Patients no longer need to depend on inpatient medical facilities to meet all of their healthcare needs. Today, a wide range of health, social and rehabilitative services can be delivered to individuals in their home. Home care services allow those suffering or recovering from an illness to receive the quality care they need, while avoiding the inconveniences of hospitals, nursing homes and rehabilitation facilities.
What is home care?
"Home Care" is a term that encompasses a wide range of health and social services that are offered to recovering, disabled, chronically or terminally ill patients in the comfort of their home. Patients and families may choose home care during different stages of their cancer journey: following an extended hospitalization or intensive treatment for example.
How do I know if home care is right for me?
Choosing home-care services can be an emotional decision and tough process for patients, families, and caregivers. Patients may have difficulty giving up feelings of independence at home. Families may question if they are capable of fulfilling all of their loved one's needs.
Gathering useful information about the services available and how to access them may help to alleviate some of the distress associated with this decision.
What types of home-care services are available?
- Registered Nurses (RNs)
Provide "skilled services" that can not be performed safely or effectively by nonprofessionals, e.g., dispense medication, wound care, dressing changes, intravenous administration.
- Licensed Practical Nurses (LPNs)
Provide basic bedside care, such as taking vital signs, temperature, blood pressure, pulse and respiration. They also prepare and give injections, monitor catheters, apply dressings, treat bedsores, and give alcohol rubs and massages. LPNs do not dispense medication.
- Physical Therapists
Work with patients to restore their strength and mobility through exercise, massage, or other methods.
- Social Workers
Assess the psychosocial factors affecting the individual and provide counseling, serve as case managers to coordinate services, assist in identifying available community resources.
- Speech Language Pathologists
Work with patients to restore speech by retraining them in breathing, swallowing and muscle control.
- Occupational Therapists
Assist patients who have disabilities that prevent them from performing activities of daily living (ADLS).
- Nutritionists
Provide counseling to individuals who may benefit from dietary assessment and guidance to help in managing their illness.
- Home Health Aides (HHA)/Home Care Aides (HCA)
Provide individuals with hands-on assistance with ADLs, such as bathing, getting out of bed, walking, toileting and dressing.
- Homemaker and Chore Workers
Assist with light house chores such as laundry, meal preparation, cleaning and shopping.
- Volunteers
Provide a range of services, depending largely on their training and experience. Services may include transportation, companionship and emotional support, household chores and personal care.
What types of agencies provide home-care services?
- Home Health Agencies
Provide a range of services, while other agencies may limit to nursing care and one or two other services.
- Homemaker and Home-Care Aide Agencies
Employ homemakers and home care aides.
- Staffing and Private-Duty Agencies
Generally, these agencies provide nursing, homemaker, HCA and companion services.
- Pharmaceutical and Infusion Therapy Companies
Deliver drugs, equipment and professional services for patients who are receiving IV or nutritional therapies through tubes.
- Durable Medical Equipment and Supply Dealers
Provide and deliver respirators, wheelchairs, walkers, catheters, and wound care supplies to patients in their homes. Typically, these agencies do not provide physical care for the patients.
- Registries
Are employment agencies for home care nurses and aides that match providers with clients, and then collect a finder's fee.
- Independent Providers
Refer to privately employed home care workers, including nurses, therapists, aides, homemakers, and companions.
How do I talk to my docotor about home care?
The patient's physician must initiate a referral to an agency with a doctor's order for home care services. Talk to the patient's doctor directly about what types of services may or may not be needed to the home. If the patient will receive home care services following a hospitalization, typically the hospital social worker will initiate the contact with the home care agency and coordinate the services with the MD, patient and family.
Some questions to ask the doctor
You may want to discuss the types of services that you foresee needing at home. Familiarize yourself and the doctor with details including:
- How often is the patient typically alone during the day/night?
- How many hours is the family/caregiver able to assist the patient on average?
- What types of assistance can the family/caregiver provide (cleaning, cooking, laundry, assistance with ambulation?)
- How many flights of stairs does the patient have to walk to get to the bedroom? The bathroom?
