INFORMATION ABOUT HOME CARE
Home care services are a range of health and related support services available to the older person who prefers to remain at home but cannot live alone without assistance. Home care may help some people achieve and sustain an optimum level of health and independence. For others, it may help to sustain the person for an interim period while institutional alternatives are being explored or awaited.
Home is more than physical space or shelter. It implies security, privacy, independence and comfort, a world of family interactions and activities, pleasurable memories and valued possessions. Understandably then, most frail older persons and their families prefer home care if they can also manage the costs, monitor services and locate appropriate resources.
WHAT ARE THE TYPES OF HOME CARE?
The two general categories for home care services are skilled care and supportive services.
Skilled Care is given under the direction of a physician and consists of health services provided by professionals such as nurses and therapists. Services include nursing care, physical therapy, speech and hearing therapy, occupational therapy, social services, etc.
Supportive Services include assistance with personal care needs (walking, bathing, dressing), chore services (shopping, meal preparation, light housekeeping), home delivered meals, telephone reassurance, etc.
WHAT AGENCIES PROVIDE HOME CARE SERVICES?
A variety of nonprofit and private agencies, hospitals, public health departments and practitioners provide home care services. Names can be obtained from hospital discharge planners, the Department of Social Services, the Department of Health, the Department of Senior Citizen Affairs and physicians.
For private agencies and practitioners a person can also refer to the Yellow Pages of the telephone directory under “Home Health Services,” “Nurses,” and “Family Counseling Services.” Churches, mosques, synagogues, and other community service organizations may also be able to provide home care workers.
WHAT KEY TERMS SHOULD BE UNDERSTOOD?
An agency committed to quality care carefully evaluates the home situation and develops a plan of service with the older person and his family that meets health, social and financial needs. Certain key terms (LICENSED, BONDED, CERTIFIED, ACCREDITED) describe agencies and their personnel. Some are a clue to quality; others are not.
- Licensed Agencies. In New York State, agencies must be licensed in order to operate. The State Department of Health usually oversees these licenses. An agency has to meet basic legal and operating requirements. Generally, these requirements do not indicate the quality of services an agency provides.
- Bonded Agencies. To become bonded, an agency pays a fixed dollar amount to obtain a bond which acts as a kind of insurance policy. If the consumer has a problem with the agency (not the employee) and sues, the consumer can be paid from the bond. Bonding does not assure good services.
- Certified Agencies. The State Department of Health certifies home health agencies. In Nassau County certified agencies are the only ones that are eligible for payment from Medicare. Some Medicaid home health services are also provided. To become certified, an agency must meet basic federal and state standards where required for financial management and patient care.
- Accredited Agencies. Accredited agencies meet standards of quality developed by nonprofit organizations dedicated to promoting excellence in home care. To become accredited, an agency must pass a careful review of all services and practices. Accreditation indicates a level of protection when choosing an agency. These national organizations accredit aspects of home care:
It is also important to understand key words (BONDED, LICENSED, CERTIFIED) used by agencies to describe their personnel.
- Bonded personnel have some protection or “insurance” against consumer claims. If a consumer has a problem with a bonded employee (for example, personal property damage), takes court action and wins, the bond can pay for the damages. The term “bonded” does not mean that employees are qualified to provide safe and satisfactory care. When agencies use the term, this almost always refers to the agency and claims against it, not their employee.
- Licensed health personnel pass a state test and are issued a license by the N.Y. State Department of Health or Education which permits them to work. Homemakers/home health aides are not generally licensed by states.
- Certified health personnel must meet the specific standards set by the national organization representing their profession. The standards usually require passing a national test and/or providing proof of work experience.
WHAT PERSONNEL PROVIDE HOME CARE SERVICES?
- Public Health Nurse is a professional registered nurse who makes an initial assessment in the home of the sick person and, together with the patient and family, designs a plan of care to carry out a physician’s medical treatment plan. Specific services include the following:
- Assesses patient’s needs.
- Provides nursing care such as giving injections, changing dressings, and colostomy, catheter and tracheotomy care.
- Teaches and provides guidance to patient and family on how to manage care.
- Interprets physician’s orders for treatment, special diets, and medicines.
- Reports back to doctor as needed.
- Physical Therapist provides the therapy needed by a patient who has lost some use of limbs or muscles.
- Speech/Language Therapist helps a patient whose speaking or hearing ability is impaired to relearn and practice language skills.
- Occupational Therapist evaluates a patient’s ability to perform the tasks of daily living (dressing, washing, walking) and retrains the patient in these activities.
- Home Health Aide/Personal Care Aide provides the following personal care services under the supervision of a nurse:
- Prepares and serves normal diets.
- Assists with grooming, bathing, walking, eating, dressing.
- Arranges schedule so that patient follows medical recommendations such as increased physical activities.
- Performs incidental household tasks essential to the patient’s health needs.
- Housekeeper/Chore worker provides assistance with routine household tasks, such as housecleaning, laundering, grocery shopping and meal preparation for the person who can care for personal needs such as toileting, dressing and walking.
- Companion offers someone to talk to and general supervision for the older person. The companion does not perform household tasks, personal care or nursing services.
WHAT QUESTIONS SHOULD BE ASKED BEFORE SELECTING
A HOME CARE AGENCY?
The following list of questions can help a person select a home health agency:
- Is the agency currently accredited, certified, and/or licensed for home care?
- Does it have written statements outlining its services, eligibility, cost and payment procedures, employee job descriptions, and malpractice and liability insurance?
- Can it provide references from professionals, such as hospital or community agency social workers, who have used this agency?
- Is the plan of care carefully and professionally developed with the individual and family?
- Is the plan of care written out? Are copies given to the workers in the home and to the older person and/or responsible family member?
- Are references on personnel required by the agency and on file?
- Are workers adequately trained?
- Are workers supervised in the home? How often? By whom?
- What arrangements are made for emergency situations?
- What is the minimum number of hours per day that an aide can be hired?
IT IS ESSENTIAL TO DEVELOP AND MAINTAIN CLEAR COMMUNICATION WITH THE HEALTH CARE AGENCY AND THE WORKERS COMING INTO THE HOME TO INSURE THAT THE OLDER PERSON RECEIVES NEEDED SERVICES AND TO HANDLE PROBLEMS AS SOON AS THEY ARISE.
WHAT IS THE COST OF HOME CARE?
The actual cost of home care depends on such factors as type of service, number of hours of service per day, the level of personnel giving care and the length of time services are needed. In addition, regular ongoing expenses such as housing, utilities, food, medical care, etc., must be included when comparing the cost of home care services to the cost of institutional care. Medicare and Medicaid pay for some home health services as do some group health plans, private long term care insurance, Veterans Administration programs, and County and philanthropic organizations. However, it is essential to check carefully, since benefits, limits, and eligibility requirements change. For those with adequate financial resources, many services can be paid for privately.
BEFORE MAKING ARRANGEMENTS FOR HOME CARE, IT IS IMPORTANT TO UNDERSTAND CLEARLY WHICH SERVICES ARE COVERED THROUGH MEDICARE AND MEDICAID. Click Here for Entitlement Programs & Financial Assistance