Understanding In-Home Care Options and How to Manage Services. Part One

Finding the correct match for “Need to Providers” has become increasing difficult. The need can spontaneously appear with any sudden health crisis. I hear all the time “I don’t need this, now” and sadly more often “I wish I had known this 2 months ago”.   This will be in two parts, the first here is understanding home care options.  I will follow with how to manage services.

To get the best answers it is always safest go an expert.  Carol Connor business is to get the patient or family to the correct service provider. She does the “Need to Provider” connection.

Carol, can you give us an overview of what you are seeing in our community?

I find many residents of Sun City love your life and enjoy being active, but for many it is becoming harder to accomplish what you want to do. Sometimes, bodies just can’t keep up with our spirit. Chronic conditions like arthritis, progressive diseases like Parkinson’s or sudden events like falls or even stroke are limiting our activity level. We’re not ready to give up our circle of friends and our interests, we just need a little help. Adding care in the home can make all the difference in recovery from an illness or maintaining a good quality of life. It can provide daily or weekly support for things like safe showering, meal preparation, exercise, transportation and more to keep you going strong. As with much healthcare, there is a lot confusion about care in the home, what it can do and who pays for it.

Carol where is the best place to start?  I think need to understand what does Medicare is and what it covers.  Let’s start with what Medicare IS?  Medicare is health insurance for anyone over 65 or who is under 65 and receiving Social Security Disability. Medicare covers all or part of the costs of physician visits, hospital stays, short term rehab after a hospital stay and some medical equipment. It does not cover long term care. It does cover some limited temporary home healthcare after a hospital stay or when there is a nursing need, i.e. wound care, to be met.

Carol are you able to simplify the difference between Home Healthcare and Home Care?

Home Healthcare services, ordered by a physician, are nursing or therapy visits to homebound patients by a licensed RN, LPN, Licensed Therapist. It’s typically recommended after a hospital stay or for those with ongoing skilled nursing needs. Wound care, ostomy care, tracheotomy and ventilator management and other complex care, performed by a nurse. Home healthcare is limited to nursing visits plus physical, occupational and speech therapy for home bound patients.  These visits are paid for by Medicare, as long as they are medically ordered as a skilled need.

Home Care services provide Certified Nursing Assistants or aides to assist with activities of daily living (ADLs.) They can assist with bathing, dressing, hygiene, toileting, meals and transportation. They are not permitted to dispense or touch medications Home healthcare is limited to physician ordered nursing visits plus physical, occupational and speech therapy for home bound patients.

How much does Home Care cost?  Costs are calculated on an hourly rate and is based on the shift, the day of the week, the length of the visit and the number of hours per week. The scope of care will also impact your rate. Weekend and evening hours are typically billed at a higher rate than day shift during the week. Shorter visits are billed at a higher rate. Maintaining a regular schedule is important. It is much easier to find a qualified care giver if hours are consistent.  While some home care services can provide a caregiver on short notice, home care is not “on demand” for sporadic needs. Pricing may vary with agencies but the range is typically $21/hour-$26/hour.

Carol how can we maximize home care service: Think about your goals for goals for home care and discuss them with your physician first to see if any can be ordered as home healthcare and not paid for as out of pocket.   Then discuss with the caregiver you will be working with to  provide both assistance and engagement during their visit. Share as much information about the person needing care as you can. Background information like interests (former and current), activity level, education, cognition and personality gives the team insight into how to interact with and stimulate your loved one. When aides stay on their phones or preoccupy themselves to pass time, they are likely to annoy or aggravate both the family and  the client needing care. For dementia patients, it can create agitation or a feeling of “being guarded.” Collaborate on a list of tips, games, outings, activities, music, conversation topics, etc the patient enjoys to help the caregiver successfully connect with their client. Is exercise or time outdoors important? Share any routine or schedule that you’re using, as well as any risks to watch for. Is your loved one prone to falls or wandering? Do they prefer to do as much or as little for themselves as they can? Make the aide aware and offer tips on how you successfully manage that. Remember that there’s learning curve for both you and the care staff. Work with the care team to help them understand the person as well as the physical need, and get to know the caregivers. If you feel a particular caregiver is not a good fit, explain why to your case manager and work together to find a better fit.

Agencies employ many caregivers and fitting the pieces of their schedules together among several clients is like working a puzzle in some cases. Like any working person, caregivers need to know they will consistently have work. Frequent cancellations or changes to your schedule can affect how secure in their position and aide feels. Shorter shifts are harder to fill than longer shifts on a regular schedule. Let the agency know if your hours are specific or if you can be flexible for the right caregiver. Find out their policy on filling a shift when one of their caregivers is out sick or on vacation. If it’s critical that the shift is filled, let them know that up front. Cases can be opened quickly, sometimes even the same day, but understand that the first few shifts will be filled with caregivers available on short notice. It may take a few days or a week until a consistent caregiver and good fit is available. Agencies will do their best to provide the best team member as quickly as possible.

Is it right for you? Home care and home health can be great options for helping someone stay in their home. It can aid in recovery from medical events and help sustain someone with chronic conditions. It should enhance their quality of life at home and in the community. If care needs start to exceed 8 hours/day, or if your loved one is at risk of wandering or living in solitary , it’s time to look at other options like day care or assisted living. Caregiver burnout in families is very real and will cause mental and physical decline for both the caregiver and the person they are caring for. The national statistic can be as high as two out of three can predecease the ailing person.

Communication is everything. If your social circle has dwindled and your stress level has increased, your own health is being impacted. Talk with family, a trusted friend, or a support group to help manage the stress and to support you as you care for someone. If it’s time for a change, contact a senior care advisor like 65 Senior Street to help guide you through options for communities that will fit your need.