Q: I have heard a lot of different references to what I assume are types of home care, like visiting nurses, companion care, live-in care and respite care. What is the difference between these services?

A: Visiting nurses are licensed nurses who provide skilled nursing services in the home or community  for those who need care due to illness or injury.  Companion care offers non-skilled care for things like errands, household maintenance and shopping.  Live-in care, where a caregiver resides in an individual’s home with them, could be provided by either nurses or companions, depending upon the individual’s needs.  Respite care is care delivered for a short period of time while a primary caregiver, perhaps a family member or friend, is unable to care for a loved one. 

Q: What does the term “care management” refer to?

A: Care management encompasses all the steps involved with assessing someone’s needs, developing a personal plan of care to address those needs with the input of the individual, their family, their physician and the appropriate nursing and rehabilitative staff, identifying and accessing the resources needed to carry out the care plan, and the continuous monitoring of the care plan.

Q.  My mother recently had a minor seizure which required a hospital stay.  She was then discharged to a nursing home but it appears that she would have been fine going back to her assisted living facility with home care.   Who makes the ultimate decision about where care is rendered when Medicare is paying for it?

A:  Of course the patient and their family should have input as to where care is delivered but ultimately, Medicare, with the physician’s input, will determine the level of care most appropriate for the person’s needs.  Stay in close contact with your mother’s doctor and attend the weekly care planning meeting at the nursing  home to insure that your questions are addressed.