Home Care

In home care for elderly adults is a convenient way for many seniors to stay in their own homes for long term care. However, Family members should also discuss an aging parent’s at home care needs with the parent before they secure at-home services. Aging parents should be involved in all decisions regarding their care, whether it is at home or away from home. Keeping elderly parents involved in decisions regarding their care prevents family disagreements and emotional outbursts. It can also help seniors to avoid feeling isolated and as if they no longer are in control of their own life.  Before adult children secure the services of at home care agencies they should make sure that their aging parent lives in an area that is easily accessible. They should also make sure that they and other family members can meet expenses associated with at home care, particularly if the care is needed long term. Since providing home care for the elderly is expensive and stressful, learning more about home care financing options is a good way to ease the stress of paying for long term care.

Using Medicaid and Medicare for Long Term Care

Older adults with limited funds usually receive help with some or all of their home care expenses via Medicaid. All of the states except Arizona have some form of home and community-based Medicaid waiver that promotes in home care for seniors. Elderly adults that meet the requirements for nursing home services and have a limited income may be eligible for the Medicaid home and community waiver in their state.

Medicare is available to all adults 65 and older. However, Medicare is meant for acute health episodes, and not long term care. Although Medicare will not pay the majority of home care costs, older adults who are homebound, need skilled services, and require intermittent help may be able to receive some home health care services under Medicare funding.

Consider Long Term Health Care Insurance

Many seniors do not purchase long term care insurance. Large premiums and a fear of aging make it impossible or improbable that some will even think about a long term care insurance policy. However, those who have investments totaling over $500,000 may want to consider purchasing a long term care policy. Each policy is different, with some covering only nursing home costs while others cover much more. Do appropriate research and read the fine print before agreeing to a long-term care insurance policy.

State Programs and Out of Pocket Costs for Senior Long Term Care

Finding state programs that provide in home care funding for an elderly relative can be difficult. This is because each state has its own policies and regulations. However, older adults that do not qualify for larger government programs like Medicaid can qualify for more local state programs. Because states have greater freedom in establishing requirements for their programs, some seniors may qualify for programs at the state level.

Home Care Options

Many caregivers and families of elderly adults choose to perform many of the home care services for an older relative themselves. On the other hand, some seniors require skilled services. Determining what type of in home care, and how much of it is needed, is part of the service that home health care agencies provide. Many of these agencies will send a professional to the family’s home to assess the situation, make recommendations about what kinds of caregiver help could be useful and how much time to start out with. Usually this first visit is free and does not require people to sign up for services.

Sometimes family caregivers feel the need for more help but hesitate to call a home care agency because of a mistaken belief that they need to know exactly what they need before they call. However, calling first can help people learn what options they have, making it easier to decide whether or not to utilize home care.

Types of Care Provided by Home Health Agencies

Non-medical care – some home care agencies provide strictly non-medical care which includes things like household chores, cleaning, running errands, preparing meals, keeping the patient company or driving the patient places.

Personal care – other agencies will provide personal care aides who can help the patient bathe, dress, and move around the house. It is common for people to hire this type of aide when bathing and moving the patient to the toilet become too difficult for the family member. It is also common to use this type of care aide when the risk of the patient falling becomes great, requiring constant monitoring of the patient. Personal care aides will often do household chores during down time, for example, while the patient naps.

Medical care – some agencies may provide an in-home health care nurse or trained medical professional to provide medical services such as wound care, injections, rehabilitation and physical therapy. These types of services are often provided as part of a discharge plan after a hospital stay.

Hospice care – if the doctor has stated that the patient is terminal, hospice services may be received.

Intermittent Home Health Care

Intermittent home care is skilled care ordered by a physician following, or in lieu of, hospitalization for an episode of illness or injury. It is designed to provide a short term solution and assist patients to assume responsibility for their own care and achieve optimum outcomes for an episode of illness or injury.It includes personal care and therapies such as speech/language (ST), physical (PT) or occupational therapy (OT). Intermittent care must be skilled care and is covered by Medicare, Medicaid and private insurance.

Home Care Visits in Intermittent Home Health Care

Intermittent home health care is provided by each discipline in what is termed a visit. The visit can be as short as thirty minutes or may last as long as two hours depending on the need. The average is about 30-45 minutes. This is not long term in home care.

Skilled Care

Intermittent home health care must provide skilled care, but the pay source expects that the patient, family or other caregiver is to be taught to provide this care if it is needed for a long term basis. The skilled discipline would then make a few supervisory visits to assess the success and discuss changes to the plan with the physician as necessary.

In other words, it is the nurse’s job to teach the patient, family or other caregiver how to do the procedures such as wound care, the insulin injections or how to change the IV cassettes in between visits. The PT, OT or ST would teach the patient and caregivers how to perform the exercises needed to regain function or improve strength or skills.

As long as a nurse or therapist is providing continued skilled care visits, the patient may be eligible for home health aide visits. Again, the HHA is expected to teach the patient or caregivers how to assist the patient with personal care such as bathing, dressing, feeding.

An MSW can make one or two visits to assist with short and long term planning for the care of the patient. The MSW can also assist with counseling issues for emotional problems and coping skills if needed.

The Goal of Intermittent Home Health Care

The goal is for the patient and family or caregivers to learn and assume the care for the patient. The nurse or therapist is not there to provide the care long term. Exceptions may include patients with Foley catheters and feeding tubes which are changed periodically (i.e. once a month) by the nurse.

If patients or caregivers wish to do so, arrangements can usually be made to switch the care to a private pay system whereby the nurse or therapist does continue to provide the care and the patient or family assumes the financial responsibility for the visits.

Other Restrictions on Intermittent Home Health Care

In most cases, patients must be homebound which basically means they are (temporarily) unable to leave their home without assistance of another person. The care must be ordered and overseen by a local physician. If Medicare is the pay source, the home health agency must be a Medicare certified agency as well.

Benefits of Using a Home Health Agency

• When working with an agency it is important to make sure that they are licensed, bonded and insured, which protects the family from problems.
• Agencies can usually provide a caregiver on short notice in an emergency, or they can provide several candidates for the family to choose from.
• If the caregiver hired through the agency doesn’t work out, the agency should be able to provide someone satisfactory in their place.
• Agencies often have rigorous screening procedures and provide competent training for their employees.

Benefits of Seeking in Home Care Without Going Through an Agency

• In caregiving circles, very good home health care aids develop positive reputations and can often be found by simply asking around.
• Recommendations of whom to hire and whom to avoid can be secured by asking the medical doctor, physical therapist, hospital or nursing home personnel, friends, church members, other family caregivers.
• Sometimes it costs less to hire someone directly. Agency fees can be avoided. But more of the decisions and potential problems are left to the family caregivers to manage, as there is no agency support.

Psychological Aspects of Securing In Home Health Care

Sometimes the most difficult aspect of getting help is accepting the fact that the loved one’s illness is progressing, and that it may be too difficult to care for them on one’s own. Or, the patient may object. Support groups and counseling can be helpful in dealing with these aspects of the home health care decision.