Thinking about home care? Remember that Medicare does not pay for everything and that agency quality varies

By MaryAnn Brierly
ResCare Home Care - Magnolia
Atlanta, Georgia

Member of the national ElderCare Matters® Alliance, Georgia ElderCare Chapter 

"Home care" is a simple phrase that encompasses a wide range of health and social services,  These services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.

This scene is all too familiar.

A parent comes home from the hospital after major surgery or after a serious injury from a fall, and the discharging doctor tells the family that the elder can no longer live alone safely.

Traditionally, a family member or a friend of the family provided long-term care at home.  However, today often no family member lives nearby or no one can take time off from work.

Families should consider that Medicare will not pay for most long-term care services, including private home care, which are defined by Medicare as all personal care services such as bathing, grooming, meal preparation, feeding, and companionship.

Pays For Some Skilled Care

Medicare will pay for some skilled care (also known as home health care) - on a limited basis - if the patient has an order from the discharging doctor, and the skilled care services provided by a licensed medical professional include such items as wound care, physical therapy, diabetic teaching, and speech therapy.

Once the family realizes that "personal care" is their responsibility, where do they turn for help?  Private duty home care agencies take most of the worry out of arranging for home care.  However, their services are not inexpensive and standards of care and operation vary by agency.

Private Provider Should Be State Licensed

A private home care provider in Georgia should be licensed by the State Department of Human Resources and subject to yearly inspections.  The  care provided by home care agencies typically falls under the guidelines of personal care tasks, which includes assistance with bathing, toileting, grooming, shaving, dental care, dressing, and meal preparation.

Personal care tasks may also include nutrition monitoring, home management, housekeeping, assistance with walking, as well as escorting patients to medical and dental appointments.

Plan Ahead

Easier said than done.  But try to plan for a crisis before it happens.  Thinking ahead and choosing an agency before surgery, or when you start seeing changes in the health of your loved one, is the ideal situation.

Making choices when you are not in a crisis mode allows you the time to locate a home care agency with high standards.  It provides you with the necessary time to develop a good working relationship with the home care agency, so that there will be a smooth transition from independent living to having caregivers in the elder's home.

Factors to consider when choosing a reputable home care company

• The home care company should be licensed by the State Department of Human Resources;
• References should be readily available;
• Goals of the company should include continuity of caregivers, consistent quality of care, and good communication with the client and family;
• A registered nurse should do the initial assessment and prepare the written care plan.  Hiring practices of all caregivers (nurses, nurses aids, or sitters) should include interviews, reference checks, criminal background checks, credential verification and annual TB tests.  Caregivers should be bonded and covered by workers' compensation insurance;
• Competency tests, CPR certifications, performance evaluations, and continuing education in the field of geriatrics should be provided to caregivers by the company;
• Ongoing supervision of the caregivers should be provided by a registered nurse; and
• A knowledgeable staff person should be on-call for after hour needs and questions.