Home Care

WHAT IS HOME HEALTH CARE?

Home Health Care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of services and can often delay the need for long-term nursing home care.

More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.

At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.

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HOW DO I MAKE SURE THAT HOME HEALTH CARE IS QUALITY CARE

As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.
In looking for a home health care agency, the following 20 questions can be used to help guide your search:

1)     How long has the agency been serving this community?
2)     Does the agency have any printed brochures describing the services it offers and
         how much they cost? If so, get one.
3)     Is the agency an approved Medicare provider?
4)     Is the quality of care certified by a national accrediting body such as the Joint Commission
         for the Accreditation of Healthcare Organizations?
5)     Does the agency have a current license to practice (if required in the state where you live)?
6)     Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights
         and responsibilities of both the agency and the senior being cared for?
7)     Does the agency write a plan of care for the patient (with input from the patient, his or
         her doctor and family), and update the plan as necessary?
8)     Does the care plan outline the patient’s course of treatment, describing the specific tasks to
         be performed by each caregiver?
9)     How closely do supervisors oversee care to ensure quality?
10)   Will agency caregivers keep family members informed about the kind of care their
         loved one is getting?
11)   Are agency staff members available around the clock, seven days a week, if necessary?
12)   Does the agency have a nursing supervisor available to provide on-call assistance
         24 hours a day?
13)   How does the agency ensure patient confidentiality?
14)   How are agency caregivers hired and trained?
15)   What is the procedure for resolving problems when they occur, and who can I call
         with questions or complaints?
16)   How does the agency handle billing?
17)   Is there a sliding fee schedule based on ability to pay, and is financial assistance
         available to pay for services?
18)   Will the agency provide a list of references for its caregivers?
19)   Who does the agency call if the home health care worker cannot come when scheduled?
20)   What type of employee screening is done?

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.

Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services).

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

• Illnesses/injuries, and signs of an emergency medical situation
• Likes and dislikes
• Medications, and how and when they should be taken
• Need for dentures, eyeglasses, canes, walkers, etc.
• Possible behavior problems and how best to deal with them
• Problems getting around (in or out of a wheelchair, for example, or trouble walking)
• Special diets or nutritional needs
• Therapeutic exercises

In addition, you should give the home health care provider more information about:

• Clothing the senior may need (if/when it gets too hot or too cold)
• How you can be contacted (and who else should be contacted in an emergency)
• How to find and use medical supplies and medications
• When to lock up the apartment/house and where to find the keys
• Where to find food, cooking utensils, and serving items
• Where to find cleaning supplies
• Where to find light bulbs and flash lights, and where the fuse box is located
   (in case of a power failure)
• Where to find the washer, dryer, and other household appliances
   (as well as instructions for how to use them)

A WORD OF CAUTION . . .

Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

HOW CAN I PAY FOR HOME HEALTH CARE

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans' Administration, and private insurance.

Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:

• The patient must be homebound and under a doctor’s care;
• The patient must need skilled nursing care, or occupational, physical, or speech therapy,
   on at least an intermittent basis (that is, regularly but not continuously)
• The services provided must be under a doctor’s supervision and performed as part of a
   home health care plan written specifically for that patient
• The patient must be eligible for the Medicare program and the services ordered must
   be “medically reasonable and necessary”
• The home health care agency providing the services must be certified by the
   Medicare program.

WHAT SERVICES DO YOU NEED

Home care services can enhance your health and quality of life by helping you maintain your independence. The type of home care service you may need depends on factors such as your mental and physical health, what kind of support you have from family or friends, and whether you live in your own home or in a facility that provides some types of assistance. Home care services can range from help with chores to professional health care and rehabilitation.

WHO SHOULD CONSIDER HOME CARE OR HOME HEALTH CARE
You may consider home care services if you need assistance caring for yourself because:
• You're less able to care for yourself as you get older
• You have a disability
• You're recovering from an illness, surgery or a hospital stay
• You're living with a chronic illness
• You have a terminal illness

WHAT HOME CARE SERVICES ARE AVAILABLE
Home care services provide you with a range of assistance, including skilled medical care, home support services or a combination of both.

