Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.

Coverage by other financing options will vary widely, but the follow services, programs, or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:
Ø Is the provider Medicare/Medicaid certified?
Ø If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).
Ø How many years has the provider been in business?
Ø Is the provider associated with a larger health care group or hospital?
Ø Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?
Ø Will the agency help you find the best homecare options for you?
Ø Does the provider have a written policy describing the patient’s rights?
Ø Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
Ø Will the provider give you written information describing how they commence and discontinue services to patients?
Ø What backup does the patient have if their caregiver cannot show up at the scheduled time?
Ø What are the internal complaint procedures?
Ø Will the provider give a list of citations they have received from state surveyors over the past year?
Ø Does the provider have a nursing supervisor on call and available 24 hours per day?
Ø How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
Ø What types of reimbursements will the agency accept?
Ø Will the provider give a list of references?

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Are you or a loved one struggling with health issues that are making it harder to remain at home? Are you looking for care to help you recover from surgery or an injury? Do you need help with household chores or activities of daily living? Is managing a long-term illness becoming more difficult? Home Health Care is a rapidly growing field in the senior care industry that may help families negotiate these challenges and remain in their own home.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place—receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.

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“No need to ask those questions”, I pleaded with the nurse as she began her determined assessment of my mother. “Do you know what year it is?” the nurse asked. As I was intervening to help this young professional understand my mothers’ condition of dementia, it occurred to me that my mothers’ dignity was in question.

At this very moment I realized just how important the role of being a daughter was at this stage in my mothers’ last days. After years of caring for her 10 children it was our time to care for our mother as if she were our own child. Roles were now reversed and guaranteeing our mothers’ dignity became increasingly more important.

“I need to ask these questions – it’s my job”, insisted the nurse. As I persevered to discontinue those questions that were obviously upsetting my mother, she became irritated with both of us. How dare, I, a daughter of 42 years interfere with her expertise? The ‘experienced care-giver’ became insolent with me and asked me if I wanted a new nurse. “Absolutely”, I replied, explaining that the tone she was using with my mother was not acceptable. Within minutes we were greeted with the sweetest nurse who took my mother’s hand in hers, and gently kissed her cheek. Mum instantly warmed up to her – smiling, even through the adversity of all her pain.

When our parents age and become dependent upon us, for both physical and emotional survival, we become parents of our parents. Ensuring that their well-being is properly and lovingly cared for is a full-time job. And it is our job. While not all care giving staff are disrespectful, it only takes one to break their spirit and attack their dignity. This is an unnecessary invasion, preventable with an unconditional love and a gentle kindness.

It’s ok to question and be concerned about the care that your loved one is receiving. In fact, it’s essential. If you don’t, there’s a slim chance that others will assume that vital role. Stand up for what is right. If you have children, remember they learn what they live. Watching loved ones being cared for with a devotion of respect is a teaching experience that no school or university can match.

I am blessed to have such dedicated siblings who took turns sitting with mum for every minute of every day. We cared for mum with a tender and heartfelt love - not all that different from how you would love a newborn baby- caressing her cheek as she slept; combing her hair with our fingers as she looked lovingly into our eyes.

Not long after her stay in hospital, mum passed away – most peacefully, with children near her side. I know that in her heart she felt a proudness in knowing that her children were there to ensure her dignity was kept in tact – and yes – that someone cared.

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If you are taking in your loved one to emergency, don’t show fear, show strength. Tell them how well they look, how they’ll be out in no time, how they are in the right place to be fixed and that they’ll be on the road to recovery in no time. Talk about the future and plan for a health strategy. Talk about nice things. Keep their mind at ease and their heart rate down. Just be there with them, for them, and tell them how well they’re doing.

NEW HOME

Our bodies aren’t what they used to be, therefore, our living spaces maybe can’t be what they used to be. For instance, stairs seem to become steeper and longer as we age, so you may want a single story home, or you could think about renting out the top floor, that way, not only would you have an income, but you’d have people around you. So think about your needs.

Also, think about your environment, such as, is your house on a slope? On a hill? On a slight incline?

As we age not only does our balance waiver, but our bodies do not react as quickly, not to mention our impaired judgment of distance due our aging eyes.

When you think about your living space and your style of living, keep in mind if you have to have help as in a nurse or a maid, or maybe both. Do you or will you have enough room for a live-in maid or nurse or caregiver? If you need the help, do you have enough space for you and for them?

And where do you want to live? The mountains, the beach, smack dab in a highrise in the city?

