MedScope: Medical Alert Systems

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Home care includes a wide variety of services—from skilled intravenous therapy to snow shoveling—all provided to individuals in their homes or in an assisted, nursing, or hospital facility. Home care often supplements the care individuals receive in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.
Whether performed in the comfort of their own homes or in a facility, home care helps seniors to maintain their independence. Additionally, home care prevents the full responsibility of caregiving from falling on friends and family. These services are intended to promote, maintain, or restore health and help individuals to manage the responsibilities of daily life. Aides and nursing professionals can be engaged privately or through an agency.

What types of Home Care are available?
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section.
Home Support Care – is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not yet require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments. Training and certifications will vary from provider to provider.
Skilled Nursing Care – is care that is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

How much will Home Care services cost, and who will pay for them?
Home Support Care – is traditionally a “private-pay” service, which means that it is an out-of-pocket expense for the customer. Prices range from $10-$20 per hour. However, most long-term care insurance policies will cover home support care. You should carefully review your long term care insurance policy with your insurance agent to be sure that the type and amount of coverage you will need will be covered. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.
Skilled Nursing Care – will be paid for by Medicare, a government program that covers some of the medical needs of seniors over the age of 65, as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Be sure to fully understand what Medicare and your health insurance policy will cover before making arrangements for skilled nursing care. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.
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Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.

Coverage by other financing options will vary widely, but the follow services, programs, or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:
Ø Is the provider Medicare/Medicaid certified?
Ø If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).
Ø How many years has the provider been in business?
Ø Is the provider associated with a larger health care group or hospital?
Ø Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?
Ø Will the agency help you find the best homecare options for you?
Ø Does the provider have a written policy describing the patient’s rights?
Ø Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
Ø Will the provider give you written information describing how they commence and discontinue services to patients?
Ø What backup does the patient have if their caregiver cannot show up at the scheduled time?
Ø What are the internal complaint procedures?
Ø Will the provider give a list of citations they have received from state surveyors over the past year?
Ø Does the provider have a nursing supervisor on call and available 24 hours per day?
Ø How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
Ø What types of reimbursements will the agency accept?
Ø Will the provider give a list of references?

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Are you or a loved one struggling with health issues that are making it harder to remain at home? Are you looking for care to help you recover from surgery or an injury? Do you need help with household chores or activities of daily living? Is managing a long-term illness becoming more difficult? Home Health Care is a rapidly growing field in the senior care industry that may help families negotiate these challenges and remain in their own home.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place—receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.
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Paying for Medical Supplies and Equipment
Medicare helps pay the costs for durable medical equipment. According to Medicare, in order to be covered, “items must be reusable, such as walkers, wheelchairs, or hospital beds.” Durable medical equipment for home health services is paid for under both Medicare Part B and Part A. Medicare coverage varies, and some equipment must be rented, while other equipment must be purchased. Durable medical equipment regional carriers can provide more specific information on coverage by Medicare.

Coverage by private insurance for durable medical equipment will vary greatly depending on the company and the specific policy. Coverage for medical supplies by both Medicare and private insurance will depend on the products required, specific medical needs, and doctors’ recommendations.

Finding a Medical Supplies and Equipment Provider
Medical supplies and equipment providers can offer a single solution product or multiple products to meet a range of needs. Before purchasing from a medical supplies and equipment provider, individuals should be comfortable with the professionalism and reliability of the company. Request specific information about costs and product delivery time frames. Consumers should also be aware of any warranties that cover maintenance, repair, or replacement of durable goods.

Finding a reliable provider is an important decision. The products that these providers deliver can lead to important and positive changes in the lifestyles of individuals with increased health care needs, decreased mobility, or who simply want to maintain or increase their level of independence.
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Whether you are a senior seeking products that will improve your mobility and your lifestyle or a family caregiver looking for better supplies to care for your loved one, there are a variety of medical supplies and equipment providers available to help. Impressive advancements in medical equipment technology have afforded more Americans the opportunity to remain independent in a healthy and safe environment.

Medical supplies and equipment fall into two major categories: medical supplies and durable medical equipment. Medical supplies generally refers to products that are used to make patients more comfortable and need to be replenished on a regular basis. Durable medical equipment includes items that are long-lasting and are generally one-time purchases. Medical supplies and durable medical equipment can be used together or separately to help elderly and disabled individuals maintain their independence and mobility.

Medical Supplies
Medical supply products help individuals cope with and manage the symptoms of illness or old age. Products include specially adapted socks and stockings, protective undergarments, skin care products, cushions and positioners, and many other helpful items. A wide variety of daily living aids are also available to help individuals who need assistance with bathing, dressing, or taking medication. Home health monitors let patients track everything from blood pressure to heart rate. Specialized in-home tests also allow patients to track their blood sugar and cholesterol levels.

