Home care encompasses a wide range of health and social services. These services are delivered at home to recovering, disabled, chronically, or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends. More and more older people, electing to live independent, non-institutionalized lives, are receiving home care services as their physical capabilities diminish. Younger adults who are disabled or recuperating from acute illness are choosing home care whenever possible. Chronically ill infants and children are receiving sophisticated medical treatment in their loving and secure home environments. Adults and children diagnosed with terminal illness also are being cared for at home, receiving compassion and maintaining dignity at the end of life.
As hospital stays decrease, increasing numbers of patients need highly skilled services when they return home. Other patients are able to stay at home to begin with, receiving safe and effective care in the comfort of their own homes.
Why Home Care?
- Home care is cost-effective. Numerous studies have shown that home care is generally the most cost-effective care option. Used prior to, in place of, or after hospitalization, home care can reduce the length-of-stay and save money over the course of an illness.
- Home care keeps people independent. With assistance, persons of all ages can continue to function as viable members of the community.
- Home care keeps families together. The joy of being with loved ones is particularly important in times of illness, and keeping families together has a positive social and economic impact on our communities.
- Home care involves the individual and the family in the care that is delivered. Home care is patient centered — it empowers individuals and their families to assume greater responsibility for their own health, and to assist them to make informed health care decisions.
Time and Type of Services Available
Understanding the different types of services available for home care can be confusing to say the least. The following list is designed to clear up some of the confusion.
Length of Care
- Hourly: Hourly care can be provided by a companion or homemaker, Certified Nursing Assistant (CNA)/Home Health Aide (HHA), Licensed Practical Nurse (LPN), or Registered Nurse (RN). The caregiver can provide care available under their licensure/certification as well as companion/homemaker services. A minimum of five hours of care is required. RN, LPN, and bed-and-bath visits are also available.
- Live-in: Care can be provided by companions/homemakers, CNAs/HHAs, LPNs, or RNs 24 hours a day, seven days a week. The caregiver can provide care available under their licensure as well as companion/homemaker services. A live-in caregiver must be able to have eight hours of uninterrupted sleep, in contract. For individuals who need full 24-hour attention, look for shift-work care.
- 24-hour care: This level of care and service is when a home health professional is awake and ready to attend to a patient’s needs 24 hours a day. The level of service usually, with rare exception, applies to home health aide care. This level of care requires multiple shifts by care providers over the 24-hour period. Provision of this service is via private pay and the use of long-term care insurance.
- Visits: A visit is when the health professional, aide, or nurse, comes into a patient’s home or residence and performs certain specific tasks or duties. A visit can last up to an hour, but is defined, time-wise, by the completion of the required duties. When the tasks have been performed and completed, the visit is over. An example of a skilled nursing visit includes removing a dressing on a wound, documenting the wound in the client’s medical record, treating the wound, applying a new dressing on the wound, and monitoring the general health of the client. An example of a visit by an HHA includes assisting the client with undressing, helping the client bathe, and helping the client get dressed and change bed linens.
Types of Care
- Homemaker/Companion/Sitter: A homemaker/companion is a person who cares for an elderly, handicapped, or convalescent individual or couple and can accompany them on trips, outings, and appointments, as well as prepare and serve meals. Companions are available for hourly, shift, or live-in care. Following are some of the possible services of a companion. Typical duties of homemaker/companions/sitters include but are not limited to: companionship and conversation; sorting and reading mail; arrange appointments; assistance with walking; letter writing and correspondence; reading; meal planning and preparation; making bed; answering the phone and door; basic grooming; apparel selection assistance; caring for indoor house plants; appointment reminders; entertainment (playing cards, sewing assistance, etc.); monitoring diet and eating habits; grocery shopping; medication reminders
- Certified Nursing Assistant/Home Health Aide: CNAs and HHAs have a nursing assistant certificate. A person receiving care from a CNA/HHA should be under the care of a physician and/or supervised by a Registered Nurse. Nurse aides assist with bathing, dressing, toileting, grooming, eating, physical transfer, and those normal daily routines the client could perform for himself or herself were he/she physically capable. Nurse aides can also perform all the services of a companion or homemaker and are available hourly, for shift-work, or on a live-in basis.
- Licensed Practical Nurse: LPNs have practical nurse licenses and are under the supervision of our registered nurse or a physician. An LPN maintains the medical plan of treatment created by the registered nurse and approved by the physician. An LPN can also perform the services of a CNA, homemaker, and companion.
- Registered Nurse: RNs are licensed and maintain clinical records for clients receiving nursing care. An RN develops medical plans for treatment and can maintain them or supervise their maintenance. An RN supervises LPNs and CNAs/HHAs. An RN can manage client medications and is available on an hourly, shift, visit, or live-in basis.
Who Pays for Home Care?
Home care is paid for by a variety of sources. Benefits and requirements vary greatly, however. Major home care payment sources include:
- Patient/private pay – Home care services can be personally paid. The scope of services and the charges are negotiated between the patient/family and the agency. For those whose resources do not cover home care, some home care agencies offer a sliding-scale fee schedule so that a family need only pay what it can afford.
- Private health insurance – Policy coverage varies. Generally private insurance coverage is limited to physician-directed medical services and equipment. The patient and family should check with their insurance agent to determine coverage specifics.
- Medicare – The patient must be under a physician’s plan of care, homebound and in need of part time or intermittent skilled nursing care or occupational/physical/speech therapy. Eligible clients may receive a range of services which include skilled nursing, home care aide, speech and occupational therapy, medical social work and medical supplies/equipment.
- Medicaid – This federal/state administered medical assistance program provides services similar to Medicare for low-income people. No prior hospitalization or “skilled” level of service is required to qualify. Individuals do not need to be homebound.
- Social services block grants – These Title XX funds are available for in-home care services including home care aide, chore and personal care.
- Older Americans Act – Title III of the Older Americans Act provides in-home services including home-delivered meals, home care aide, personal care, chore, escort, and shopping services.
- Workers’ compensation – Any person needing home care services as a result of injury on the job is eligible. Workers’ compensation representatives have information on eligibility.
- Health Maintenance Organizations (HMOs) – HMOs and Comprehensive Medical Plans (CMP) with Medicare contracts must provide the full range of Medicare-covered services that are available in a geographic area, including home care services.
- CHAMPUS – On a cost-shared basis this program covers skilled nursing care and other professional medical home care for dependents of active military personnel, retirees and their dependents and survivors.