"E" Economic Hardship

As many as 40% of older Americans have incomes of less than $6000 per year. Having less and choosing to spend less as you see the prices rise in the grocery store, makes it very hard to spend $25-$30/week on food that will keep you healthy.

One program that targets the nutrition of low-income elderly is the Administration on Aging (AOA) Elderly Nutrition Program which offers a variety of nutrition services to the elderly throughout the nation. These programs provide for congregate and home-delivered meals, and each meal must provide at least 1/3 of the recommended dietary allowances established by government. Although there is no means test to be eligible, the over 4,000 such nutrition programs across the US primarily serve low-income elderly among those 3 million plus individuals who depend on the meals provided daily.

The Elder Nutrition Program is not just about getting nutritious food to the table, it is also about helping seniors access a range of services such as nutrition screening, assessment, and education to help an individual meet needs that may be threatening their independence. Volunteers and paid staff who work in the program have an important role in reporting any health or other problem that they learn of when delivering the meals or interacting at the congregate meal sites so that other community-based services such as homemakers, home health aide services, transportation or physical activity programs can be accessed and help to keep a senior at home and independent longer.

Who Pays for Home Care?

Here is a look at some typical payors and what they usually cover for home care services.

Medicare Not all home care agencies are approved by Medicare to provide services to Medicare beneficiaries. A home care agency who is approved by Medicare is called certified. A certified agency has met strict federal requirements for patient care and management and therefore can provide home health services that are paid for by Medicare or Medicaid. These agencies typically focus on medical-related care such as nursing, therapies, and home health aides, but can also provide a range of supportive services. Most commercial health insurers require that services they cover be provided by Certified agencies.

The federal Medicare program provides comparative data on their website as to how certified home health agencies compare in providing care for some of their patients. Quality information that can be used to help you compare home health agencies can be found on Medicare's website www.medicare.gov

If you are a Medicare beneficiary and meet certain criteria, Medicare will cover:

• Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).

• Home health aide services on a part-time or intermittent basis. A home health aide does not have a nursing license. The aide provides services that support any services that the nurse provides. These services include help with personal care such as bathing, using the toilet, or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.

• Physical therapy, speech-language pathology services, and occupational therapy:

• Physical therapy, which includes exercise to regain movement and strength to a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.

• Speech-language pathology services, which includes exercise to regain and strengthen speech and swallowing skills.

• Occupational therapy, which helps you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities.

• Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.

• Certain medical supplies, like wound dressings, that are ordered as part of your care.

The criteria you must meet to be eligible for Medicare’s home health benefit have been defined by Medicare:

Physician involvement - Your doctor must decide that you need medical care at home, and make a plan for your care at home.

Patient is homebound - You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care doesn’t keep you from getting home health care.

Patient requires skilled care or SN,PT,ST (or OT with another skill) - You must need at least one of the following: intermittent skilled nursing care, or physical therapy, or speech-language therapy, or occupational therapy.

The services are part-time/ intermittent - Eligibility is also based on the amount of services you need. Medicare covers your home health services for as long as you are eligible and your doctor says you need these services. However, the skilled nursing care and home health aide services are only covered on a part-time or “intermittent” basis. This means there are limits on the number of hours per day and days per week that you can get skilled nursing or home health aide services.
Therapy services don’t have to be part-time or intermittent.

Medicare doesn’t pay for
• 24-hour-a-day care at home;

• meals delivered to your home;

• homemaker services like shopping, cleaning, and laundry

• personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.

Although Medicare doesn’t cover prescription drugs as part of home health care, a recent law added new prescription drug benefits to the Medicare program as a whole.

Medicare HMO
Medicare Advantage is the name for the Medicare Managed Care Plan or HMO. Your Medicare HMO plan is required by Medicare to provide the same home care benefits as the regular Medicare plan.

If you belong to a Medicare Advantage Plan, you may only be able to choose a home health agency that works with the health care plan. Call your plan if you have questions about the plan’s home health care rules, coverage, appeal rights, and your costs. If you get services from a home care agency that doesn’t work with your Medicare Advantage Plan, neither the plan nor Medicare will pay the bill.

Medicaid
Most states provide state-funded supportive services to elders and disabled individuals who meet income and functional eligibility guidelines. These non-medical supportive services are designed to enable frail elders to remain in their homes.

Most states also provide for state-funded nursing or physical therapy services at home for those individuals who qualify.

Insurance
Medicare is not the only payor who pays for home care. Commercial health insurance policies typically cover some home care services for when a person is recovering from surgery or illness. However, benefits for long-term services vary from plan to plan. Commercial insurers generally pay for medical care in the home with a cost-sharing provision. Cost sharing varies with individual policies. You should contact your health insurer for more information.

