved one or the loss of a job is an expected reaction, and does not usually interfere with a person’s daily routine. Depression is different. The symptoms tend to last longer, generally two or more weeks, and interfere with a person’s ability to manage their day-to-day activities. They may also experience a loss of interest or pleasure in activities they regularly enjoy. And, they can be affected physically as well as mentally.

According to the National Institute of Health, only about 10 percent of seniors suffering from depression receive treatment. When treated, however, studies show that older patients respond well. A Pittsburgh Medical Center study found that 80 percent of seniors treated over a three-year period didn’t suffer recurrent bouts, while only 10 percent of those without treatment avoided relapse.

Getting proper treatment can make a significant difference in a person’s health and overall quality of life. Mary Ellen Knecht, RN and Nurse Liaison with THE MEDICAL TEAM advises, “If you suspect that a loved one has behavioral health issues such as depression, it’s important to talk with their physician as there are unique research-based programs designed to assist them and their families at home.” THE MEDICAL TEAM’s Journey Behavioral Home Health program, which was developed with a nationally-recognized expert on psychiatric home care, helps individuals cope with issues that may affect their ability to care for themselves, including changes in physical or mental abilities and change in behavior. It can be suitable for seniors, whether they reside at a private home, or in a senior community.

In addition to helping your loved one find treatment, there are many other ways you can help. It is common to feel at a loss about how to respond to someone who may be depressed but there are things you can say to help reassure your loved one.

• “I care about you.”
• “You are important to me.”
• “You’re not alone in this.”
• “It will pass; we can ride it out together.”
• “Do you want a hug?”
• “I’m not going to leave/abandon you.”
• “If you need a friend….”
• “I like/love all of you.”
• “I’ll stick with you no matter what.”
• “All I want to do is give you a hug and a shoulder to cry on.”
• “You are not crazy.”
• “I’m sorry you’re in so much pain.”

Examples of other ways to help include; inviting them out and scheduling regular social activities, seeing that they eat healthy meals, encouraging them to follow through with treatment, making sure all medications are taken as instructed and most importantly watching for suicide warning signs and reporting immediately if you suspect they might be thinking about suicide.

Helen was born in Ithaca, NY on Feb. 14, 1908 and eventually moved to Washington, D.C. at age nine. She is the daughter of Robert Harold Ogle, one of the founders of the Alpha Phi Alpha organization which began at Cornell University in the same year as her birth.

Over the years, Helen and her sister were raised by her father and grandmothers after her mother had passed away when she was an infant.

Helen, who graduated from Dunbar High School, the Miner Normal School for colored Girls (now part of the University of the District of Columbia), and Howard University, has always been a warm, friendly and outgoing person with a love for poetry.

After 37 years of teaching in the Washington D.C. public school system, Helen retired to utilize her passion and skills to write poetry and children stories. Always wanting to enjoy life to the fullest, she also started a poetry club while traveling to various locations and working feverously in her church.

When arthritis eventually took its toll, she decided it was time to make the transition to an assisted living home. She was looking for a place with a home-like atmosphere in a family setting. With a little research, Helen and her loved ones found the perfect fit at Gentle Steps Assisted Living located in Riverdale, Md.

Here, she is genuinely loved and cared for. She and her family are superbly pleased with the high level of warm professional care that she receives from the staff as well as the cleanliness and ambiance of the facility. “The food is good and I have some friends here to keep me company,” she says.

Another aspect that makes Helen extremely happy is the security in knowing that the owner is a registered nurse who is very visible.

Most importantly, the warm and friendly environment the community provides has allowed and encouraged Helen to recite from memory the hundreds of poems she loves and cherishes.

Though they share similar interests, it is no wonder Josephine and Ray have become great friends as caring individuals who have served others during their lives.

A registered nurse, Josephine utilized her certification in different areas. From working in the emergency room to industrial nursing, she truly enjoyed making a difference in people’s lives, and it is something she has carried with her to this day.