Durable Medical Equipment
Durable medical equipment includes items that help elderly or disabled individuals maintain mobility and/or receive necessary care in the comfort of their homes. These products are designed to help those who need extra assistance performing the tasks of daily living. Durable medical equipment products can be broken into two major categories: mobility products and care assistance products.

Mobility products include a wide range of highly advanced equipment to help individuals get around. From Scooters to canes, products are available for every mobility need.

Scooters are available in a range of styles and feature various options to meet individualized needs. Many individuals find outdoor mobility challenging and are searching for a personal mobility vehicle that can help them continue to participate in activities they enjoy. Others need more comprehensive daily assistance. Today’s wide range of scooters are more maneuverable, lighter, and more durable than their older counterparts and can be customized to fit every lifestyle—from that of the active outdoorsman to the individual with decreased mobility who wants to remain independent.

Lift chairs are another popular mobility product. They look like standard recliners but provide assistance with moving from a sitting to a standing position. Most chairs provide settings that allow users to move comfortably and easily from lying, to sitting, to standing.

Stair lifts complete the motorized mobility offerings that are available to help today’s seniors. Stair lifts allow individuals to move from one level of their home to another with ease, eliminating the sometimes dangerous and difficult task of climbing and descending stairs. Stair lifts help seniors avoid becoming confined to a single level of their multi-story home. Advanced technology makes modern stair lifts smaller, quieter, and more attractive.

A wide array of wheelchairs, walkers, and canes are also available to help those with mobility assistance needs. Technology has dramatically increased the range of options available and the quality of mobility products, from the high-tech wheelchair to the low-tech but highly durable cane. As mobility technology has enhanced, seniors have found it increasingly easier to remain independent, even as their abilities change, and continue participating in the activities they enjoy.

Care assistance products include hospital-style beds, equipment to help with transferring, specially formulated mattresses that help reduce pressure, respiratory equipment, bathroom safety aids, and other equipment that promotes safety and wellness. All of these products are especially important for individuals who wish to remain in the home environment during an illness or convalescence. Durable medical equipment can also make the caregivers job easier by providing them with professional grade products to help meet their caregiving responsibilities.
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Today in the New York Times, a story featured the plight of one New York elder couple insisting on staying at home.  It is proof that American seniors, despite concerns with general and mental health, want to be where they are most comfortable: in their homes. 

A portion of the article reads as follows:
“Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and expects to lose his driver’s license when it comes up for renewal when he turns 85. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb, or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.
So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them here in Washington and its suburbs — they are part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help but not ready for assisted living, and for baby boomers anticipating the future.
‘We are totally dependent on ourselves,’ Mr. Allen said. ‘But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.’
The Allens’ wish to live out their lives in familiar surroundings, shared by almost nine in 10 Americans over age 60, according to numerous polls, may soon become a reality. Their group has registered as a nonprofit association, developed a business plan based on membership dues and begun lining up providers of transportation, home repair, companionship, daily security check-ins and other services to meet their needs at home for as long as possible.
Urban planners and senior housing experts say that this movement, organized by residents rather than government agencies or social services providers, could make ‘aging in place’ safe and affordable for the majority of elderly people. Many of these communities are calling themselves ‘villages,’ playing on the notion that it takes a village to raise a child and also support the aged in their decline. They are expected to open this fall on Capitol Hill, in Cambridge, Mass., New Canaan, Conn., Palo Alto, Calif., and Bronxville, N.Y .
‘Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.’”
Did you see those numbers?  A full 90% of seniors over the age of 60 want to stay at home.

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Boomers Helping Senior Parent
• Most (63%) say they are actively involved in providing some kind of help or assistance to a parent (over half say they also have children under age 25).
• Household maintenance (40%), transportation (34%), medical issues (33%), help with financial decisions (28%) and financial support (19%) were the most frequent types of support reported by Boomers.
• Baby Boomers with children are more likely than those without children to provide non-financial assistance to their parents, including help with household maintenance, medical issues and medication, and transportation.
• Baby Boomers without children are more likely than those with children to provide financial assistance to their parents, including making purchasing or financial decisions and providing financial support.
Boomers Have Not Turned to Technology to Help Parents
• Like seniors, Baby Boomers are open to new technologies that would help seniors age in place but very few are actively seeking these products.
• Half of Baby Boomers (49%) are interested in new technologies that would help them monitor their parents’ safety and wellbeing.
• 51% also think there are technology products available aimed at meeting the needs of seniors.
• 50% would be open to the use of ambient technology - specifically, sensors - to monitor the health and safety of their aging parents.
• However, just 14% of Baby Boomers have actually looked for any technology solutions that would help them ensure the health and safety of their parents.

Part 4 of 4
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