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Our commitment to caring extends right out into cyberspace which is why we’ve compiled this section: To provide you with links and information to make your life easier and your home care experience more rewarding. (The idea here is that we make our clients better clients. We help you take full advantage of our services with good advice and contacts.)
If you are navigating the seas of home care for the first time, you may be wondering, “doesn’t Medicare pay for help in the home?” Before answering that question, you should understand the difference between Home Health and private-duty, in-home care. Home Health care is medically focused while private-duty care usually focuses on non-medical care, such as bathing, dressing, meal preparation, and light housekeeping. Some states, however, allow private-duty nursing (like wound care, injections, and venipuncture) as well. Each Always There office can tell you about the laws in their state. The other big difference between Home Health and private-duty care is the payer source – who pays the bill. Home Health can be covered by traditional health insurance and Medicare. Private-duty care is usually paid by the client, or by a long-term care insurance company, if the client has that kind of policy.
Most people would like to take advantage of an insurance benefit, if possible. People covered under traditional health insurance policies should contact their local plan administrator to determine if they have home care coverage. For Medicare recipients, the information below may be helpful in learning about the home health benefit.
In the most general terms, home health care is medically oriented (meaning nursing or therapy), short-term care provided to a home-bound individual. Clients who need assistance only with bathing, dressing, or meal preparation are NOT eligible for any Medicare-covered home health care. These are considered “custodial” tasks and not medical tasks.
The table below demonstrates some of the key differences between Medicare’s home health coverage and the in-home services provided by Always There.
Home Health Care
1. Paid by Medicare
2. Must be prescribed by a doctor
3. Triggered only by a need for skilled nursing, physical therapy, speech/language therapy, or occupational therapy
4. Client must be “homebound”*
5. Care is intermittent and short term
6. Assistance only with a bath not covered
7. Duration of visit by nurse or aide usually less than one hour
8. No coverage for housekeeping or errands |
Private-Duty Home Care
1. Paid out-of-pocket or by long-term care insurance
2. Does not need to be prescribed by a doctor
3. Requires no trigger. Client can hire private-duty home care whenever he/she desires
4. No such restrictions
5. Care can endure as long as client requests
6. Assistance only with a bath is available
7. Duration of visit usually 4 hours or longer
8. Caregivers may perform housekeeping and
assist with errands |
What does “homebound” mean? According to the Centers for Medicare and Medicaid, a person is defined as homebound if they are, “normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort.” Therefore, if a person is extremely short of breath and must rest every few feet while walking, he/she would probably be considered homebound. Furthermore, the Medicare rules state that a person may still be considered homebound even if they do leave the home for… “short, infrequent trips for non-medical reasons, such as a trip to the barber or to attend religious services. However, if a person leaves the home more than once a week, he/she is NOT considered homebound and will not be eligible for Medicare-covered home health care.
If you think you may be eligible for services that would be covered by Medicare, you should call your physician who can refer you to a reputable home health agency.
Medicare’s coverage of home health care is very different from private-duty home care, but the two often compliment each other. Sometimes Always There works independently in a client’s home, and sometimes we work in conjunction with a home health agency. The following is an example of a typical situation where a client may use both Always There In-Home Care and a Medicare-covered Home Health Agency.
Mrs. Smith was discharged from the hospital after a long illness. She lives with her husband. The ABC Home Health agency has been asked to send a physical therapist to her home twice a week and a home health aide from the same agency three times a week. The aide will give Mrs. Smith a bath.
The Smiths think they need more help. They hire Always There. It is determined at the initial assessment that our caregiver will be at the Smith’s home Monday through Friday from 9 a.m. until 4 p.m. The Smiths’ daughter stays with them on the weekends.
The ABC agency therapist tells Mr. and Mrs. Smith that she will visit on Tuesdays and Thursdays and she’ll “probably” be there about 10 a.m. Some days she does not arrive until noon. She usually stays about 30 minutes. The aide comes Monday, Wednesday and Friday. Mr. and Mrs. Smith are never sure what time she will arrive. She stays about 40 minutes when she comes. On the other hand, the Always There caregiver arrives promptly at 9 a.m. every morning and stays until 4 p.m. every day. She is busy helping the Smiths at all times.