“Up until about two years ago, she continued to have annual reunions with her nursing school class,” said Ann Newman, Josephine’s daughter.

It was when her macular degeneration worsened that prompted her to seek a community with the help of her daughter.

“The day she called, I had gotten an ad in the mail for Arbour Square and I was impressed with the no down payment, month-to-month rental,” said Ann. “I then visited and was so impressed with the building and the wonderful people.”

For Ann, the amenities and services her mother would receive were a great deal compared to other communities that had large entrance fees. Site unseen, Josephine settled into her stylish apartment with a view in 2007 and could not be happier.

Along with group exercise programs at the community’s fitness center, she remains active attending music programs, and of course, playing pinochle every week with her best friend.

Originally from western Pennsylvania, Ray joined the Army and served in the Corps for over three years. When he returned from overseas, he worked 42 years for U.S. Steel and Fairless Steel Works.

After his wife of 60 years passed, one of their three sons suggested he downsize and make the transition to a community that could offer everything he needed.

“My son lived around here at the time and saw Arbour Square,” said Ray. “He told me about it, so we visited and that is when I decided to come here.”

Since his move two years ago, he has enjoyed a maintenance-free lifestyle with his fellow residents as several services including housekeeping, meal preparation and transportation are all provided at the community. This has allowed Ray more time for the numerous available activities as he takes bus trips to casinos and race tracks while showing off his Wii bowling skills.

“I had surgery, so I’m hoping to eventually get back into swimming and playing Golf too,” he said.

From the frequented indoor Main Street to energetic ‘Brain Teaser’ games there are plenty of opportunities for people to stay active. The numerous amenities and services, however, will only expand as staff and residents eagerly anticipate the opening of The Birches, Arbour Square’s Assisted Living Community. This will feature 44 assisted living apartments with an additional 25 in a secure memory care unit.

For Ann, this will be just one more perk for her mother and their new friend.

“This is truly a lovely place,” she said. “The décor is great, there are lots of activities for them, and the people here could not be any more helpful.”

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.

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.

“Pain management had been a constant struggle,” said Margaret’s daughter-in-law, Robbie. So was the relatively simple act of changing the linens or any other movement that might suggest to Margaret that she was falling again. When Margaret developed pneumonia and her health declined further, her physician, Dr. Anil Patel, recommended that the family consider hospice care. They knew that hospice care was available in the home, but they were surprised to learn that home can include assisted living or long-term care facilities, or even hospitals.

Luckily, Margaret lived at one of several area facilities that participate in Capital Hospice’s Centers of Excellence, a new program designed to make hospice care more accessible in long-term care facilities.

“The American Medical Directors Association has indicated that a significant percentage of nursing home residents may be hospice eligible. Our goal is to make access to hospice expertise easy,” said J. Cameron Muir, M.D., Capital Hospice Vice President of Medical Services. Hospice experts are able to offer end-of-life care and pain management specially tailored to the patient’s needs, as well as grief support to the family and long-term care facility staff, who often become part of a resident’s extended family.

For instance, when Capital Hospice’s Georgine Tedrow, an RN with advanced training in pain and symptom management, began to work with Margaret and her family, she recommended changes to her care plan. Georgine also recommended changes in Margaret’s medication to better manage her pain. And she changed her physical therapy goals to make them more realistic. At her suggestion, a Capital Hospice chaplain came to visit Margaret to address her spiritual needs. And when Margaret became agitated by people in or near her room, Georgine told her it was okay to ask them to quiet down or leave.

Robbie found that Georgine’s expertise and self-assurance inspired confidence in her mother-in-law. When Margaret was feeling better, she began calling Georgine “the boss.” Robbie related that during the next couple of months Margaret was comfortable enough to become quite social again.

Margaret died in late December 2004, her pain under control, her family at ease with her care and by her side. Robbie says Capital Hospice left an indelible mark on her family: “It affected my mother-in-law’s overall quality of life. At one point, I’d look into her eyes and the spark seemed to be gone. Then it returned. That’s what hospice did.”