by Thomas D. Begley, Jr., CELA

Families of many individuals who require long-term care believe that their only option is to place their loved one in a nursing home. Actually, there is an eight-step continuum of care:

• Informal Caregiving. Most care for Alzheimer’s patients is provided by informal caregiving provided by a family member or friend who aids and supervises the daily care of the patient.

• Geriatric Care Managers. Geriatric Care Managers generally perform six functions: an initial assessment of the patient, development of a Care Plan, implementation and coordination of the Care Plan, monitoring services, appropriate re-assessment, and appropriate discharge.

• Adult Day Care. There are two types of adult day care facilities. One is medical, the other is non-medical. Transportation is generally provided by the adult day care facility to pick up the patient at home and transport them to the adult day care center and return the patient at the end of the day.

• Home Health Care. Elderly persons who require care almost universally prefer to receive the care in the comfort of their own homes. They are familiar with their surroundings, often with loved ones nearby. Home health care is also often less expensive than institutional care.

• Assisted Living. Approximately one million people live in assisted living facilities. Typically, they provide custodial care and are usually not licensed to provide skilled care.

• Nursing Homes. Nursing homes provide skilled nursing care and related services as well as custodial care for residents.

• Continuing Care Retirement Communities. Continuing care retirement communities (CCRCs) are an excellent type of long-term care for the middle and upper-middle income population. Typically residents enter independent living facilities, such as an apartment, and then as their health declines they are eligible to move on to assisted living and then ultimately a nursing home at the same campus as such care is required.

• Hospice is designed for people who no longer want medical treatment and are preparing to die.

As a professional servicing seniors for the past 10 years, I have recognized the importance of clarity of information for both caregivers and seniors to properly discern the services that are needed both immediately and in the future. My analogy has always been that, when you are young parents, you have no clue as the choices, cost and requirement of child care services until you are there frantically calling around searching for the right options that are both safe, convenient and within your budget.
The same holds true for senior care. People rarely plan in advance for the choices that seems so far off into the future. Let me begin by explaining Home Care options.
Although most forms of home care are bundled into that one phrase, there are extreme differences when comparing, medical and non-medical options.
Non-medical home care is basically caregiving paid on an hourly basis to provide general assistance with activities of daily living. These might include assistance with cooking, cleaning, showering or even medication assistance. This type of home care is paid for privately with typically a minimum number of hours per day or week required by the provider.
Medical home care, also referred to as skilled nursing care, includes providing nursing assistance along with physical/occupational and speech therapy if needed. Home Health Care is paid for by either Medicare/Medicaid or a private insurance if the eligibly is met. The criteria includes:

• Doctor’s orders for referral
• The patient is having difficulty leaving the home without assistance (home bound)
• A change in medical status

If the patient meets this criteria, then a nurse will go to the patient’s home to evaluate, treat and educate them to eliminate a relapse or readmission into the hospital.
To better explain medical home health care, here is a complete explanation provided by Medicare.gov establishing what it is and what to expect:

What is home health care?

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

Examples of skilled home health services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status

The goal of home health care is to treat an illness or injury, to regain your independence, and become as self-sufficient as possible.

If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.

If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.

If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area, but must tell you whether their organization has a financial interest in any agency listed. The decision on what agency to select is the patient or family choice.

What should you expect from home health care?

• Doctor’s orders are needed to start care. Then the home health agency will schedule an appointment and come to your home to talk to you about your needs
• The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.

Examples of what the home health staff should do include:

• Check what you’re eating and drinking.
• Check your blood pressure, temperature, heart rate, and breathing.
• Check that you’re taking your prescription and other drugs and any treatments correctly.
• Ask if you’re having pain.
• Check your safety in the home and teach you how to take care of yourself
• Coordinate your care with Physician

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