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You don't necessarily need to depend on inpatient medical facilities to meet all your healthcare needs. If your condition allows, you can get the quality care you need at home and avoid the inconveniences of hospitals, nursing homes, and rehabilitation facilities.
What is home care?
Home care encompasses a wide range of health, social, and rehabilitative services for recovering, disabled, chronically ill, or terminally ill patients. Patients and their families choose home care during different stages of their cancer journey, such as after an extended hospitalization or intensive treatment.
How do I know if home care is right for me?
Choosing home care services can be an emotionally difficult decision for patients and their families who may question whether they're capable of fulfilling all of their loved one's needs.
Where should I start?
Gather useful information about the services available and how to access them. Work with your healthcare team (social worker, nurse, and doctor) to discuss and assess patient needs. You can start the process of using home care services by:
- Talking with your doctor: They must prescribe home care services.
- Talking with your social worker: Social workers initiate the referral and arrange for home care services with your doctor. They often use the agency they're most familiar with, so discuss other agency options if you wish. If your insurance company requires pre-authorization, verify that it's been notified about your home care request.
- Contacting your insurance company: Ask your insurer for a list of participating providers. Remember that some insurance companies require pre-authorization of services.
How do I talk with my doctor about home care?
Talk with your or your loved one's doctor directly about the types of services that may be needed at home. Your loved one must initiate a referral to an agency with a doctor's order for home-care services. If you will be receiving home-care services following a hospitalization, typically the hospital social worker initiates contact with the home-care agency and coordinates services with you, your family, and your doctor.
Discuss with your doctor the types of services you think you'll need at home.
To make an informed decision, you'll need to be able to answer the following questions to help determine how many hours and what type of care is needed:
- How often is the patient typically alone during the day and night?
- How many hours can the family or caregiver assist the patient on average?
- What types of assistance can the family or caregiver provide (cleaning, cooking, laundry, assistance with walking?)
- How many flights of stairs does the patient have to walk to get to the bedroom? The bathroom?
How can I find a home care agency in my area?
The National Association for Home Care and Hospice (NAHC) provides helpful information about home care, including an agency locator, which contains a comprehensive database of more than 20,000 home care and hospice agencies. Your state and local health departments should also have a registry of licensed home care agencies in your community.
In addition, a Blood Cancer United Information Specialist can help with your questions and concerns.
Types of home care
You have many options when it comes to choosing the type of home care service you prefer:
- Registered nurses (RNs) provide skilled services that can't be performed safely or effectively by nonprofessionals, such as dispensing drugs, administering wound care, changing dressings, and delivering intravenous fluids
- Licensed practical nurses (LPNs) provide basic bedside care, such as taking vital signs, temperature, blood pressure, pulse and respiration. They also prepare and give injections, monitor catheters, apply dressings, treat bedsores, and give alcohol rubs and massages. LPNs don't dispense drugs.
- Physical therapists work with patients to restore their strength and mobility through exercise, massage, or other methods
- Social workers assess the psychosocial factors affecting patients and provide counseling, serve as case managers to coordinate services and assist in identifying available community resources
- Speech language pathologists work with patients to restore speech by retraining them in breathing, swallowing, and muscle control
- Occupational therapists assist patients who have disabilities that prevent them from performing activities of daily living (ADLs)
- Nutritionists provide counseling to patients who may benefit from dietary assessment and guidance to help in managing their illness
- Home health aides (HHA) and home care aides (HCA) provide hands-on assistance with ADLs, such as bathing, getting out of bed, walking, toileting, and dressing
- Homemaker and chore workers help with light household chores such as laundry, meal preparation, cleaning, and shopping
- Volunteers provide a range of services, depending largely on their training and experience. Services can include transportation, companionship and emotional support, household chores, and personal care.
What types of agencies provide home care services?
You can get home care services from the following:
- Home health agencies provide a range of services, instead of one or two specialized services such as nursing care
- Homemaker and home care aid agencies employ homemakers and home care aides
- Staffing and private-duty agencies generally provide nursing, homemaker, home care aides, and companion services
- Pharmaceutical and infusion therapy companies deliver drugs, equipment, and professional services for patients receiving IV or nutritional therapies through tubes
- Durable medical equipment and supply dealers provide and deliver respirators, wheelchairs, walkers, catheters, and wound care supplies to homes. Typically, these agencies don't provide physical care for patients.
- Registries are employment agencies for home care nurses and aides that match providers with clients and then collect a finder's fee
- Independent providers refer privately employed home care workers, including nurses, therapists, aides, homemakers, and companions
Who will cover my home care costs?
Medicare covers home care services if the following conditions are met:
- The Medicare recipient's doctor must decide that the patient needs medical care at home and must initiate the plan
- The patient must need at least one of the following: intermittent skilled nursing care, physical therapy, speech-language therapy, or occupational therapy
- The home health agency caring for the patient must be a Medicare-certified agency
- The patient must be homebound or normally unable to leave home unassisted (a need for adult day care doesn't stop the patient from getting home health care)
Under Medicare, home health aide services are only covered on a part-time or intermittent basis, not long term. Medicare limits the number of hours a day and days a week you can receive skilled nursing or home health aide services. Therapy services are covered for as long as your doctor determines that you need them.
Medicare will not cover the following services as part of a home care plan:
- 24-hour-a-day home care
- Prescription drugs (although they may be covered by Medicare part B or D)
- Meals delivered at home
- Homemaker services such as shopping, cleaning, and laundry
- Personal care provided by home health aides such as bathing, dressing, and toileting when this is the only care the patient needs
For a list of certified home healthcare agencies, contact Medicare.
States are mandated to provide home health services only to individuals who receive federally assisted income maintenance payments, such as Social Security, or who are considered "categorically needy." Categorically needy recipients include certain disabled individuals whose incomes are too high to qualify for mandatory coverage but are below federal poverty levels.
Under federal Medicaid rules, home health services coverage must include:
- Part-time nursing
- Home care aide services
- Medical supplies and equipment
However, at the state's discretion, Medicaid may also cover:
- Physical, occupational, and speech therapies
- Medical social services
For more information about your Medicare and Medicaid entitlements, contact The Centers for Medicare and Medicaid Services.
Community health insurance companies generally pay for skilled professional home care services. They often cover some home health services for acute needs, though benefits vary from one plan to another.
Managed care organizations and other group health plans sometimes include coverage for home care services as well. However, these organizations only pay for pre-approved services.
The Veterans Administration (VA) covers home healthcare services for veterans who are at least 50 percent disabled because of a service-related condition. For more information, contact the VA at (800) 827-1000.
Every state and U.S. territory has a state health insurance assistance program (SHIP) whose counselors can provide free health insurance information and help. This includes answering questions about home care services and what Medicare, Medicaid, and other types of insurance pay for. To find out more about your state's program, visit SHIP.
You may want to look into state and local social service programs that may cover the costs related to services such as home care aids; personal care, chore, and shopping assistance; escorts; and meal deliveries to persons 60 years and older.
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