Home care is medical or personal assistance provided in the client’s residence to help them maintain or improve their health. It is frequently used for transitional care after a hospitalization or a stay at a rehabilitation facility. Home care is sometimes used for short term treatments such as IV antibiotics or wound care and sometimes for long term health maintenance such as catheter care, medication management or help with bathing. Hospice is care that focuses on quality of life for clients and their families when an illness is advanced and treatment has been stopped. Hospice care is person-focused and coordinated to provide not only physical care but also social and emotional care so the client’s remaining life is the best it can be.
What kind of services are available at home?
Different agencies offer different services. An agency may provide some or all of the following:
• Skilled nursing offers overall case management to help you set and achieve goals, medication management, wound care, disease or symptom management, IV therapy, some labs (including INRs), catheter care, post-surgical care, picc site care, teaching for new medications like insulin, and more.
• Physical therapy is there to help you gain or regain ability – strength and gait training, balance, and range of motion.
• Occupational therapy offers methods for meeting daily needs and modifications of the home environment for safety and ability to be independent in activities of daily living.
• Speech therapy provides language, social/cognitive aid for communication, and help with swallowing disorders due to a disease like Parkinson’s or after a stroke.
• Respite care is skilled or non-skilled care providing short term relief for primary caregivers, enabling the caregiver to run errands, do self-care or regenerate. Respite may assist when the caregiver is temporarily unable to provide care and is often for longer time periods than other cares.
• Home health aides provide cares such as bathing, dressing, grooming, exercises, lotions, some wound care and other personal cares.
• Homemaking offers non-personal cares such as light housekeeping, meal preparation, errands, and bill paying.
• PCA (Personal Care Assistant), or Concierge services, help their clients with routine daily living activities which may include homemaking, transportation to appointments, companionship, and some non-medical personal cares.
• Companions provide a consistent social connection and a variety of helpful services for those who may be homebound but generally healthy. Companions could be paid or volunteers who establish a relationship, which improves clients’ quality of life and offers a critical link to society.
Other helpers outside a clinical setting could include spiritual advisors, social workers, pharmacy services, travel nurses and more.
You may want to find a single agency that can provide most or all of the services you will need. Check with the home care agency (or ask your social worker or discharge planner to check) to see what services the agency offers and whether they have staff available to help when you need it. If you decide that home care is the best option in your case, a social worker or nurse will usually contact the agency, provide intake information, and send the documentation needed to secure care and make sure the care will meet your needs. In some instances, initial requests for care are made by clients themselves or their families.
When is home care appropriate?
Care in the home is appropriate for people with conditions that make it difficult for them to leave their residence and where assistance is beyond the skill or ability of a primary caregiver to provide. Sometimes there is no primary caregiver in the home to help. Care will often be paid by Medicare, the VA, Medicaid, or insurance when being an outpatient for necessary services is physically very difficult or even impossible. There is often confusion about what qualifies a person as homebound. It has nothing to do with whether a person is able to drive, whether they have a vehicle, whether they tend to stay home all the time or even if they do not have family or friends available to transport them. This is because medical transportation services are readily available in most areas “If someone can call and say ‘Let’s go out for lunch. I’ll pick you up in 15 minutes’ and you can answer, ‘Sure,’ most likely you are not homebound,” explains Angie Pederson, office manager with Good Samaritan Home Care. If, however, it is very difficult to get out of the house, services in your home may be the way to go.
People sometimes think that once they are homebound they must always be homebound. That’s not the case. Once you gain enough strength or mobility to resume your activities outside the home, your homebound status ends. Some people then choose to continue services on a private pay basis.
When would you need home care and when would you need hospice?
There is a difference in the focus of care. Home care works with clients on rehabilitation and on helping them manage and/or improve their condition. Hospice provides comfort care and multi-faceted assistance to make life as good as possible when there is a prognosis of six months or less to live as certified by a physician.
What are the benefits of home care and hospice?