The above questions are some examples of details to consider when contemplating the types of services the patient may benefit from at home. This will help to determine how many hours and what type of care is needed.
Who will cover the cost of my home-care services?
Medicare
Medicare covers home care services under the following conditions:
- The Medicare recipient's doctor must decide that they need medical care at home and must initiate the plan.
- The patient must meet at least one of the following: intermittent skilled nursing care, physical therapy, speech-language therapy, or continue to need occupational therapy.
- The home health agency caring for the patient must be a Medicare-certified agency.
- The patient must be homebound, or normally unable to leave home unassisted. (A need for adult day care does not keep the patient from getting home health care).
Under Medicare, home health aide services are only covered on a part-time or intermittent basis and not long-term. There are limits on the number of hours/day and days/week that you can receive skilled nursing or home health aide services under the Medicare benefit. Therapy services are covered for as long as your doctor determines that you need them.
Medicare will not cover the following services:
- 24-hour-a-day care at home
- Prescription drugs
- Meals delivered at home.
- Homemaker services like shopping, cleaning, and laundry services.
- Personal care given by home health aides like bathing, dressing, toileting when this is the only care that the patient needs.
To obtain a list of Medicare-certified home healthcare agencies, contact Medicare directly at (800) 633-4227.
Medicaid
States are only mandated to provide home health services to individuals who received federally assisted income maintenance payments, e.g., SSI, or "categorically needy." Categorically needy recipients include certain disabled individuals whose incomes are too high to qualify for mandatory coverage but below federal poverty levels.
Under federal Medicaid rules, coverage of home health services must include the following services:
- Part-time nursing
- Home care aide services
- Medical supplies and equipment
However, at the state's discretion, Medicaid may also cover:
- Physical, occupational, and speech therapies
- Medical social services
For further information about your Medicare and Medicaid entitlements, please contact The Centers for Medicare and Medicaid Services at (877) 267-2323.
Community Health Insurance Companies
These companies will generally pay for skilled professional home care services.
They typically cover some home health services for acute needs, though benefits will vary from one plan to another.
Managed Care Organizations
Managed care organizations and other group health plans sometimes include coverage for home care services as well. However, these organizations will only pay for services that are pre-approved.
Some Other Helpful Resources
You may want to inquire about both state and local social service programs which may cover the costs related to services such as home care aids, personal care, chore, escort, meal delivery and shopping to persons who are 60 years of age and older.
Veterans Administration (VA)
The VA will cover home health care services for veterans who are at least 50 percent disabled due to a service-related condition. For more information, contact the VA directly at (800) 827-1000.
State Health Insurance Assistance Program (SHIP)
Every state and territory has a SHIP with counselors who can provide free health insurance information and help. This includes questions about home care services and what Medicare, Medicaid and other types of insurance pay for.
How can I find a home-care agency in my area?
The National Association for Home Care (NAHC) publishes How to Choose a Home Care Agency: A Consumer's Guide. Call (202) 547-7424 to order a copy of this book.
NAHC's Home Care/Hospice Agency Locator contains the most comprehensive database of more than 20,000 home care and hospice agencies. Use this resource to find all the agencies in any particular area of the country.
NAHC also provides a state by state listing of organizations that can assist in obtaining the care you need within your community.
Your state and local health departments should also have a registry of licensed home care agencies in the caller's community.
Where should I start?
- Talk to Your Doctor
Your medical doctor must initiate a referral to an agency and call in an order for home care services.
- Talk to a Social Worker
Social workers will work with your doctor to initiate the referral and arrange for home care services. They will often use the agency they are most familiar with, so you should discuss other agency options if you wish. If your insurance company requires pre-authorization, verify that they have been contacted regarding such.
- Contact Your Insurance Company
Contact your insurance company if you have private insurance to obtain a list of participating providers. Remember that some insurance companies will require pre-authorization of services.
As always, it is important to work with the healthcare team (social worker, nurse and doctor) to discuss and assess patient needs. In addition, LLS's Information Resource Center can assist you with your questions and concerns.
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