WHAT IS HOMECARE?
Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends.
More and more older people are electing to live independent, non-institutionalized lives, and are receiving home care services as their physical capabilities diminish. Younger adults who are disabled or recuperating from acute illness are choosing home care whenever possible. Chronically ill infants and children are receiving sophisticated medical treatment in their loving and secure home environments. Adults and children diagnosed with terminal illness also are being cared for at home, receiving compassionate care and maintaining dignity at the end of life. As hospital stays decrease, increasing numbers of patients need highly skilled services when they return home. Other patients are able to avoid institutionalization altogether, receiving safe and effective care in the comfort of their own homes.
Listed below is a brief description of the different kinds of homecare agencies. Some providers may offer two or more kinds of program.
Medicare Certified Home Health Agencies: Medicare Certified Home Health Agencies in Maryland and DC must meet federal and state standards. A doctor’s orders are required for care. Medicare-certified agencies deliver "skilled" nursing care and therapeutic services such as occupational therapy, physical therapy, and speech therapy. Medicare-certified agencies deliver "brief and intermittent care" meaning that they work off of a doctor's order that only runs for an episode of 60 days. Episodes can be renewed by doctors when necessary.
Private Duty Agencies/ Residential Service Agencies: All private duty agencies in Maryland and DC are regulated by the state. (In Maryland private duty agencies are called Residential Service Agencies.) This process is in place to ensure that agencies are adhering to strict health and safety requirements. These agencies typically hire a variety of staff and provide a wide range of services. Many agencies have both nurses and companion care workers that provide assistance with everything from skilled nursing care through assistance with the instrumental activates of daily living such as cooking, cleaning, driving customers to appointments, and paying bills. Private duty agencies can be contracted to provide as many hours as needed – including overnight care or 24 hour- 7 day a week care.
Registry: All registries in Maryland and DC are regulated by the state to ensure that the agency is adhering to strict health and safety requirements. Registries can deliver skilled services such as nursing care or companion style services to assist the customer with their activities of daily living. Staffing is the primary difference between a private duty agency and registry. While private duty agencies employ the workers that are sent to customers’ homes, registries do not. Once you call a registry looking for services, they will refer an independent contractor. This means that the caregiver in the customer’s home does not work for an agency.
Home Medical Equipment:All Home Medical Equipment Providers in Maryland and DC are regulated by the state. Any Home Medical Equipment business that received Medicare or Medicaid reimbursement must also meet federal standards. Home medical equipment providers deliver healthcare products and supplies directly to the homes of consumers. The products can vary from complex rehabilitation equipment through oxygen and diabetic supplies. HME providers typically hire a variety of staff to ensure that customers not only receive their products and supplies but that trained professionals ensure that more complex equipment is customized to meet the needs of the customer.
Homecare Offers a Variety of Choices
Homecare providers deliver a wide variety of health care and supportive services. These can range from professional nursing and home health aide services to physical, occupational, respiratory, and speech therapies. Providers may be for-profit, non-profit, or hospital based.
Homecare services can be provided by:
• Companions
• Medical Social Workers
• Registered Nurses/Licensed Practical Nurses
• Family Caregivers
• Occupational Therapists
• Respiratory Therapists
• Home Health Aides
• Physical Therapists
• Speech Language Pathologists
• Homemakers/Chore Workers
• Physicians
Companions provide companionship and comfort to individuals who, for medical and/or safety reasons, may not be left at home alone. They may assist clients with household tasks, but primarily provide sitter services.
Home Health Aides assist patients with activities of daily living (ADLs) such as getting in and out of bed, walking, bathing, toileting, and dressing. Some aids have received additional training and are qualified to provide more complex services under the supervision of a nursing professional.
Homemaker and chore workers perform light household duties such as laundry, meal preparation, general housekeeping, and shopping. These services are directed at maintaining patient households rather than providing hand-on assistance with personal care.
Medical Social Workers evaluate the social and emotional factors affecting ill and disabled individuals and provide counseling. They may assist patients and their family members identify available community resources. Social workers also serve as case managers when patient's conditions are so complex that professionals need to assess medical and supportive needs and coordinate a variety of services.
Occupational Therapists (OTs) help individuals who have physical, developmental, social, or emotional problems that prevent them from performing the general activities of daily living (ADLs). They also instruct patients on using specialized rehabilitation techniques and equipment to improve function in basic household tasks such as eating, bathing, and dressing.
Physical Therapists (PTs) work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage and other techniques. PTs also often alleviate pain and restore injured muscles with specialized equipment and teach patients and caregivers special techniques for walking and transfer.
Physicians occasionally visit patients in their homes to diagnose and treat illnesses just as they do in hospitals and private offices. They work with home care providers to determine services that are needed by patients, which specialists are most suitable to render these services and the frequency of services to be provided. They also prescribe and oversee patient plans of care.
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) provide skilled services. Some of these services include injections and intravenous therapy, wound care, education on disease treatment and prevention, and patient assessments. RNs may also provide case management services. LPNs have one year of specialized training and are licensed to work under the supervision of registered nurses. The patient's medical condition and required treatment regimen determines whether care should be provided by an RN or an LPN.
Speech Language Pathologists work to develop and restore the speech of individuals with communication disorders, usually as a result of traumas such as surgery or stroke. They also retrain patients in breathing, swallowing, and muscle control.
Definitions and Other Useful Information
Confused by some healthcare definitions? The information below will help you better understand the meaning of various homecare terms.
Approved Amount: The fee Medicare sets as reasonable for a covered medical service. It may be less than the actual amount charged. Approved amount is sometimes called "approved charge."
Durable Medical Equipment: Medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds.
Centers for Medicare & Medicaid Services (CMS) formerly known as Health Care Financing Administration (HCFA): The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Program, and works to make sure that the beneficiaries in these programs have access to high quality health care.
Homebound: Normally unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber.
Home Health Care: Skilled nursing care and certain other health care that you get in your home for the treatment of an illness or injury.
Medicare: A health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (people with permanent kidney failure who need dialysis or a transplant).
Medicaid: A joint Federal and State program that helps with medical costs for some people with low incomes. Programs vary from State to State, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medically Necessary: Services or supplies that:
• are proper and needed for the diagnosis, or treatment of your medical condition;
• are provided for the diagnosis, direct care, and treatment of your medical condition;
• meet the standards of good medical practice in the medical community of your local area; and
• are not mainly for the convenience of you or your doctor.
Out-of-Pocket Costs: Health care costs that you must pay on your own because they are not covered by Medicare.
Plan Of Care: A plan written by your doctor that describes what kind of services and care you must receive for your health problem.
Provider: A doctor, hospital, health care professional, or health care facility.
Skilled Nursing Care: A level of care that must be given or supervised by licensed nurses and is under the general direction of a doctor. All of your needs are taken care of with this type of service, including giving direct services. Examples of skilled nursing care are: getting intravenous injections, tube feeding, oxygen to help you breathe, and changing sterile dressings on a wound. Any service that could be safely performed by an average non-medical person (pr one's self) without the direct supervision of a licensed nurse is not covered.
