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Home Care: When Extra Help Is Needed

by Elizabeth Weiss McGolerick

Home Care encompasses a broad array of health and social services that are delivered directly to a patient at his or her home. Services are available for people in need of assistance with the essential activities of daily living (ADLs) such as eating, bathing, dressing, and carrying out basic household duties, as well as for recovering, disabled, and chronically or terminally ill people who require medical or therapeutic treatment.

Home Care services are typically provided by home care organizations. Home health agencies supply skilled and highly supervised Medicare-certified care through licensed and regulated professionals. Home care services may also be obtained from private-duty agencies, registries, and durable medical equipment and supply dealers.

The Advantages of Home Care
Home care is appropriate for people who require ongoing care but wish to avoid hospitalization and maintain their independence. More often than not, aides assist the patient's primary caregiver with duties they cannot solely provide. This is the case with Christie Akers and her 78-year-old mother. "My mother had a stroke that took her to rehab and then a nursing home," Akers says, "but she didn't belong there. I had to find a way to get her home, but I wasn't in a position to give up my job to take care of her." At that point, Akers turned to Home Instead Senior Care, the world's largest provider of non-medical companionship and home care services for seniors.

Akers' mother is in good health, other than the physical impairments she now suffers as a result of her stroke, but she does need constant care. Along with a live-in companion, Akers employs the services of Home Instead to help her mother with her ADLs.

"Assisted Living doesn't cover [these home care services] and medically Mom does not need a nursing home. Home care is the only option," Akers says.

According to the National Association for Home Care and Hospice, more and more older adults are receiving home care services as their physical capabilities diminish, though the service is available for patients of all ages.

What Is the Cost of Home Care?
Under public and private third-party payors, such as Medicare, Medicaid, Veterans Administration, and commercial health insurance companies, patients may be entitled to certain services offered by home health agencies. Home care services not covered under any of these plans must be paid for out of pocket.

The 2005 MetLife Market Survey of Nursing Home and Home Care Costs found the average hourly rate to be $19 for home health aides and $17 for homemakers/companions.

The American Association of Homes and Services for the Aging found that 36% of long-term care spending is paid for by private pay providers, 17% by Medicare, and 47% by Medicaid. Akers stresses that, while her mother receives exactly what she needs from her home care services, the price of daily care is high and would be impossible to manage had her mother not enrolled in long-term health care insurance years ago.

What Services Are Offered Through Home Care?
A wide range of medical and non-medical services are available through home care, and providers offer therapy options that can be carried out by a variety of professionals, paraprofessionals, and volunteers. While services for the treatment of medical conditions must be prescribed by a physician, supportive services - such as those offered by companions and volunteers - do not require a physician's clearance.

Under a nurse's care, patients receive injections and intravenous therapy, as well as wound treatment. Physical therapists (PTs) rehabilitate patients needing to restore their mobility and strength. Similarly, occupational therapists (OTs) instruct patients in the use of specialized equipment and techniques to improve their ADL functions. Social workers, speech therapists, and dietitians also provide home care services. Home health aides assist patients with ADLs, while homemakers perform light chores to help maintain a patient's home, but do not offer direct, hands-on personal care.

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