You may also want to think about living with your relatives, like your sibling and sharing expenses. Or maybe one of many of your children have wanted you to come and live with them. If you want to be close to the family, living in a Mother-In-Law apartment may be the way to go. That way you’re close to those you love, you’ll always have loving company for socialization and they will always keep a watchful eye on you.

Your town or city should have some type of senior friendly transportation also, such as cabs or a health-care van. And how about food? In addition to taking a cab or bus, many items can be ordered on-line, such as fresh fruit from Harry and David’s or groceries from your large grocery market chain, or even medications from the drugstore.

Also, think about what you want to do as you age. You may be aging but you still have muscle control and your mind.

So what will make you happy? What type of activities will bring enjoyment?

Would you like to paint? You’ll need space and light. Garden? You’ll need a rail to hold onto, a waist level hose bib, and a raised garden bed. Want to keep active? How about a lap pool? Swimming is great, buoyant, weightless, aerobic exercise.but will or do you have room for a pool? Maybe your home is or will be a townhome with lots of neighbors for company and a community pool for socialization and exercise.

There are a myriad of combinations, all of which should be carefully thought out.

It’s never to late to plan or daydream how you see yourself in your aging years. You have options just as you did when you were first starting out in life, only now your needs have changed.

Look at aging as an opportunity, not as a loss.

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Whether you take a family member or are assisted by your nurse, everyone seems to eventually enter the emergency room. Don’t be nervous. It’s just a big room with many rooms and everyone needs attention right then. There’s an administrator at the front for the inevitable paperwork, so bring your Medical cards for certain, and bring your checkbook, and speak up when you need to.

The administration will go much easier if you have your information and proof of insurance right in your wallet. So, put it there now, so you’ll never have to think if you have it, because in an emergency, it’s hard enough to keep your head on straight, let alone the details of business.

Okay, once in emergency, you go to administration. They say wait. It is excruciating. If you know your family member is dying, make a huge stink. Don’t be shy and think, they’ll get to your loved one. Be heard. The hospitals are shorthanded. Get what you need and do what you need to do, to get to get what you need, but only if it is a true emergency.

So, the administrator and their nurse finally call you. If the emergency is for your loved one, when you go into a room and they sometimes they ask you to leave. Do what you want, stay, go; that all depends on the type of person you are and the relationship you have with the person you brought in. You wait in the little space, which may be a room, or may be a curtain drawn closed, but it is your space. The Doctor shows and the assessment begins.

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There are many questions about what will happen to us when we are extremely sick. And now, while you’re well, is the time to decide your course of action.

Know which convalescing homes are in your area. Tour them now. Write down which one you’d like to go to so that there is no question as to your wishes. If you live alone, post your information somewhere so that everyone is aware of its existence, such as taped to your dresser mirror.

If you need nursing care, find a competent company now, in your area and call for rates, that way you know for how much to budget, and your destination and the experience will not be so unnerving.

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We know we or one of our loved ones will eventually get extremely sick and/or need some type of convalescing. So, let’s look into the world of convalescing.

We also know we will eventually enter an emergency room, whether for ourselves or for a loved one. So, let’s look into the world of the ER.

We also know that the majority of us will be moving into a different house as we age. So, let’s look into our options.

CONVALESCING

To think that we’ll eventually get sick is a thought no one should think. And to think that we’d need such nurturing that we’d have to go to a convalescing place is almost out of our reality. Well, it may be time to think these thoughts. There is of course, long-term care insurance, which is really something to very seriously check into and purchase some type, so that you don’t lose all of your savings.

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These nursing homes are necessary, and I’m glad they’re available. However, like my Grandma before me, I believe there’s no better medicine for great-grandma or great-grandpa then to be a part of their daily lives, to see and hear the sights and sounds of a household, to smell the aroma of a favorite recipe simmering on the kitchen stove,  to hear the sound of a grandchild’s  tears and laugher- the whole nine yards of sharing the invigorating experience of life-in-progress.

In Grandma’s day taking in the elderly meant adding to an already crowded household. It meant three or four generations under one roof.  At times there would be slamming of doors, arguments galore and hurtful words screamed out in anger. It also meant there would be shrieks of joy, plenty of encouraging words, doors being opened, shared disappointments, comfort, hugs, and kisses while all the while he music of Puccini echoed down the hall. Most of all, it meant being a family.