As the public's need and preference for home care has grown, private long-term care insurance policies have expanded their coverage for in-home care. Home care benefits vary greatly among plans but most plans today cover home care.

Other payors
There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, the Military Health Program, the Older Americans Act and more. Many home care providers have foundations that will pay for home care for low-income families.

Private Pay
If an individual does not qualify for home care benefits through insurance or Medicare or Medicaid, that individual may want to consider arranging payment privately with the agency.

Types of Home Care Providers

Just like there are different types of home care services available, there are also different types of home care providers to consider. As a consumer it's important for you to fully understand the advantages and disadvantages of each type of home care provider before making a decision.

Home Care Agency - A home care agency is an organization that provides home care services, like skilled nursing care, physical therapy, occupational therapy, speech therapy, and personal care by home health aides.

The home care agency employs the qualified individuals to provide these services. The agency is responsible for its employees’ taxes, insurance, bonding and worker's compensation (as required by law). Employment is the key word. It carries with it an array of protections. If an employee is sick or goes on vacation, the agency provides another employee to perform the needed services. Employees receive training specific to the kind of care they provide. A licensed home care agency provides ongoing supervision for their employees. This helps the agency monitor and respond to the changing needs of clients, assuring that the appropriate level/skill of caregiver is assigned and mediating any other issues. The agency conducts background checks according to state law. In many instances the agency is licensed to provide all levels of home care (skilled nursing, therapy and non-medical services for example) so the individual does not need to work with more than one company and can access formal payor sources such as Medicare or insurance for those needs.

Registries or placement agencies differ from home care agencies in that the nurses, therapists, or home care aides they provide are contractors, not employees. Using a placement agency may seem a less expensive alternative; however, placement agencies provide less supervision and oversight of their workers. In some cases, the registry offers only referral and screening services, with the client taking the responsibility to pay the worker directly. In that case, you act as the employer and may be responsible for paying workers compensation and payroll taxes for the worker.

An independent worker is a person who is individually hired by either a family member or the person needing help. Employing a health care professional is an important decision, and one in which most people have little training or practice. While this may appear less expensive, there are many "hidden" costs and some significant risks.

Anyone who hires an independent worker must pay all appropriate payroll taxes - they are the employer. If the independent worker is injured on the job, the person who hires the individual is responsible for medical bills and any other expenses. Also, if the independent worker is sick or goes on vacation, he or she is not obligated to find a replacement. There is no supervision or training program. Unfortunately, there is always the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail and sometimes functionally limited individual. While most individuals who provide care do so out of a desire to help others, there will always be those who see this type of work as an opportunity to take advantage of someone. This becomes especially easy in a private home setting with little or no supervision. Perhaps lower in hourly costs, choosing an independent contractor does not provide the security, trust and assurance most people want for themselves or their loved ones.

Types of Home Care Services

November is national Home Care Month and to celebrate it, we will be putting up posts about the different realms home care covers, so you may understand what to look for when deciding to use home care.

Home care is one of the fastest growing and most cost-effective providers of the health care industry, and is clearly preferred by patients. Who of us wouldn’t prefer to be cared for in our own homes rather than in a hospital or other institution?

Types of Home Care Services:

Actually home care is a name that encompasses many different forms of care and services.

There are non-medical supportive services available through home care that help people who need some assistance remain independent. These are services which can extend the ability of many people to live in their own homes. These services are provided by paraprofessionals such as home health aides, certified nursing assistants, homemakers and companions. Services can include assistance with bathing, meal preparation, companionship, shopping, etc. Companions and homemakers give comfort, support and assistance to those who want to continue an active, independent lifestyle in their own home.

Intermittent skilled services are provided through a home care agency by Registered Nurses RNs), Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs). These professionals visit your home periodically and provide health status assessments, teaching about diseases and treatment for clients and families, taking samples for lab tests, nutritional counseling, medication training and compliance, wound care, venipuncture, ostomy teaching and management, IV management and more.

Additionally, many therapies can be provided at home to speed recovery from illness, injury or surgery. These include physical therapy to regain physical motion and strength, occupational therapy to regain day to day skills such as dressing and feeding oneself, and speech and language therapy to improve breathing, swallowing or communicating.

Many home care patients require continuous care for major portions of every day, if
not 24 hours a day. These include:

• Technology-dependent patients who have respiratory conditions treated by ventilators, infusion.

• Functionally disabled patients who may include individuals who are paralyzed,mentally disabled, or unable to perform activities of daily living.