In-home care workers can be hired privately or through a home health agency. There are many advantages to hiring home health aides or companions through an agency:
1. If Medicare, Medicaid, or another third party will be footing the bills, the services must be provided through a licensed home health agency. This license or certification also means an agency has met minimal standards set by the federal government.
2. The agency finds the workers, screens them, and monitors the work. If an agency offers a full range of services, the care tends to be coordinated and more comprehensive.
3. Agencies have insurance in the event an accident occurs or a worker is injured while on the job.
4. The agency handles all of the paperwork involving social security and income tax withholding.
5. The agency replaces a worker if someone does not report for work.
There are many things to consider when hiring private caregivers:
1. Someone will need to obtain references and monitor the work closely. Criminal background checks can be obtained through the state police.
2. A schedule will need to be completed and a contingency plan agreed to by all workers.
3. Who is responsible for the tax withholding and worker's' compensation insurance? Someone should talk with the patient's accountant regarding the income tax issues.
Medicare Funded Home Health Services
A common misconception is that Medicare-funded home health services will meet all of a patient's care needs. The circumstances under which a patient would qualify for Medicare coverage of home health care are very limited. The patient would have to be 1) home bound (have a medical condition which makes it difficult to obtain services outside of the home); 2) in need of skilled nursing or rehabilitation services, rather than simply requiring personal care; and 3) approved to receive these services by the attending physician. Medicare does not cover a nursing assistant to stay with the patient all day while the caregiver goes out or to work.
Living Together in One Home
If living alone is not feasible, another alternative is for the patient and the caregiver to share living arrangements. Living with an individual who needs care will greatly impact the lifestyle of the entire household. The patient's needs as well as the caregiver's (and his or her family's) needs should be carefully evaluated.
Medical Alert Services
These are systems that can be used to summon help in an emergency. Typically the patient in distress presses a button on a necklace or watch which signals to a central call center. The center then either calls a list of emergency contacts that the patient has provided or summons 911. These systems can be installed for approximately $50 to $100 and charge a monthly monitoring fee which ranges from $25 to $40.
Adult Day Centers
Adult day care can provide needed respite for caregivers. It can provide an option for keeping a patient at home by providing needed respite care. There are more than 3,400 adult day care centers. They typically provide care Monday through Friday from 8:00 a.m. to 5:00 p.m. The average cost for adult day care is $56 daily. This cost may be covered by the Medicaid program in some states.
Care is also available through Albright's LIFE program. This program provides comprehensive healthcare and supportive services that enable participants to remain at home and live as independently as possible. This program provides both in-home support services as well as a day center.
Assisted Living Facilities
Assisted living facilities (or personal care homes as they are also known) are ideal for patients requiring some assistance with the activities of daily living (bathing, toileting, dressing, transferring, and eating), but not constant supervision of more acute medical needs. Residents are encouraged to be as active and as independent as possible. Assisted living facilities offer three meals per day, recreation and socialization, transportation, assistance with the activities of daily living and medication, and laundry/housekeeping. Some facilities offer private rooms and residents can often bring their own furniture and personal belongings to create a more homelike environment.
Continuing Care Retirement Communities
Continuing care retirement communities (CCRCs) are also sometimes known as "life care centers." They offer it all from independent living to skilled nursing facility care, but usually at a rather hefty price. Once a resident is admitted, he or she can receive the level of care needed for the duration of his or her life. These communities typically contain houses or apartments for those who are still relatively independent. Additionally, there is assisted living available when more care is needed, and, finally, skilled nursing facilities are available when an individual needs assistance with all of his or her activities of daily living. Residents can move within the CCRC as care needs change. This helps keep a family together. If one spouse needs nursing home care, but the other needs only care in an assisted living facility, both can continue to reside on the same campus.
Hospice is the philosophy and practice of caring for the dying. It is based on the belief that death is a natural and inevitable part of life and that at some point all efforts should be focused on enhancing whatever life remains. Hospice can assist a patient in his or her home by attempting to keep the patient comfortable and free from pain the last days of life.
Hospices provide doctors, nurses, social workers, therapists, dieticians, clergy, home health aides, and volunteers. Staff members are available 24 hours a day, 7 days a week to meet the needs of the patient and his or her family, to answer questions, and to make visits as needed. Hospice services can be provided both at home and in health care facilities.
The care managers at Steinbacher & Stahl can assist you in finding and arranging the care your loved one needs. Once these services are in place, the care manager is able to monitor them on a regular basis.
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