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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.
Case
Study |
WHEN
IS HOME HEALTH CARE APPROPRIATE?
Because it is not always clear to the average person when an ailing senior
needs home health care and when he or she needs nursing home care, it is
usually best to consult a medical professional for advice. The following
case study describes one situation in which home health care proved to
be the right choice.
Francis is 84 years old and recently had a stroke. She was hospitalized
briefly and then discharged to continue recovering at home. To enable her
to return home, her doctor called a home health care agency, and the agency
gave Francis a complete home health care plan for six weeks. Since the
doctor ordered the home care for Francis, Medicare paid for it.
For the first week after Francis went home, a nurse visited her every day.
The nurse met with Francis’s family to discuss her special dietary
needs and to arrange for exercise therapy to help Francis regain her strength.
Once that was done, the nurse visited Francis twice a week to check on
how well she was recovering. The home health care agency also sent a homemaker,
a personal care attendant, and a physical therapist to visit Francis several
times during the week. The homemaker would do the shopping and cook light
meals. The personal care attendant would help Francis bathe, get dressed,
and walk. The physical therapist would keep Francis moving and see to it
that she got some exercise to aid in her recovery.
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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:
- How long has the agency
been serving this community?
- Does the agency have any
printed brochures describing the services it offers
and how much they cost? If so,
get one.
- Is the agency an approved Medicare provider?
- Is the
quality of care certified by a national accrediting
body such as the Joint Commission for the Accreditation
of Healthcare Organizations?
- Does the agency have
a current license to practice (if required in the
state where you live)?
- 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?
- 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?
- Does the
care plan outline the patient’s course of treatment,
describing the specific tasks to be performed by
each caregiver?
- How closely do supervisors oversee care
to ensure
quality?
- Will agency caregivers keep family members
informed about the kind of care their loved one is
getting?
- Are agency staff members available around the
clock, seven days a week, if necessary?
- Does the agency
have a nursing supervisor available to provide on-call
assistance 24 hours a day?
- How does the agency ensure
patient confidentiality?
- How are agency caregivers
hired and trained?
- What is the procedure for resolving
problems when they occur, and who can I call with
questions or complaints?
- How does the agency
handle billing?
- Is there a sliding fee schedule based
on ability to pay, and is financial
assistance available to pay for services?
- Will the
agency provide a list of references for its caregivers?
- Who
does the agency call if the home health care worker
cannot come
when scheduled?
- 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.
To get help with your Medicare questions, call 1-800-MEDICARE
(1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech
and hearing impaired) or look on the Internet at http://www.medicare.gov.
WHERE CAN I LEARN MORE ABOUT HOME HEALTH CARE?
There are several national organizations that can provide
additional consumer information about home health care
services. These include the following:
- The National Association for Home Care, which can
be reached at 202-547-7424 or by visiting its website
at
www.nahc.org. The postal address is: 228 7th St.,
SE; Washington, DC 20003.
- The Visiting Nurse Associations
of America, which can be reached at 617-737-3200
or by visiting its
website at www.vnaa.org. The postal addresses are:
99 Summer
St., Suite 1700; Boston, MA 02110.
To find out more about home health care programs
where you live, you will want to contact your
local aging
information and assistance provider or area agency
on aging (AAA). The Eldercare Locator, a public service of the Administration
on Aging (at 1-800-677-1116 or www.eldercare.gov) can help connect you
to these agencies.
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