Making the choice: What home health care fits you best?
11/11/2019 by Chad Ellis, LICSW
At some point, all of us will have to make health care decisions for ourselves or loved ones. One option is receiving care at home, which can increase the quality of live for the patient and their family since the patient is cared for in the comfort of their own home. One size doesn't fit all, so home health care agencies tailor care to meet the individual consumer's needs. Services can be provided on a short-term, long-term or intermittent basis and range from complex skilled nursing to brief custodial care. These services can cost less than care provided at a facility.
Arranging for home care
Finding an experienced and compassionate caregiver can be challenging, but doesn't have to be. Consumers can arrange home care services through an agency or by hiring an individual directly. Home care providers must be registered or licensed by the Minnesota Department of Health. Some agencies are also Medicare-certified, which requires both a state license and federal certification for certain standards of operation. Home health care agencies work to ensure the consumer is matched with a caregiver that has the skills, qualities and expertise to meet their needs.
It's important to be an informed consumer when deciding on home health care. Agencies provide information about their services directly over the phone. Generally, it's best to compare the availability of service, insurance coverage, policies and credentials of the agency before deciding to hire them. A face-to-face meeting with the patient's health care provider must take place 90 days before or 30 days after the start of service. This visit needs to be related to the reason for seeking in-home services.
Once you've chosen an agency, the patient will have an appointment with a registered nurse care coordinator who will oversee their care. The nurse care coordinator will collaborate with the care provider and patient to detail a plan identifying the type and frequency of service and its projected outcome. The agency will then begin making regular scheduled visits, providing the agreed-upon care to meet the patient's needs.
People are often eager to resume their activities and lifestyle after being in the hospital. Their provider may refer them to a home health care agency for occupational, physical and/or speech therapy.
- An occupational or physical therapist can assess the patient's ability to function safely and independently at home. They check out the home environment, identify fall risks and make recommendations, if needed, for adaptive equipment, such as ramps and grab bars. They also provide in-home training to maximize the patient's ability to perform daily tasks.
- An occupational therapist helps the patient regain independence in taking care of themselves, such as dressing, bathing and preparing meals.
- A physical therapist helps the patient restore strength, balance, mobility and stamina.
- A speech therapist helps improve the patient's ability to communicate and swallow.
Home health care agencies also can provide skilled nursing care, which often reduces the length of a hospital stay and prevents recurrent hospitalizations. In-home skilled nursing helps the patient recover from an illness and increase their independence as they learn to take care of their own health needs. Some typical needs for skilled nursing would include IV therapy, wound care, medication management and palliative care.
Home health care agencies use home health aides to provide hands-on assistance with activities of daily living to patients who aren't able to safely perform them independently due to physical or cognitive limitations. They commonly perform tasks that don't require the expertise of skilled nursing, including managing personal cares, bathing, grooming, hygiene, walking, transfers, light housekeeping and meal preparation. The services provided by home health aides are only covered through Medicare insurance when there is also a "skilled" need.
Medicare, Medicaid, VA benefits, county-waivered funds, and some private health insurance policies may cover the fees for the services. Home health care services are most commonly covered by Medicare, as long as it's medically necessary and prescribed by a provider, there's a "skilled" need, and the individual is homebound.
- Skilled need. This refers to occupational, physical or speech therapy, or a skilled nursing service for IV therapy, wound care, medication management and palliative care.
- Homebound. Medicare considers an individual homebound if leaving the home involves considerable and taxing effort and absences from home are infrequent and brief. Even if the individual is considered homebound, they can still go to medical appointments, religious services, and for short periods of time, special non-medical events without affecting their homebound status.
For more information and assistance, call the Senior LinkAge Line at 1-800-333-2433. This is a free service to help you find answers to a wide variety of questions. Trained information specialists will work with you to understand your needs and goals and can connect you to services. You can also find more resources on the National Council on Aging's BenefitsCheckUp website.
Chad Ellis, LICSW, is a licensed, independent clinical social worker and a member of the Integrated Behavioral Health team (IBH) within Employee and Community Health (ECH). He has previous experience with inpatient psychiatry and in the community, working primarily with adults, children and families.