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Making Home Care Work for Your Aging Loved One, Part Two

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This is the second of five installments in our Making Home Care Work for Your Aging Loved One series. The transition of introducing care into your aging loved one’s home can feel very overwhelming! We started by compiling five of the main concerns our customers have expressed to us. Each installment focuses on one specific obstacle and how to tackle it, based on our 30 years of home care experience.

Remember: you can do this.

Concern #2: I don’t know what to expect as home care begins.

There are two main types of home care. We’ll describe each of them, including what to expect from each service type. Home care that addresses medical needs is called skilled home health care. This care is provided by licensed clinicians, ranging from certified nurse aides to nurses or therapists. Skilled care is funded by insurance; for those 65 and older by Medicare, Medicare Advantage, or another insurance plan. Your doctor must write a prescription for skilled care including care type (nursing and physical therapy are very common) and frequency (usually about two to three visits per week).

There are additional, specific guidelines and qualifiers that apply to skilled home health care. Main qualifiers include being unable to leave your home, except for doctor appointments and religious services. You must also demonstrate potential to improve. If you stop making measurable progress while receiving skilled home health, you will be discharged. If you continue to meet all of the qualifiers, you are eligible for up to 60 days of care. If you need care at the end of your 60-day episode, you may be approved for an additional 60 day episode.

Skilled home health care is not designed to provide ongoing supervision. When your aging loved one requires assistance with their daily activities and/or for safety and supervision, non-skilled or private home care is needed. One can receive both skilled and private home care services at the same time as they are distinct services that are funded by different payers.

Private home care services help with non-medical, everyday tasks like getting out of bed, showering/bathing, dressing, meal preparation, toileting, and general housekeeping. Private services can also include help going on errands, to and from appointment, and for companionship. Private services are helpful when you need a little help, such as a weekly wellness visit to pack your medications, as well as if your loved one has dementia and needs ongoing supervision for safety.

Summary:

  • Skilled home health care is regulated medical care, provided by licensed clinicians, funded by Medicare (or other insurance).
  • Private home care is non-regulated in many states; it is non-medical help with everyday activities, provided mainly by caregivers (supervised by a nurse) and funded by self-pay or long-term care insurance.
  • You can receive one or both of these services because they help with different things.

Example:

Your aging parent is discharged home from the hospital after hip replacement surgery. She is using a walker and cannot stand from a chair without assistance. Her doctor has ordered nursing and physical therapy through skilled home health care, funded by Medicare. Your mother’s nurse will ensure her hip incision is healing properly, and her home health care physical therapist will teach her exercises to help her stand safely from her chair. They will update her doctor on her progress and she will continue receiving these services until her goals are met or she stops making progress. If your mother lives alone you may also arrange private home care services to help her get out of bed, move safely around her home, shower, prepare meals and assist her to complete her PT exercises. Her caregiver should encourage her to do as much as she can while helping her as needed. As she becomes stronger and able to do more for herself, you decrease her private services until they are no longer needed at all; you can also maintain her private services, always adjusting them according to her needs.

Next up is a big one. Concern #3: How do I pay for home care?

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