Home Health Care

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Are you or a loved one struggling with health issues that are making it harder to remain at home? Are you looking for care to help you recover from surgery or an injury? Do you need help with household chores or activities of daily living? Is managing a long-term illness becoming more difficult? Home Health Care is a rapidly growing field in the senior care industry that may help families negotiate these challenges and remain in their own home.

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.

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