Chapter 2: Getting Help at Home

As time progresses, and mom or dad’s physical functioning or cognition deteriorate to the point where they can’t remain living independently without help, there is a wide continuum of services that you can access to support them at home. Considering the older adult’s need for autonomy, the rule of thumb when planning for which service to access is to pick the one that provides the appropriate level of assistance needed to allow them to function as independently as possible. For example, a person who just is forgetful about his or her medications probably does not need to be placed in a nursing home setting prepared to provide total care. Conversely, a bed-bound person with pressure ulcers and a feeding tube and minimal resources would probably not be well served to be placed on home care. The first level of this support is home care, provided in the individual’s own home, or the home of a loved one or significant other with whom they are staying. Home care is generally an option when the individual requiring care has enough independence to be left alone for periods of time, is able to summon help if needed, and can ambulate or transfer from bed to chair either independently, or with minimal assistance. There are several types of home care: skilled and chronic.

Skilled home care is generally limited to a period of several weeks to several months. The focus of this type of home care is to provided skilled intermittent services to help the patient recover from an acute illness or injury. A Registered Nurse makes a home visit to make an initial assessment of needs and establishes a plan of care. Services planned may include additional nursing visits for ongoing symptom management, medication reconciliation and supervision, and skilled care such as dressing changes, catheter care, injections, etc. If needed, rehabilitative services in the home may be scheduled for several times a week by a physical, occupational, or speech therapist. Several hours of home health aide service several days a week may be scheduled to support the nursing or rehabilitation plan of care with bathing, exercises, ambulation, simple meal preparation, and other personal care. These services are provided until the restorative goals are met, usually within two to six months. Social workers are available to help with longer term planning.

Chronic or long term home care is focused on providing services over a longer period of time, or even permanently, to help an individual remain at home. The services again begin with a nursing assessment visit. In this case, the home supervision visits by a nurse occur only every several weeks or even monthly. Home health aide services for bathing, personal care, meal preparation, and light housekeeping can be provided up to daily for as few as two and as many as twelve hours and may be covered in whole or in part by long term care insurance or Medicaid. Twenty-four hour and live-in services may be provided, but typically are not covered by third parties such as insurance or Medicaid.

Complex care can be provided in home to enable a person to return to home sooner than might otherwise be the case. An insurance company, for example, may be willing to provide financial coverage for a home care agency to provide home intravenous infusion or medication therapy as it may be less expensive for that person to be cared for at home rather than in a hospital. Even dialysis and pulmonary ventilator care can be provided in the home setting. Coverage varies from policy to policy, and the given situation.

Safe home care of any level depends upon the availability and engagement of committed family and friends. The home care agency cannot provide staff around the clock at all times. Reputable agencies will not admit patients who do not have a safe home environment and support system available. The degree to which home care can help someone remain independently at home depends not only the availability of the resources of nurses, therapists, aides, etc., but also the financial resources the individual has to access these resources. These financial resources may be in the form of personal assets, or coverage by insurance or Medicaid. Home care agencies will make home evaluation visits without charge. The purpose of these home evaluations is to assess the needs and resources of the individual, and to determine if home care is appropriate. If so, the nurse will contact the primary care provider of the individual for medical orders and certification of the need for home care, and will plan and initiate services.