David DiFilippo, President of Concord Home Health Services, is a regular columnist in Senior Digest. The following are answers to readers’ questions from recent issues.
Q: I would like to look into home care for my father but I’m not sure we can afford it. How much do home care services cost?
A: Costs for home health care depend on the amount and type of care provided so you will need to speak directly with a home care representative to determine exactly what services you need in order to get a definitive price. If your father needs only the assistance of a home health aide or companion, the cost would be less than that of a registered nurse or licensed practical nurse. An additional factor is the amount of care needed: patients generally need anywhere from one-hour-a-day to 24-hour-a-day care.
One advantage of home health care rests in its flexibility. With home care, you pay only for the amount of care you actually need, and then receive that care on a one-to-one basis. This flexibility allows you to tailor the health services perfectly to fit your needs and schedule.
As for insurance coverage of home health care, different policies range in the amount of care covered. Some insurance plans cover full home health care costs, others cover part, and others cover none at all. It all depends on your policy and company. Medicare also pays for many skilled services needed to recuperate from a hospital stay and Medicaid may contribute toward long term home care needs.
Q: How do I start using home health care services?
A: You can access home health care services by contacting a home health care agency directly. You must undergo an assessment by a registered nurse to determine your health care needs. The home health care agency can provide that assessment and will work with your physician and insurance company to help put appropriate services in place for you. If you would like Medicaid to pay for home care services, you must be assessed by the State of Rhode Island’s assessment team to determine if your needs are eligible for Medicaid funding. The Rhode Island Departments of Elderly Affairs or Human Services can provide you with information regarding Medicaid funded long term care options.
Q: My grandfather has Alzheimer’s Disease and his condition is getting to the point where he is too much for my grandmother to care for alone. Is home health care a safe option?
A: It can be. For many, the stress of caring for a loved one with Alzheimer’s Disease is overwhelming. Often, having a home health aide take over so that the primary caregiver can take some time for themselves is all that is needed. In other situations, excessive wandering, aggression and/or incontinence may create the need for round-the-clock care. Depending on the specific situation, that type of 24-hour care could be provided by a secure facility specializing in dementia care or 24/7 home care services. An assessment by a registered nurse or physician should give you the answer you’re looking for.
Q: What is the CLASS Act?
A: The Community Living Assistance Services and Supports Act was passed as part of the health care reform package. Essentially, the CLASS Act will make long term care insurance available to all Americans, who will be automatically enrolled with the choice to opt out. After five years of premium payments, those with functional limitations have the option of receiving a cash benefit of approximately $50 per day that can be used to offset the cost of long term care services. Individuals may utilize this benefit to receive necessary services in their home.
Q: What other changes can be expected in home care due to health care reform?
A: Health reform will provide much-needed support to Medicaid enrollees seeking home and community based services. Under the health reform legislation, States can elect to provide home and community-based attendant services and supports to Medicaid beneficiaries with enhanced Federal funding. Also, the law provides additional funding for the Money Follows the Person program, which provides grants to states to help transition Medicaid-enrolled nursing home residents back into their communities. The legislation also creates a new Medicare pilot program aimed at helping patients and caregivers successfully transition from a hospital stay to their homes or other care settings.
Q: My mother’s health is failing. She wants to remain in her home but I’m worried that she may need the 24-hour supervision of a nursing home. How can I determine the best way to care for her?
A: Your mother should have a needs assessment by a registered nurse, preferably one that deals primarily in geriatric nursing. They will be able to determine what conditions need care and monitoring and how much assistance she needs with Activities of Daily Living (ADLs) such as dressing, bathing, walking or eating. Nurses that perform these assessments are often called Geriatric Care Managers. The Rhode Island Department of Elderly Affairs can help you find local agencies that provide these services. Nursing homes and home care agencies provide these reviews as well. If you’re mother does need round the clock monitoring, a nursing home or full-service home care agency can provide the care she needs.
Q: My father is in a nursing home for cardiac rehabilitation following a hospital stay. He’ll be going home soon and we need to arrange for in-home care. I know nursing homes go through annual inspections which they are required to post publicly. Is there any kind of “report card” for home care agencies so we can be sure that we’re getting a reputable company?
Currently there is no public posting related to state surveys. To obtain information regarding state surveys, you may call the RI Department of Health and ask for Facility Regulations. The Department will disclose when the agency was last surveyed and if there were any deficiencies related to patient care. Also, if the agency has a national accreditation by the Community Health Accreditation Program (CHAP) or the Joint Commission Accreditation of Health Care Organizations (JCAHO), surveys are conducted regularly and information can be obtained by calling the accrediting agency directly.
