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General definitions
Much as a family might wish to provide all the
care for an ailing loved one, achieving that objective is not always possible.
Caregiving is hard work. The person may need anything from help with meals or
housekeeping, up to full, 24-hour-a-day care. Fortunately, it’s not an all
or nothing proposition.
Certainly, no one can replace the love provided
by family members. But if you can get help with some of the physical aspects
of caring—things others can easily do—then you will have more time
and energy to provide valuable emotional support. Three levels of assistance
can be provided by others:
Supportive care includes assistance such
as transportation to and from appointments, meal preparation, shopping, housekeeping,
and laundry services.
Personal care includes help with dressing,
grooming, bathing, feeding, incontinence care, and transferring the patient from
bed to chair. It can also include taking and recording vital signs (e.g., blood
pressure or pulse) and giving medications.
Skilled care includes procedures or evaluations
that require the skills of a licensed nurse. It involves tasks such as hooking
up an IV, giving a shot, or monitoring rapid changes in condition.
These types of care can be provided in many different
ways. Some services are offered at home. Some require a move to a specific setting
such as an assisted living facility or a nursing home. No matter where your loved
one lives, if he or she has been diagnosed with a serious illness, PARTNERS IN
CARE can offer tremendous support in helping you decide what services would be
most helpful, and where to obtain them in our community. (Return
to list)
Care
in the patient's home
Most patients prefer to stay at home as long as
they can. The familiar environment provides comfort in and of itself. Home
health care is a service that can be ordered by your physician IF the
patient is homebound and requires the skilled care of a nurse several times a
week. With this service, a nurse comes on a periodic, scheduled basis for an
hour or two, and a nurse’s aide may also come for an hour or two several
times a week to help with personal care such as bathing and grooming. This service
is usually paid for by insurance, and is time-limited depending on the nature
of the skilled need provided by the nurse.
Home health care does not provide supportive services
such as shopping, laundry, or housecleaning, or even personal care if there is
no skilled need involved. If the patient needs this kind of help, you may want
to contact a company that offers in-home
care providers. Although this term sounds very similar to the term home health
care, this type of care encompasses a broader range of services. You do not need
a doctor’s order to work with an in-home care provider. This type of service
can provide assistance from a few hours a day to twenty-four hour care. This
type of care is not considered to be medical assistance, and is not generally
covered by insurance unless you have a specific, separate home-care or long-term
care policy.
Skilled home health care must be ordered by your
physician, and s/he will usually choose an agency they work with frequently.
You may request a different agency if you have a preference. Non-skilled home
care can be arranged by the patient or family. There are agencies listed in the
yellow pages that provide this service. Additionally, there are a number of independent
providers that can be hired independent of an agency. Marshall Hospital, the
Community Services Center, and PARTNERS IN CARE maintain lists of agencies, as
well as some independent providers. Independent providers may also be found by
advertising in the paper, or by asking friends and neighbors for recommendations.
Payment for these services is sometimes difficult.
As noted above, insurance may pay in some limited circumstances, but usually
the patient or family is responsible for payment. For low-income patients, the
county has a program called In-Home Support Services that may help to pay for
some care and services. You would need to contact the Adult
Services Office of the Department of Social Services to see if you qualify
for this assistance. (Return to list)
Assisted living facilities
For some people, assisted living may be a good
choice. Assisted living facilities provide
help with tasks such as meal preparation, light housekeeping, and reminders to
take medication. These facilities are usually comprised of furnished or unfurnished
one-bedroom and studio apartments. They are very social settings and often include
organized activities and a central dining room for meals. This arrangement can
be very helpful not only for the person who is alone, but also for a couple as
it offsets the isolation common to people caring for the seriously ill. If the
person who is ill needs more help than that provided at assisted living facilities
and no spouse or family member is available to give this care, you can usually
arrange for home health care or in-home care providers to assist with these needs
in that setting.
Because the care provided in an assisted living
facility is considered to be supportive service, Medicare, Medicaid, or insurance
companies do not reimburse the cost of the monthly fee. Reimbursable skilled
services (i.e., home health care) can be provided in an assisted living facility,
as can hospice. In our community, Gold Country in Placerville and Eskaton in
Cameron Park offer this level of care. (Return to list)
Board
and care homes
Board
and care facilities typically are family-run businesses where the owner of
the house takes in older adult boarders who can no longer live on their own.
