The arrival of spring typically equates to the ‘spring-cleaning’ of your home. In this article, I challenge family caregivers and those of you wishing to age in place to polish your knowledge and spruce up your care-planning toolkit. A little spring-cleaning can go a long way with your goal of keeping yourself or your loved one at home as long as possible. Read on to discover more about the various levels of care in the home, who pays for it, and alternatives.

The terms “home health” and “home care” sound alike, and you may hear folks using them interchangeably. However, unlike home care, home health is covered under private insurance or the Medicare umbrella and requires a physician’s order. Home care is generally not covered by insurance.  Although, you may find that your viable long-term care insurance policy includes this care benefit, or a newer Medicare Advantage plan may offer a meager home care visit or two. 

Key Differences

Home Health:

• Clinical care ordered by a physician
• Typically initiated after discharging from a hospital or rehabilitation stint
• Can also be utilized for a physical decline in function to regain independence in the home
• Covered by private insurance or Medicare under certain eligibility criteria
• Services are provided by licensed professionals such as nurses, therapists, and social workers
• May include the monitoring of health status, wound care, and various medical testing

Home Care:

• Care for non-medical services that do not require a physician’s order
• Typically referred to as companion care or care provided by a sitter agency
• Provided by trained care aides who are generally not licensed to provide medical duties
• Includes assistance for daily activities like bathing and dressing, safety and medication monitoring, cleaning, organizing, transportation, and companionship
• Usually paid by personal finances (current rates in the range of $25/hour)
• Can also be covered under the Medicaid program or Veterans Administration (VA) if all eligibility criteria is met

Additional In-Home Care Tools

Home Based Primary Care: This is a new standard of in-home physician care provided to home bound, high-risk, and medically vulnerable patients; it’s covered by traditional Medicare, most private insurances, and some Medicare Advantage plans. It includes most services received at a traditional doctor’s office with a goal of preventing chronic conditions and unnecessary emergency department visits.

Palliative Care Services: A special form of medical care (that is not hospice care), palliative care is ordered by your physician who provides patients help with the relief of pain and other symptoms of a serious illness with the goal to improve daily function. Palliative care is covered by private insurance or Medicare if you meet eligibility criteria. It can be used in conjunction with other services; it’s typically provided in the home by a team of clinicians like specially trained doctors, nurse practitioners, social workers, and chaplains, who work closely with families to meet goals. For more information, visit the Center to Advance Palliative Care website.

Hospice Care Services: This is likely the best option when you decide that continued treatment for an illness is not worth all of the pain and suffering. It requires a physician’s order and is covered under the Medicare umbrella if you meet eligibility criteria. It does not equate to giving up and may be implemented for a short period of time; hospice care can include a plethora of 24/7 services to help improve the quality of life and takes place wherever your loved-one resides, but it is not a sitter service. Hospice care provides an amazing support network for the caregiver; sometimes your doctor may not agree on who should get hospice care due to lack of clearly defined ‘terminal illness’ standards, but it is a Medicare right to receive an assessment.

Technology: New electronic gadgets make it easier and more affordable to increase your comfort level of living alone in the home. Take advantage of safety monitoring tools and services, medication reminder appliances, remote locking systems and temperature controls, and social applications to alleviate loneliness. 

Importance of Layered Care

We’ve all heard of the phrase, “it takes a village.” If you or your loved one is trying to live independently at home as long as possible, it is important to consider all options for layering a circle of support to meet everyone’s goal.

For Example —

Want to know what’s in my caregiver toolkit? I chose to implement both home health and home care into my loved one’s residence, along with the additional aid and support of palliative care. Under home health care, my care recipient qualifies for physical and occupational therapy via Medicare, and it provides exercises and modifications to increase in-home function. Under home care, we privately pay for weekly transportation to the beauty salon and light housekeeping. The palliative care company that I chose comes into the home and provides an extra set of medical eyes and serves as an extension of the physician’s office, relaying information from in-home medical assessments back to the primary care doctor. Not only does this service offer monthly visits, I can call on my palliative care team 24/7 when medical issues arise and avoid having to wait for a doctor’s office visit. Together these entities coordinate a sound treatment plan all in the comfort of my loved one’s own home. This holistic approach satisfies the medical and emotional well-being of my care recipient.

Drawbacks to layering these services is the myriad of evaluations and interviews at the onset of each service that challenges the patience of my care recipient and my ability to manage the calls of weekly scheduling. However, this is a small price to pay, in my opinion, for the amount of gain in supervision and social stimulation as I muddle through my work-life balance in the throes of a sandwich generation!

Some layering of care comes with only the cost of time. I have implemented a phone call system where several family members are slated to reach out to our care recipient on a set day for needs monitoring and social engagement.

My technologies of choice include utilizing a Ring doorbell (to see comings and goings of the various home care agencies); Blink cameras (to monitor falls and indoor patterns of daily activities); and Jitterbug and Life Alert (GPS and emergency alert systems).

Spring-Cleaning in Your Situation

This all sounds easy, doesn’t it? Be aware of the hurdles stemming from (1) reluctance to welcome (or else any tendency to resist) strangers into the home and the perception of loss of privacy; and (2) the need to advocate for rights and benefits in obtaining services. There are ways to make this transition easier by starting gradually and listening to fears and feelings.