Home Care and Home Health Care Services
In the event a senior chooses to remain in their home rather than move into a senior living community, they may require home care or home health care. Home care, also called “companion care,” consists of non-medical services that allows an individual to receive assistance with Activities of Daily Living (“ADL”) including assistance with home functions like cleaning, shopping for and preparing meals or managing medications..
Activities of Daily Living generally include the following:
- Hygiene (brushing hair, brushing teeth, denture care, etc.)
- Toileting (including hygiene, use of incontinence products)
- Transferring (moving from bed to chair, walker to toilet, etc.)
The frequency of home care services provided varies depending on several factors. One factor is the level of independence that a senior is able to maintain while ensuring their basic care needs are met. For example, a senior that is still independent in all ADLs may only need assistance with such as house-cleaning, laundry and transportation to shopping once a week. In other situations, seniors may need daily supervision of particular activities in order to ensure their physical safety and well-being.
Medication management is one of the most important services provided to seniors living alone in their homes. If medications are taken more than once a day, a home care provider can be hired to ensure correct dosages and the appropriate timing of each dose. Meal preparation provided at the same time ensures proper nutrition and hydration throughout the day. For couples in which one spouse acts as the primary caregiver, home care services may serve as an intermittent, yet much needed break in day-to-day responsibilities.
Home care also offers flexibility as services can be arranged on a short-term or long-term basis. For example, services are often arranged for seniors after a medical crisis has occurred, such as a stroke or fall. In such cases, temporary assistance may be needed while regaining strength and mobility. Services may also be provided on a long-term basis in order to allow a senior to receive care while their adult child is working during the day. A prospective home care client’s needs are determined by a licensed medical professional through an initial assessment. This process typically takes place at the home of the client but the location of the assessment varies as well. An assessment determines the frequency of care needed and thus the estimated expense based on an hourly rate. Most home care agencies have a four-hour minimum per day. For more information about Home Care, please visit Home Care Association of New York State.
While Medicare does not cover home care, those eligible for Medicaid may receive financial assistance for services provided in the home. However, most home care agencies do not accept Medicaid and thus private pay is required. For veterans or spouses of veterans, Veteran’s Aid and Attendance benefits may also be available. Visit Veteran’s Aid and Attendance for more information.
Home Health Care
Home health care services are provided by licensed and trained medical personnel and ordered by a physician. In many cases, home health care services are required for seniors who have recently been discharged from the hospital or a skilled nursing facility yet still need skilled medical care in their home. As the average length of stay in hospitals and skilled nursing facilities has decreased over time, home health care services ensure that a senior’s medical needs are met in a less costly and more comfortable home environment.
Home health care services include the following types of care:
- Intermittent skilled nursing care
- Physical therapy
- Occupational therapy
- Speech pathology
Skilled nursing care consists of services that must be provided or supervised by a licensed nurse, typically a Registered Nurse (RN). These services may include the management of feeding tubes, in-dwelling catheters or the administration of intravenous medications.
Other services might include providing or supervising oxygen treatments (especially for seniors with conditions such as chronic bronchitis or emphysema) or the injections of medications, such as insulin, particularly when blood sugar levels must be monitored regularly. Wound care must also be provided by a skilled nurse to ensure sterilization and reduce the risk of infection.
Physical therapy consists of rehabilitation services to restore and/or maintain independence when a senior’s physical strength has become compromised. This might be caused by a fall which may lead to a fractured hip, requiring surgery or joint replacement.
While the initial portion of the physical therapy may be provided during a short-term stay in a skilled nursing facility, services can be continued at home once a senior has gained a suitable amount of strength. In such cases, a licensed physical therapist may provide continuing therapy by visiting a senior in their home to provide treatment until they have maximized their level of independence.
Occupational therapy consists of skilled treatment needed for a senior to maintain independence in their ADLs. This type of care is often provided after a certain level of strength has been achieved through physical therapy and allows a senior to regain and/or learn new skills needed to remain independent.
An occupational therapist will typically visit a senior’s home prior to their return from a skilled nursing facility to suggest home modifications and equipment to ensure their safety. Therapy provided in the home may consist of proper use of a walker, assistance with safely transferring, preparing meals and daily grooming/hygiene.
Speech pathology or therapy allows seniors to regain speech, language and/or swallowing abilities that may have been compromised by a stroke or disorder that affects the brain. A speech pathologist will create a plan of care to increase the effectiveness of a senior’s communication and/or gain strength in muscles that support swallowing.
Home health agencies provide these licensed services according to a care plan that has been determined with the coordination of a senior’s physician. The written plan of care determines what services are provided and the length of time each is required in order to regain maximum independence and functioning in the home. As home health care services are medically necessary, they are covered by Medicare, Medicaid and private insurance companies under specific conditions.