By Phyllis Mensh Brostoff, CISW, CMC, Aging Life Care AssociationTM Member, Fellow of the Leadership Academy
If you took a poll of older adults and asked each person if they wanted to remain in their own home until the end of their life, most people would say, “of course.” That is a wonderful goal, which often takes a lot of sound planning to be successful. Anything can get in the way—accidents, illness, lack of energy, declining physical abilities—of achieving your desired independence. It is hard to give up even a little autonomy, but asking for assistance can help keep you where you want to be—in your own home.
What if You Become Homebound?
If you are recovering from an acute illness, you may be eligible for home health services that are paid for by the Medicare program. An Aging Life Care Manager™ can help you access licensed home health services by facilitating a conversation with your physician about your need for skilled nursing services, physical therapy, occupational therapy, and/or speech therapy in your home. This is an important conversation to have with your doctor and discharge planner if you are in the hospital or a nursing facility and need to decide on and plan for services in your home once you are discharged.
However, Medicare will only pay for these services if you are “homebound.” Homebound is defined as only leaving your home for “medical treatment or short, infrequent absences for nonmedical reasons, like attending religious services.”
You may also receive help from a home health aide under the supervision of a professional nurse or therapist. A physical or occupational therapist can evaluate your home and recommend equipment (such as guard bars in the bathroom) that will improve your safety.
These services must be obtained from a state licensed home health agency certified to provide Medicare-reimbursed services. They may be freestanding agencies, or they may be part of a large, hospital-based organization. Licensed home health services are usually timelimited, ending when you have met the goals of treatment and the need for the skilled care has ended.
If you have enrolled in a Medicare Advantage program, you may also have access to additional services such as home visits after a hospitalization.
Other Home Care Services
Many other care services are provided in the home but are not licensed or paid for by Medicare. An Aging Life Care Manager can help you understand what they can offer, access reputable services, and monitor them on an on-going basis.
Non-Medical Aides, Companions and Homemakers
There are many types of paid care giving services available—often called non-medical aides, companions and homemakers—who many people hire privately. If you do, you or your family should check at least two work-related references, develop a specific set of tasks and expectations for the caregiver, arrange to pay all appropriate taxes, and have the required insurance coverage.
Caregiver services can also be arranged through an agency. While this may cost more per hour than hiring an aide yourself, hiring an agency assures you of coverage when the aide is sick, on vacation or quits. The agency also carries liability insurance and is responsible for all employment taxes and employee bonding. An Aging Life Care Manager can help you find a reputable agency and get important questions answered, such as: do they check police and driver license records; do they provide supervision; how do they handle cancellations; and how long have they been in business?
Your family can come together and construct a plan for supporting you in your wishes to remain in your home. If it becomes clear that you all need help in doing that, hiring an Aging Life Care Manager is a wise investment. The Care Manager can facilitate a family understanding of the situation and help everyone recognize what your needs are, help bring on board important services, and provide caring support to you and your family on an ongoing basis.
Phyllis Mensh Brostoff, CISW, CMC, is a social worker and co-founder of Stowell Associates – a care management and home care company in Milwaukee, Wisconsin. She has written numerous articles and presented seminars across the country. More information is available at www.caremanagedhomecare.com. Follow Phyllis on Twitter, Facebook, or email her at firstname.lastname@example.org.
Thank you to the Aging Life Care Association™ for permission to share this information. You may learn more about
Aging Life Care™ at aginglifecare.org.