1. If your loved one needs extra help at home, check into one of the home care programs available.

    Skilled Home Health Care

    Skilled home health care is most commonly paid for by Medicare Part A, but it may also be covered by Medicaid or private insurance. In order to qualify, the patient must require intermittent (not 24/7) skilled nursing, physical therapy, occupational therapy, or speech therapy. The patient must also be homebound, able to leave home only with great difficulty.

    While your loved one is receiving skilled services, he or she may be eligible for home health aide visits. The home health aide will come out a few times a week to help with personal hygiene, dressing and grooming.

    Skilled home health care is designed to be finite. The assumption exists that eventually the patient will get better and the service will end.

    Skilled home health care is perfect if your loved one develops an infection and needs a round of IV antibiotics or if he or she needs some physical therapy to recover from a fall. It does not address non-medical needs, however, nor does it provide what is known as custodial care or care directed at maintaining your loved one at home.

    Hospice Care

    Like skilled home health, hospice care is covered by Medicare Part A, Medicaid, and private insurance. In order to qualify for hospice care, the patient must have a life-limiting illness with a physician willing to certify that the prognosis is six months or less. The patient must also be willing to forego any further treatment aimed at curing her or his disease. A cancer patient who was still receiving chemotherapy, for instance, would not be appropriate for hospice. The patient must also have an "able, available, and willing caregiver" who will be responsible for his or her day to day care.

    Hospice provides regular nursing visits for symptom management in order to enhance the quality of the patient’s life. Hospice also provides aides who visit usually two or three times a week to assist with personal care like bathing; chaplains to provide spiritual support; social workers to provide emotional support and assistance obtaining community resources; and volunteers who can provide a couple of hours of respite care while the primary caregiver takes a break.

    Like home health, however, hospice does not provide 24/7 care or custodial care.

    Unless the patient’s condition stabilizes, or the patient opts to revoke hospice and receive aggressive treatment, hospice stays involved until the end of the patient’s life. Even after the patient dies, a bereavement counselor follows the family for a year to provide grief support services.

    Private Duty Home Care

    Some long term care insurance policies cover private duty care, and there are some senior services’ programs and home and community based services (HCBS) programs for low-income seniors that will pay for private duty, but usually the patient is responsible for paying for private duty care out of pocket. Private duty home care can cost anywhere from $18.00 to $25.00 per hour.  

    Private duty care is roughly split into two categories: companion services and physical assistance.

    The companion does not provide hands on care. He or she may run errands for the patient, do some light housekeeping, prepare meals, help the patient catch up with bookkeeping or correspondence, remind the patient to take medications, or just be in the home as a friendly presence.

    The assistant provides physical care. He or she is usually a licensed certified nurse’s assistant (CNA) and may help the patient take a shower, transfer from wheelchair to commode or turn from one side to the other in bed, clean up after an "accident," dress, and eat.

    Private duty care usually lasts a minimum of two to four hours. If the patient’s finances hold out, it can go on round the clock seven days a week. Private duty care may be used in conjunction with both skilled home health care and hospice.

    Questions and Comments  

    If you have questions about any of these programs or where to find a program in your area, or if there is anything else you’d like to ask me about adult caregiving, please send me an email.

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