Q: My mother receives home care services and my family has been very unhappy with the services. They’re often late and sometimes they don’t show up at all. Is there any kind of state agency I can report them to?
A: In Rhode Island, the Alliance for Better Long Term Care is the consumer advocate for long term care services. The Alliance for Better Long Term Care houses the Office of the State Long Term Care Ombudsman. The Ombudsman is empowered by the Older Americans Act to intercede on behalf of residents in cases of abuse, neglect, quality of care, quality of life, exploitation and any other problem that comes to their attention. The agency advocates for residents of nursing facilities, assisted living residences, and people receiving community based care. The office provides mediation, advocacy, and problem solving. The Alliance can be reached at 401-785-3340.
Q: I understand that Rhode Island has a new system for accessing long term care services like nursing home care or home care. From what I understand, you have to be assessed by the state and they will determine what type of care you can receive. Why does the state have the final say over my health care options?
A: Just over a year ago, Rhode Island changed the way Medicaid funds are disbursed, with the blessing of the Centers for Medicaid and Medicare Services (CMS). The new system, called the Global Waiver, seeks to allow more access to Medicaid funds to people in the community. If you pay for your health care needs with your own money, you can receive health care services wherever and whenever you want. If you are eligible to receive Medicaid funds to pay for your health care however, the state will assess your condition to insure that you are being cared for in the most cost-efficient, least restrictive environment possible.
Q: I live in a different state than my Mom who suffers from dementia. I hired a home care company to help her with some of her weekly needs. How can I verify that a shift was completed?
A: In the past this was difficult, however technology has provided assurance for out of state or unavailable family members. Through “Telephony”, caregivers are required to call in to a designated line from the client’s home upon arrival, and then again when leaving. This call acts as a stamp or time marker for the caregiver thus providing accurate accounting of hours and the security of knowing that someone is always there with your family member. A computer printout is sent to the family assuring timeliness and reliability. Not all agencies use this service, so if this is a concern, be sure to ask if it is available.
Q: I recently hired a companion service for my Dad who is having a tough time adjusting to the fact that he now needs help? Who will his personal information be shared with? Are there privacy safeguards in place?
A: Only caregivers and administrative staff directly involved with your father’s care will have access to his personal information. Under Health Insurance Portability and Accountability Act (HIPAA) rules, private health information cannot be shared with third parties.
Q: I am looking into home care for a family member and was told that not all home care agencies offer services paid for by Medicare. Is this true?
A: Yes this is true. Not all agencies are Medicare certified and thus cannot bill Medicare for services provided. You can log into www.Medicare.Gov and review the different agencies in your area that have Medicare Certification. This is also important to consider when there is a potential for Medicare services. Most companion companies do not provide Medicare services, however, some Certified Home Care agencies have a companion component within their organization which provides the consumer with the security in knowing that if and when the individual requires more care, the agency they’ve chosen is able to provide the care required.
Q. My father needs help with getting dressed and taking showers in the morning. I need to hire a certified nursing assistant (CNA) to help him. Will my insurance cover that?
A. Unless your father has need for skilled services (nursing, physical therapy or speech therapy), your primary medical insurance typically will not pay for the services of a CNA. If your father had obtained long-term insurance prior to his need for a CNA, there may be a home-care provision that would cover some or all of the cost for services. If your father has no supplemental insurance, then he would have to pay out of pocket for those services.
Q. Are companions and home health aides or CNAs able to perform the same tasks?
A. The private duty services that may be legally performed differ greatly between a companion and home health aide. The Rhode Island Department of Health clearly states in its Regulations for Home Health Agencies that companion or homemakers are prohibited from any hands-on assistance. Those individuals lack the training and experience required to safely perform the more technical and personal related procedures required of most patients. Only a licensed home health aide must perform all such personal care.
Q: Are certified home care agencies and companion only agencies licensed and evaluated the same way?
A. Certified home care agencies are under both state and federal (Medicare) oversight. Extensive annual on-site evaluations are performed, ensuring peak performance in all areas of operation. In addition, certified home care companies have the opportunity to further validate the excellence of their services by applying for certification by the Community Health Accreditation Program or Joint Commission on the Accreditation of Health-care Organizations. Those grueling certifications are not easily obtained but offer the consumers of home care services the highest degree of quality, assurance and protection. No such certifications and oversight are available or required by companion only companies.
David DiFilippo is the owner of Concord Health Services, which specializes in in-home assistance and medical services. The company has three divisions: Concord Companion Services, Concord Visiting Nurses and Milestone Rehabilitation. Submit questions to kparkcompass@trmcomm.com.