Skilled care Conducted under the direction of your doctor, skilled care consists of services provided by health care professionals such as nurses, medical social workers and physical therapists. It can also include activities such as home dialysis and physical therapy. There are several types of professional home care providers:

Physicians diagnose and treat illnesses and work with your home care providers to determine which services you need and when you need them. They also recommend specialists when necessary.

Registered nurses (R.N.s) and licensed practical nurses (L.P.N.s) provide professional-level medical services such as injections and intravenous (IV) therapy, wound care, health education, and medical assessments. R.N.s may also provide case management services.
Social workers help you and your family find community resources and provide counseling. Social workers also serve as case managers and can help coordinate a variety of services to make sure you have the medical treatment and support you need.

Physical therapists help restore strength and mobility after surgery or an injury or if you are disabled. They use specialized equipment to relieve pain and treat injured joints and muscles. Physical therapists can also teach you or your caregivers techniques for walking and helping you move from one position to another.

Speech therapists help you regain your ability to speak and communicate, and may also help you with breathing, swallowing and muscle control. In most cases, these services are needed after surgery or stroke.

Occupational therapists (O.T.s) use rehabilitation techniques to help you learn how to manage everyday tasks such as eating, bathing, dressing and minor household chores.
Dietitians evaluate your dietary needs and advise you on how to make sure you are getting appropriate nutrition.

Home support services These services include tasks such as light housecleaning, running errands and preparing meals. These services may be all you need to allow you to continue living independently in your own home.

Home care assistants or home health aides help with daily activities such as getting in and out of bed, getting around, bathing, using the toilet, and getting dressed. Homemakers and chore workers help prepare meals, shop, do laundry and other housekeeping chores.

Companions stay with you if you cannot stay alone at home for medical or safety reasons. They provide companionship and some assist with household tasks.

Home care services can also include:
• Medical equipment delivery, set up and maintenance
• Lab tests and X-rays
• Medication delivery and pharmacy services
• Respiratory therapy, dental care or treatment from other health professionals
• Clergy visits
• Transportation
• Meal delivery
• Emergency monitoring systems
• Combination care

Some home care offers a combination of services provided by a team that includes a mix of doctors, social workers, registered nurses, dietitians, home health agency staff, visiting nurses, therapy specialists, home care aids, chore workers, clergy and others. The team carries out a detailed care plan tailored to meet your specific needs.

PAYING FOR HOME HEALTH CARE (2)
Home health services can be costly. You may need to pay for home care services directly, or costs may be covered through insurance or other public or private sources.

Medicare Medicare may pay for medical home health care services through a certified home health care agency, if a physician orders these services. Services covered by Medicare include skilled nursing assistance, or physical, speech or occupational therapy. If your home health services are covered under Medicare, your doctor, care manager or discharge planner will probably make arrangements for a home health care agency.

Medicaid Depending on your income and assets, if you are over 65 you may be eligible for Medicaid coverage.

Older Americans Act This federal program funds state and local programs that provide services to frail and disabled individuals who are 60 years old or older.

Veterans Affairs
If you are a veteran and at least 50 percent disabled due to a service-related injury or illness, you may be eligible for medical services through Veterans Affairs hospital-based home care services.

Community organizations Depending on your situation and finances, certain community organizations cover home care costs.

insurance Many insurance programs cover some home health care services for short-term medical needs. However, long-term coverage varies. Long term care policies are available through private insurance companies and the federal government.

HOW CAN YOU FIND THE HOME CARE SERVICES THAT ARE RIGHT FOR YOU?
The first step to finding a home care service is to talk to your doctor or your physical or occupational therapist about what services you'll need. You may only require an occasional visit from a nurse to administer medication, or you may need more elaborate medical care or other types of support.

Your nurse, doctor, hospital social worker or hospital discharge planner may be able to recommend several reputable home health care agencies. Your friends or family also may be able to provide some insight into which home care services provide the best care. Or you can check the Yellow Pages, under the heading "Home Health Care Services" or "Nurses." Other sources include your state and county health department and Area Agencies on Aging and the national Eldercare Locator, a public service of the Administration on Aging. Once you know what types of services you need, evaluate the costs, credentials and services offered by each provider you are considering.

Finding the right home health care services requires communication with your doctor or other health professionals, and a little research. But qualified home care is an important treatment option that can improve the quality of life of both the person receiving care — and the family members.

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