On Mondays, Wednesdays, and Fridays, the ABC aide gives Mrs. Smith a bath while the Always There caregiver performs other household duties, such as laundry, vacuuming and meal preparation. But Tuesdays and Thursdays, the Always There caregiver assists with the bath. On the days the therapist visits, the Always There caregiver watches and helps with the therapy session. When the therapist discontinues her home visits, the Always There caregiver can help Mrs. Smith continue to practice her exercises. Long after the ABC agency has discontinued their services, Always There remains in the home and continues service to Mr. and Mrs. Smith.
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Home accidents are a major cause of concern; a simple fall can result in serious injury. Which is why Always There’s employees are carefully trained to improve and ensure safety in the home.
The best way to prevent accidents is to eliminate potential hazards. We check for hazards every time we visit your home—and when we spot safety hazards, you’ll be the first to know. You’ll also be glad to know we document all safety hazards—and intervention steps taken—on our weekly service reports.
Below is a list of suggestions for promoting safety in your home.
- Keep a list of emergency phone numbers next to each telephone and in an easily visible place like the refrigerator. Include family member's numbers and the "Always There" office phone numbers. Also, keep the telephone within easy reach.
- Keep your home as neat and uncluttered as possible.
- Keep all medications stored in a safe and dry location, out of direct sunlight like kitchen windows, and out of children's reach. Call the office regarding old medicines that may need to be thrown away.
- If possible, keep a First Aid Kit in the home at all times.
- Whether you’re lifting or moving someone or something, remember to use proper body mechanics.
- Check extension cords for frayed wiring. Replace any that pose a risk. Cords under rugs pose a fire hazard—which is why we suggest you consider another way to place them.
- Make sure that lighting is adequate in your home, especially the pathway to the bathroom at night. Install and use nightlights throughout your home, and place a lamp or flashlight within easy reach of the bed. Replace burned out light bulbs promptly.
- Make sure wheelchairs, walkers, canes, etc., are in good working condition, and be sure you know how to use them correctly.
- Remove anything obstructing walking pathways—such as personal belongings, cords, furniture and sharp-edged objects.
- Throw rugs should be removed or secured with rubber non-skids mats underneath.
- Wipe up spills immediately.
- Keep frequently-used items within easy reach. If necessary, rearrange cabinets so that they are within easy reach.
- Look for steps, stairwells, and walkways not in good condition or that have poor lighting.
- Carpeting on steps should be securely fastened. If you have steps without carpeting, install non-skid strips.
- To help vision-impaired family members, consider marking the edges of steps with brightly-colored tape.
- Stress the importance of using handrails on steps, etc.
- Recommend shoes with non-slip soles.
- If your family member cooks, look for safe and easy ways for them to help themselves in the kitchen. If he or she is weak, sitting on a chair at the stove instead of standing may be helpful—but it’s important to take extra precaution with this arrangement.
- Sink and stove should be well lit, and curtains kept away from the stove.
- Pan handles should be turned away from the burners and the edge of the stove. Front burners should be used when possible—to prevent the need for reaching to the back burners.
- Pot holders should be kept near the stove and oven—while still safely away from flames.
- Clothing with loose sleeves should not be worn while cooking.
- Baking soda should be kept near the stove.
- Make sure appliances are turned off when not in use.
- Knives should be kept in a knife rack or drawer.
- Hazardous cleaners and chemicals should be stored out of reach.
- Be aware if your family member needs help getting in and out of the tub and/or shower.
- Bathtubs and showers should have non-skid mats, or strips on the inside and a bath mat on the outside of the tub/shower.
- Towel bars and soap dishes should be securely installed in case they’re ever needed for support.
- Soap and shampoo should be within easy reach.
- Safety equipment like grab bars and shower chairs may be advisable.
- Keep all electrical appliances away from bathtub, shower and sink areas.
- Keep razors and scissors stored safely.
- Hazardous cleaners and chemicals should be locked up or kept out of reach.
- Porches, balconies, decks, etc., should have secured railings and steps.
- Check smoke alarms monthly and replace batteries as needed.
- Know the location of all exits and remind your family member where they are located.
- In case of fire, RESCUE FIRST! THEN CALL 911.
- Sleep with bedroom doors closed. But use a “baby monitor” if you need to be able to hear your family member calling you at night.
- When using a fire extinguisher, aim at the base of the fire.
- Oxygen tanks and equipment should be stored away from heat and/or flames.
- Post NO SMOKING signs throughout the home.
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