Remember 10-15 years ago, when having the services of a nurse in your home was easily accessed? Before the late 1990s, many people — especially the elderly having Medicare — could receive a generous amount of time and multiple services from licensed healthcare professionals in their homes.
Today, patients must meet more specific physical criteria to receive insurance-based medical home care. Because of the decrease in insurance coverage for medical care, non-medical home care agencies are now providing expanded in-home care, which is paid for with private pay sources from the patient or their family.
The medical part of home care, also called "skilled" in-home care, is provided by a licensed medical professional such as a nurse, physical therapist, occupational therapist, or even a speech therapist. These services must have a doctor's order, and the person receiving the care must be considered homebound. Other in-home needs for medical care which are covered by many insurance companies include injections and blood draws, wound care, medication management and hospice.
According to the U.S. Department of Health and Human Services, in order for a patient to be eligible to receive home health services under (Medicare) both Part A and Part B, "the law requires that a physician certify in all cases that the patient is confined to his/her home. An individual does not have to be bedridden to be considered confined to the home. However, the condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort." Homebound status is determined on an individual basis, and more details on Medicare requirements for homecare can be found at www.hhs.com.
Law changes in 1997 with Medicare laws now restrict certain home health payments and disbursement to agencies, as well as the amount of time Medicare will pay for in-home health services. Other insurance companies provide varied coverage for in-home services. Some long-term care insurances will provide a certain amount of money for in-home services, and the Veterans Administration will also provide some financial assistance provided the patient meets certain medical and financial requirements.
Non-medical home care, sometimes called custodial care or personal care, can fill in the gaps where medical home-care cannot. Non-medical home care is a private pay business, and the cost is generally anywhere between $18 and $25 per hour, depending upon the length of time commitment. Personal care can include bathing, dressing, grooming and toileting; transportation and escorting to appointments; laundry and grocery shopping; and any other care for those whose condition compromises their ability to stay alone.
According to statistics from the Private Duty Homecare Association, persons reaching age 65 have an average life expectancy of an additional 19 years. Several studies have found that the overwhelming majority of seniors – 89 percent, according to an AARP survey, for example – want to age in their own homes for as long as possible. (www.privatedutyhomecare.org)
Using a non-medical home care agency can relieve stress from caregivers and provide valuable respite time for both the patient and family. They can also ensure that an elderly patient gets regular visits if they do not live close to family or friends.
Another advantage of using an agency that provides non-medical home care is that the person providing the care is a usually a certified caregiver. When interviewing a potential caregiver for you or your loved one, ask what certifications and training they have had, and if they have had experience working in personal homes. Most agencies also provide thorough background checks and drug tests for all caregivers, but make sure to ask.
Keep in mind that even though some seniors may need to move to an assisted living or care home which may provide a safer environment, home care agencies can still work in those environments to provide extra aid and assistance.
Brooke Martin can be reached through Healthcare Communications, firstname.lastname@example.org; or by phone at (520) 437-5696.