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Basic definitions
During a serious illness or
end-of-life process, people need love and emotional support.
No matter where they live, most likely they will need some
professional help that might include supportive services,
personal care, and skilled care. Those who have been told
they have a terminal illness and are unlikely to live more
than six months may also be eligible for hospice services
if that is what they desire.
Supportive
services include assistance such as transportation
to and from appointments, meal preparation, shopping, housekeeping,
and laundry services.
Personal
care includes assistance with dressing, grooming,
showering, feeding, incontinence care, transferring from bed
to chair, taking and recording vital signs (e.g., blood pressure
or pulse), and giving medications.
Skilled
care means a procedure or evaluation that requires
the skills of a licensed nurse. It includes tasks such as
hooking up an IV, giving a shot, or monitoring rapid changes
in condition. (Return to list)
Hospice
Lane County does not have an
inpatient hospice facility where terminally ill patients can
move in and reside until they die. However, there are several
hospice programs that can provide many of the previously mentioned
services across a wide variety of settings (i.e., whether
a person lives at home, in an assisted living facility, a
foster home or in a skilled nursing facility).
Staffing: Hospice uses
a multidisciplinary team of professionals to provide physical,
emotional, and spiritual support as a person moves through
the dying process. The hospice team includes nurses, social
workers, and bath aides as well as chaplains who assist with
spiritual issues in a nondenominational context. Hospice personnel
are trained to maintain comfort on all levels ("comfort
care") and safeguard the patient’s right to a pain-free
death.
Hospice services typically include
a visit from a nurse two to three times a week as well as
help from social workers who can connect you to social service
programs. Most medical equipment and medications associated
with a terminal diagnosis, including pain medicines, are provided
as part of hospice care, as is a weekly visit from a volunteer
to provide a few hours of respite for family caregivers. Nurses’
aides may come every other day to help bathe and shave the
patient. In addition, the counsel of a chaplain is available
any time upon request. As a general rule, patients may receive
hospice care whether they are living at home, in a skilled
nursing facility, an assisted living facility, retirement
apartments, a residential care facility, or foster care. Hospice
does not provide day-in, day-out care, thus most people using
this service also have ongoing caregivers available.
The financial side: If
a patient is relying upon Medicare to pay for hospice support
services, two requirements must be met: A physician must certify
that to the best of his/her knowledge, the patient is not
likely to live longer than six months; and the patient, family,
and physician must agree to forego curative treatments (for
example, chemotherapy or radiation) and focus instead on providing
comfort care and enhancing quality of life for the time the
patient has left. If a patient has private insurance, depending
on the policy, he or she may be able to continue curative
treatment while also receiving hospice services. In a situation
in which the patient has decided to opt for comfort care and
let nature take its course, hospice can be extremely helpful
for both the person who is ill and for the family caregivers.
(Return to list)
Settings for care
In-home care providers
Consumer expectation and desire
to stay at home during a time of serious illness or end-of-life
process has created a demand for services that can be delivered
in the home setting. An organization giving care to a person
in their own home is called in-home care or home healthcare.
Home healthcare offers supportive,
personal, and skilled
services and may include a professional caregiver
staying with the patient for several hours at a time.
Staffing: Depending on
the hiring practices of the organization or agency, supportive
and personal care services may be provided by a certified
nursing assistant or by non-certified personnel. Skilled care,
as described above, must be performed by a licensed practical
or registered nurse (LPN or RN). People who choose to stay
at home can also receive help from the multidisciplinary hospice
team provided they meet the eligibility requirements noted
earlier.
The financial side: Home
care services may be expensive depending on the amount and
type of services used, availability of financial resources,
and individual insurance coverage. Medicare and most private
insurance will cover, for a limited time,
skilled home health services and some personal
care as long as the patient meets "homebound"
criteria (i.e., leaving home for activities such as medical
appointments or church requires considerable effort). Unless
the patient is on Medicaid, the cost of supportive
services (e.g., meal preparation, light housekeeping,
help getting to the bathroom) is not reimbursed by Medicare
or insurance and must be paid for by the family. (Return
to list)
Skilled nursing facilities
At the other end of the spectrum
is the patient who has numerous or complex personal
care needs that require 24-hour-a-day assistance.