A board and care home is generally an appropriate choice if the patient needs
only minimal help and some supportive or personal care services. (Some facilities,
however, are certified to provide more intensive care.) As compared with other
facilities, board and care homes are small, with four to eight residents living
in a single family home. Some homes provide private bedrooms; others offer the
cost savings of sharing with a roommate. Usually the board and care home provides
the furniture, but residents bring their own personal items to decorate the room.
In keeping with the homelike setting, meals are typically served family style,
with residents gathering to eat together in the dining room.
In most board and care homes, supportive and personal
care services may be provided by a noncertified or certified nursing assistant.
They usually do not have a licensed nurse on the premises, but twenty-four hour
non-medical supervision is provided.
As with an assisted living facility, most of the
care provided at a board and care home is supportive in nature and therefore
is not reimbursed by Medicare or other medical insurance. If the owner of the
board and care home is amenable, reimbursable skilled care can be provided in
the foster home setting by outside services such as hospice or home health care.
A few facilities will work with patients and families who are on Medi-Cal and
SSI. Lists of board and care facilities can be obtained from the Community Services
Department, or PARTNERS IN CARE. (Return to list)
Skilled
nursing facilities
Skilled
nursing facilities are designed to provide care for patients with numerous
or complex personal care needs that require 24-hour-a-day assistance. Depending
on the family’s finances and caregiving abilities, the best care may involve
a move to a skilled nursing facility. This will allow the family to relax and
enjoy their visits and focus on being supportive while the licensed staff provides
the personal and skilled care services 24 hours a day.
Medicare has very specific regulations about when
it will and won’t cover care in a skilled nursing facility. It is best to
talk with the staff of the facility to determine if your situation qualifies
you for Medicare coverage. Persons with low income may be able to receive assistance
from Medi-Cal, and the facility can also help you with this.
It is important to know that there are special
financial protections built into the law when one person must go into the nursing
home while the other spouse continues to remain at home. These are to allow at-home
spouses to maintain a sufficient income and adequate resources to support themselves.
Under these laws, a nursing home patient may qualify for Medi-Cal to pay for
the facility without impoverishing the spouse or losing their home. For complicated
financial situations a visit to an attorney
familiar with Medi-Cal and elder care laws, or the attorney through the Senior
Center is highly recommended. (Return to list)
Hospice
Hospice is
specifically designed to work with patients who have a terminal illness. It is
an organization that focuses on supporting the patient and family medically,
emotionally, and spiritually during the last months of life. Their primary concern
is comfort and quality of life during this very special time. Your doctor has
to order Hospice, and indicate that all aggressive, curative treatments have
stopped and that the disease is likely to result in death within the next six
months. Please remember that no one has a crystal ball here, and this is simply
an educated guess. While many patients only receive the benefit of hospice services
during the last few weeks, there are other cases that are able to benefit from
hospice for many months, and at times, even years. The primary criterion is a
progressive illness that is in its final stages.
Hospice services consist of a nurse who will attend
to the medical needs of the patient, and instruct the family in what to expect
and how to deal with these changes. A social worker and chaplain are also assigned
to provide emotional and spiritual support and counseling during this very difficult
time. The social worker can also assist with locating community resources or
dealing with other practical matters if needed. A home health aid is assigned
to help with personal care several times a week if needed, and this person can
train the family to deal with personal care matters in between visits. Volunteers
are also available to sit with the patient to allow the family time to rest or
run errands, or to even just take time to be with friends or go to a movie. Additionally,
hospice continues to provide support and counseling for families for up to a
year after a death.
Hospice services also include payment for any medications
related to the terminal illness that are used for the care and comfort of the
patient. They also provide needed equipment such as hospital beds, wheelchairs
and commodes, and most needed medical supplies such as dressings, diapers, syringes
and catheters. Under Medicare, the hospice services listed above are covered
100%. Most private insurances also provide this coverage. For any people in our
community who do not have insurance, most hospicew have special funding sources
that allow these same benefits to be extended regardless of insurance coverage
or ability to pay. The primary hospice in our community is Snowline
Hospice, but VITAS Hospice also serves the western part of our
county as far as Cameron Park. People near the borders of the county may
be able to receive services from hospices in neighboring counties. (Return
to list)
A safety
note
Many family members worry about the safety of their
loved one when they need to have others provide care. All health care agencies
in California are required to do background checks and drug testing of their
employees, and all home care agencies are insured for the personnel they send
into your home. This is not true, however, if you hire privately. We always strongly
encourage thorough reference checks on anyone you privately hire to come into
your home. The Community Services Department and PARTNERS IN CARE maintain an
outline on how to hire an in-home provider. (Return to list) |
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