I remember asking  Grandma how she tolerated having to care for her ailing parents as well as the inconvenience of so many generations crowding  her household?  Grandma smiled and responded with an old-world tale written by Jacob Grimm. It’s a generational story that has stayed with me all of these years.                                                                    

There once was an old man who lived in a village with his son and his son’s wife and child. The old man was deaf and blind and had trouble eating his food without spilling it. Sometimes, accidentally , the old man would drop his son’s fine china and break it. The son and his wife were disgusted by the old man and made him eat out of a wooden bowl behind the stove. One day the little grandson was working with some pieces of wood. When his father asked him what he was making, the little boy answered, “I’m making a wooden trough  for you and Mother to eat out of when I’m grown up.”  The next day, the old grandfather was back at the table eating outr of his son’s best china. Not another word was said on the matter.

The realization that we’re all going to be there someday is reason enough for compassion.

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Those of us born during World War II suddenly find ourselves on the sunny side of that 13 percent. We remember our Grandparents’ and how, when they were our age,  we thought of them as being old and wise. Judging by the aches and pains in my joints every morning, I pretty much have the “old”  part down pat, but sometimes I wonder if I’ll  ever be as wise.

As I explore the world of senior citizen, I also discover that my role with my  parents is changing– that parent is becoming child and child is becoming parent. Hopefully, by the time you reach this stage in life, you’ve successfully raised your own kids, they’ve grown up, matured and moved out of your house and now have children of their own. While your kids were growing up, your parents were growing old. While the grand kids were becoming stronger, more independent, your parents were becoming weaker and more dependent.

They call this period in our lives the “golden years,” though I don’t know why. Perhaps it’s because, like gold, the days are fewer and more precious. Or maybe it refers to the “Golden Age” believed by Greek and Roman poets to be the time when one lives in the ideal state of happiness and prosperity.

Either way, neither of these definitions accurately describes these so-called golden years or helps to make the journey though them any less  complex, nor does it answer the Question, “When did parent become child and child become parent?”

I think the transformation begins when we stop asking and start telling our parents what to do: when we stop taking advice and start giving it: when we drive them to the doctor, dentist and grocery store: take them shopping for new clothes and shoes and insist they buy the most practical; take them to the market and suggest hamburger instead of steak because it’s easier to chew. It begins the first time we remind them to take their vitamins, wear a warm coat and stay out of the rain. It starts when we haven’t heard from them in a few days and we start to panic. You know: all the same loving, but aggravating, things they’ve been doing for us for more than half a century.

Role reversal isn’t anything new. It’s been going on since man began walking upright, pairing off and forming families. but how we deal with our elderly has changed, In Grandma’s day the elderly or infirm weren’t deposited in nursing homes; they were cared for at home by their adult children, just as their parents did before them and so on. If it’s at all possible, it’s a practice my generation will uphold.

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How do I choose a home care provider?
The questions below will help you choose the home care provider that is appropriate for your medical needs and family situation. Regardless of whether the care you seek is skilled or home support care, it is important that you know the answers to the following questions.

What should I consider when hiring privately or through an agency?

AGENCY:
*Is the agency performing criminal background checks?
*How long and what geographical areas are covered in the background check they perform?
*What are the experience levels and specialties of aides available?
*Will the agency be responsible for finding a replacement caregiver if my regular aide is sick or on vacation?
*What hours can I speak to someone from the agency?
*Is the agency licensed and bonded?

PRIVATELY:
*Should the family perform a background check?
*What is the aid’s previous experience?
*Who will replace my caregiver if they are sick or on vacation?
*Does the caregiver have any type of licenses or certifications?
*Do I have to do reference checking?
*Who will be my advocate if I have a problem with my
caregiver?

Points to consider when choosing a home care provider:

— How can I cancel the service I requested?

— How much is the cancellation charge?

— Who do I call if my caregiver is unable to work?

— What is their phone number?

— What are the fees?

— What exactly is covered by those fees?

— Will the agency respond to requests for “short notice” services?

— Is there an extra charge for these services?

— Is there a minimum or a maximum number of hours of home care service per day?

— Is there a minimum or a maximum number of days of home care service per week?

— Is there someone available to assist me 24 hours a day, 7 days a week?

— How long will it take someone to return my call after business hours?

— How do I make changes to the initial caregiver schedule?

— Do the aides provide transportation if needed?

— What type of screening does the agency perform?

— How long will I wait for service after placing my request?

— Will the same caregiver assist me every day or will it be somebody different?

— Will someone from the agency call to see if I am satisfied with the services provided to me?

— How often will they call and check-in with me?

— Will I be responsible for providing meals for the caregiver?

— Will my live-in caregiver require a private bedroom?

— Will my caregiver clean my house and do my laundry?

— Do I need to sign a contract with the agency?

— How long is the contract good for?

— What does it entail?

— Do I need to have a qualified, elder law attorney review this contract before signing it?

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