Depending on the family’s caregiving abilities and personal
finances, the best care may involve a move to a skilled nursing
facility. Many skilled nursing facilities have a designated
furnished room to meet the needs of a person near the end
of life. These rooms offer more privacy and special amenities
such as extra space and beds so family members can stay overnight.
Staffing: At the skilled
nursing facility, supportive,
personal, and skilled
care services are provided 24 hours every day by licensed
personnel. The hospice team can generally continue providing
comfort care for a patient who moves from home to a skilled
nursing facility and can lend additional support to the facility
with regard to the patient’s emotional, physical, and
spiritual needs.
The financial side: Medicare
has very specific regulations about when it will and won’t
cover care in a skilled nursing facility. It also includes
regulations about when a patient can stay at a skilled nursing
facility and simultaneously receive hospice care. It is best
to talk with the staff of the facility or a hospice social
worker to determine if your situation qualifies for reimbursement.
(Return to list)
Assisted living facilities
Assisted living facilities offer
an opportunity for the family to give some or even most of
the care needed but also provides assistance with a few tasks
such as meal preparation or light housekeeping. When patients
need some supportive services
and a few personal services,
they may consider moving to an assisted living facility. At
most of these facilities, a licensed nurse consultant is available
but is not necessarily on site daily. Assisted living facilities
usually are large, very social settings with many studio or
one-bedroom apartments. They often include a central dining
room meal service. Although the assisted living facility provides
most supportive services,
additional payment is required for personal
care needs. A person must bring his or her own furnishings
when moving into an assisted living facility.
Staffing: Depending on
the hiring practices of the organization or agency, non-nursing
services may be provided by certified nursing assistants or
non-certified personnel. Skilled
care must be performed by an LPN or an RN.
The financial side: Because
the care provided in an assisted living facility is considered
to be supportive services,
the monthly fee is not reimbursable by Medicare or insurance.
Reimbursable skilled services
can be provided in an assisted living facility, however, as
can hospice team support. (Return to list)
Residential care facilities
First cousin to the assisted
living facility, a residential care facility offers more supervised
services and is appropriate for people who have multiple care
needs. As a result, this option rates between a skilled
nursing facility and assisted
living. It is best to check with each facility regarding
staffing and financial arrangements. (Return
to list)
Adult foster homes
An adult foster home is generally
appropriate if the patient needs only minimal help with some
supportive or personal
care services. Some foster homes, however, are certified
to provide more-intensive care. Adult foster homes are typically
family-run businesses where the owner of the house takes in
older adult boarders who can no longer live on their own.
Adult foster homes are small, with four to eight residents
living in a single family home. Bedrooms can be single occupancy
or shared. A dining room meal service usually is provided.
Some personal care services require
additional payment (e.g., incontinence care). The foster home
provides furnishings; the resident provides his or her own
personal items.
Staffing: Depending on
the hiring practices of the foster home, supportive
and personal care services
may be provided by a non-certified or certified nursing assistant..
Foster homes usually do not have a licensed nurse or licensed
nurse consultant on the premises; however, a nurse oversees
foster homes throughout the state of Oregon.
The financial side: As
with an assisted living facility, most of the care provided
at a foster home is supportive
in nature and therefore is not reimbursed by Medicare or other
medical insurance. If the owner of the foster home is amenable,
reimbursable skilled care
can be provided in the foster home setting, as can hospice
services. (Return to list)
A safety note
If you decide to seek assistance
through one of the professional services mentioned in this
article, you may want to ask about the organization’s
hiring policy. A criminal background check is mandatory for
all employees hired for in-home agencies, skilled nursing
facilities, assisted living, residential care, and foster
care settings. Before-hire drug testing is not required by
the state but is commonly practiced by many facilities. To
ease your mind, you might want to ask if it is a routine part
of the hiring process when you call to inquire about assistance.
(Return to list)
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