According to Ashley Maiers, Dirctor of Operations at Prairie River Home Care, care in the home is less expensive than hospital, nursing home, or rehab center care. People often feel they heal better in their own homes where they are most comfortable. Statistics also show that those who are not completely on their own but instead receive home care assistance have the oversight and assistance needed to recover more completely and avoid trips to the emergency room. They tend to get help in a timely way and have far fewer hospital re-admissions. In addition, at home there may be less exposure to infections such as pneumonia or flu. Home care and hospice staff can provide a continuity of care that is often not possible in a more institutional setting. Caregivers get to know their clients and clients’ families and can follow people over time. Home care offers peace of mind knowing that a professional is regularly checking up on you and able to answer your questions. Hospice care gives people the option of spending their remaining lives in their own homes, and supports the person, their caregivers, and their loved ones who have made that choice. Hospice may even offer bereavement services after the loved one is gone.
“The benefits of hospice are greatest when the care is provided early in a patient’s eligibility, offering them the highest quality of life in the time they have left through pain and symptom management. Many families say, in fact, that they wish they had received hospice care sooner,” says Dr. Andrew Mayo, St. Croix Hospice Chief Medical Officer.
“Hospice care is for patients with a terminal diagnosis and life expectancy of six months or less, but the hospice benefit can be renewed beyond six months if needed,” according to Dr. Mayo. He continues, “Choosing hospice is about living life to the fullest and ensuring quality of life in the time remaining.”
Is home care paid for by Medicare, health insurance, the VA or public assistance?
Medicare (if eligible) and many insurance companies pay for services at home after a hospitalization where mobility is compromised because of surgery, illness, weakened condition, or equipment that is difficult to transport. The VA often covers care at home. Insurance policies may pay for at least part of home care expenses. Fillmore County Public Health provides some or all of the needed financial assistance to residents who apply and income qualify for aid in the form of Medical Assistance. Your agency will be able to tell you prior to the onset of services what your financial responsibility will be.
How do I get home care?
In order for a home care agency to provide services, they need a doctor’s orders. Often the original orders come from a hospitalist but ongoing orders must come from a primary care physician (M.D. or D.O.). A home care agency will assign a case manager to coordinate care and the case manager will be in communication with the primary care provider to manage any changes, concerns or new needs. Cheryl Newman, Branch Operations Manager with International Quality Homecare adds, “There are times when you don’t need a doctor’s order as well. Sometimes you might just need a little help with your chores or someone to stand by while you shower. These are all considered home care and you may be eligible for help.” Clients and their families can become informed and ask their provider if home care is appropriate in their case. Social workers, discharge planners, and public health nurses are knowledgeable people who can connect you with home care or hospice services.
How long does home care last?
The length of time people utilize home care will vary based on needs. Usually your home care team will work with you and your doctor to set goals. Once those goals are met, services end. You may meet goals quickly and home care will be short-term. You may need a bit more time to achieve goals so home care could be extended if all are in agreement. You may need some assistance on an ongoing basis or you may reach a point where you are able to be out and about again. When no longer homebound, services usually end. Progress may reach a plateau or even decline. If home care is no longer able to assist you in reaching goals, services will end. You may also, at any point, decide that you no longer want services and it is your option to discontinue them.
How do I find a good agency?
Like any service, referrals from people you know and trust are the best. Doctors’ offices, nurses, therapists, and social workers at hospitals and rehabilitation centers may suggest options. Fillmore County Public Health maintains a good list of resources. These are some options (in alphabetical order) in Fillmore County:
Medicare certified home care
• Good Samaritan Society Home Care, (507) 765-2700
• International Quality Home Care, (888) 304-6230
• Prairie River Home Care, (888) 525-7742
• Recover Health, (888) 865-2903
• Spring Valley Home Care, (507) 346-7381
Hospice services
• Gundersen Health Hospice, (608) 775-8400
• Heartland Hospice, (507) 292-1170
• Mayo Clinic Hospice, (507) 284-2511
• Seasons Hospice, (507) 285-1930
• St. Croix Hospice, (507) 281-5700
PCA services
• Accra, (866) 935-3515
• SEMCIL (Southeast Minnesota Center for Independent Living, assisting persons with disabilities), (507) 285-1815
Additional resources
• Fillmore County Public Health, (507) 765-3898
• Senior Linkage Line, 1 (800) 333-2433