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Is Home Care the Right Choice?
Sorting Through the Options for In-Home Care

Imagine this scenario: Your mother’s eyesight is steadily deteriorating and she just doesn’t seem to take care of herself like she should since your dad passed away. Dirty dishes and laundry are piling up and you’re not sure she’s even eating properly. You know it’s time for some additional help, but don’t want to remove her from the comforts of her home if possible. You’ve thought about home care, but how do you know which in-home care choice is the right choice?

The variety of options (who pays, what is covered, what is best for the situation) for in-home care can be confusing. I believe it is important to get educated on the similarities and differences for care in order to adequately plan for anticipated long-term care needs.

When extra help and companionship at home are needed, Private Duty/Private Pay Services are sometimes a good solution. Private Duty/Private Pay services are mostly “non-medical” and can range from companionship, housekeeping, transportation, personal care, and dementia care to 24-hour or respite care.

Within Private Duty/Private Pay, there are two models of care:

1) Full Service Agencies, which provide non-medical care by employees of the agency who are screened, trained, monitored and usually bonded and insured.

2) Nursing Registries/Healthcare Registries, which act as “matchmaker” services, assigning workers to clients and patients who need home care. With Registries, the responsibilities of managing and supervising the worker as well as the worker’s taxes and workers’ comp issues fall on the consumer. 

Private duty services are usually paid directly by the client or family members. If the recipient has the policies and if the agency qualifies for reimbursement under the policies, long-term care insurance, workers’ compensation and some armed services funding may cover some of the costs. Other potential funding resources are reverse mortgages and life insurance settlements. Medicaid and other low-income sources are other possibilities to pay for some in-home services, if one qualifies. To access Medicaid services, the client must first be assessed by a state agency that gate-keeps the program and be approved for a specific number of home care hours or given a voucher for a certain amount of care.

Home Health Care is a short-term option allowing a person to convalesce in the comforts of home while still experiencing the benefits of skilled care. Besides skilled nursing care, services at home health care agencies may include rehabilitation with physical, speech, respiratory and occupational therapists as well as care for a wound (dressing changes), injections, monitoring of health conditions like diabetes or heart disease, and assistance with medical equipment. Home health care does require a physician’s referral, which can be obtained by a physician calling the home health agency, the home health agency soliciting a referral from a physician on the patient’s behalf, or as part of a physician’s hospital discharge plan for a patient.

Hospice Care is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments. Hospice entails a range of services, from nurses and mental health professionals to spiritual advisors, and can be in a home or a hospital setting, but it is required that someone be with the dying patient at all times.

Hospice costs are sometimes covered by private insurance providers as well as a special hospice coverage that has similar requirements to Medicare. Additionally, most hospices provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.

If all of this information seems overwhelming and an overall advisor and care manager is preferred, Geriatric Care Management may be a solution. Geriatric care managers can assess the situation and provide suggestions and/or a plan of care. In addition, they oversee personal, daily money as well as household management that falls outside of the services of a direct care provider. Other services care managers provide fall into categories that bridge the gaps between direct care and ongoing care needs, which may include coordinating medical and other care providers, family communication, or assisting a move into another living arrangement and the closing up of a household. Payment is generally out of pocket for professional services, invoicing by the hour or by the project.

Please contact a local full-service home care agency for more information and for educational resources for family caregivers. With a little planning, if the situation is appropriate for it, the frail elderly can safely remain in the comfort of home—and maintain a feeling of independence.

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