Part 2 Health Care Choices
Three days ago I touched on a couple of the home care options for those needing assistance with care. Today I’d like to go into a little more detail about home care agencies, how they differ and which one may be right for you or your loved one.
I mentioned in the previous blog that if your choice was a home care agency that it was wise to choose one that was Medicare certified. There are several reasons for this. Medicare will pay for some short term care in the home if there is a skill required such as nursing or therapy. For instance home going after surgery could include dressing changes, wound care, pain management, medication education by an RN or strength training by a Physical Therapist. As long as there is a skill involved home health aides may also be assigned to assist with personal care 2-3 times per week. THIS IS NEVER 24 HOUR CARE. These are visits done in 1-2 hour increments. Medicare will usually pay for this care up to 30 days or until a family member can be taught to do the care. If there is no family member to teach 30 to 60 days is maximum. Think of it as a short term insurance policy – not long term care.
Medicare certified agencies have to meet strict guidelines to participate in the Medicare program therefore it is more likely the quality of care provided and the integrity of the agency is higher.
While many agencies are Medicare certified some are better than others and have better outcomes for their patients. This can be evaluated on the Medicare web site of Home Health Compare.gov. You will be asked to enter the zip code or the county where you are interested in receiving care. You will then be given a list of all the agencies – Medicare certified – providing care in that area. CAUTION: They will list ALL Medicare agencies serving that zip or county. That does not mean the agency is actually physically located there. That is important for several reasons. Locally run agencies have a vested interest in providing the best care to their clients as they are staffed, and run by people who live in the community. Their reputation is important to them. Trust me, I know, having been part owner and administrator of a local agency for 25 years. It is very important to know the community, be part of the community and provide staff who live in the community.
Once you see the list of agencies you will be asked to narrow it down to three to compare at a time. When you have chosen you will then see how they rate in 20+ areas of care and how that compares to the national average. Do your homework.
As you are choosing an agency don’t be afraid to ask questions. Ask how long they have been in business. Ask if they have a minimum number of hours per day that you must use them. Ask for hourly rates. Most expensive does not always mean best. Ask how many different people they would be sending to your home and if it is possible to limit it to two or three regular people. Are they insured and bonded? This is important should an employee injure herself/himself or break something while on your property. Ask how often employees are supervised and by whom. How soon are they able to start care?
Once an agency has been chosen be prepared to spend a minimum of two hours with agency personnel filling out paperwork, giving a medical history, talking about the care you expect to be given. Its very important that everyone’s expectations are laid out from the beginning so there are no surprises or misunderstandings of what will be provided and when. The nurse interviewer will want to see ALL medications, even over the counter meds, vitamins and supplements so have them on hand. She will need the name and addresses/phone numbers of all doctors involved with the patient’s care.
Some agencies provide care to Medicaid patients. While Medicaid pays for some aide and some skilled visits (on a much longer basis than Medicare) they must be justified and cannot just be for housekeeping or errands. They must involve hands-on personal care. The Ohio Waiver program is also available to Ohio Medicaid recipients, Medicaid recipients who have the need for more hours of care with a chronic on-going problem.
A third government program is called Passport. This wonderful program is meant for the lower income patient who may not need skilled care but needs assistance at home to remain at home and out of a nursing home. In most cases it is more economical for the state to keep someone at home than to pay for care in a skilled nursing facility or nursing home. Hours are assigned by a Waiver or Passport case manager once the application has been received and approved. Any good Medicare certified agency should be able to give you all the information you need about these programs and help you apply for them.
Care in the home is an excellent option for many people. It helps people maintain their independence by having a little help with care they are unable to do for themselves but may not need someone in the home full time. As a patient’s condition changes the care needs may change and hours can be increased or decreased as needed. I can remember many years ago my agency took into care a woman who’s husband only needed someone to stay with her for two hours once every two weeks while he did the grocery shopping and got a hair cut. As her condition worsened he gradually increased to a few hours a day. We provided care for her and meals for him for two years before she died. At that time he decided HE needed some help and kept our aide on to do meals and a little light housekeeping. Long and short, because we gave his wife outstanding and regular care by keeping aides he was familiar and secure with in his home, he continued with us for several more years until he died. We were able to change the amount and level of care as his and her needs changed.
In some cases home care is not an option. If intensive Physical or Occupational therapy is needed it is sometimes best provided in a rehabilitation center. While home care agencies usually have therapists on staff, the equipment needed for hydrotherapy, parallel bars, ultrasonic treatment are not. Often a short stay in a rehab center can be augmented with follow up home care therapy.
Another reason home care may not be appropriate could be the home is not safe. Would this be a good time to mention the snake that fell out of a hole in the ceiling in a home where we were caring for a patient? Safety can be something as simple as stairs the patient cannot get up or down, no downstairs bathroom or bedroom. Sometimes these conditions can be circumvented by putting a bed in a living room or other downstairs room and the use of a bedside commode. Other times equipment needed to move, transfer or transport patients is too big to fit in the home or through the doorways.
The socialization needs of the patient must be considered as well. While suitable physical care is able to be provided there may be a need for the patient to be around other people, still go on outings, have more stimulation than what the home environment provides. Living alone, with an altered health status, inability to to things that they previously enjoyed, changing health care needs, can cause depression and withdrawal. For these people I recommend an environment of planned outings and activities, social rooms, meals in a community dining room – an assisted living apartment or senior condominium arrangement that can provide as much or little care as needed.
The last type of agency care I will mention here is the type that only provides companion and housekeeping care, agencies like Home Instead. If the only deficit is in the patient’s ability to do what is needed to keep up the home, drive to the grocery, do errands, this type of agency will meet that need. The only shortcoming is continuity of care. As health care needs increase to actual personal care this type of agency cannot continue to provide care.
So in a very large nutshell that is Home Care Agency 101.
I would be happy to answer any questions anyone may have after reading this blog. Leave me a message or an e-mail and I will get back to you.