Apr 10, 2011

When is Homecare Appropriate?

Elder care options have increased over the years, yet many patients, families and even medical professionals misunderstand the variety of options available making it difficult to choose what type of care is most suitable for the needs of the patient and family...
By Angil Tarach-Ritchey
Alzheimer's Reading Room

Angil Tarach-Ritchey
The biggest misunderstanding is with homecare. There are 3 types of homecare available, and all 3 differ in their services. Rather than go into great detail about each type of care, I am providing a brief description and questions to decide which type of homecare would be most appropriate or beneficial for your situation and needs.


The 3 types of homecare are Home Health, Private Duty Homecare, and Hospice. Patients can utilize 2 types together, but never all 3. For a quick definition see each type.

Home Health Care is medical care in a person's home that is covered by Medicare, Medicaid, and most health insurance plans. It is temporary, physician ordered, for homebound patients only, with the goal of improving the health condition that warranted services. Home Health offers nursing, physical therapy, occupational therapy, speech therapy, home health aide and social work services.

Private Duty Homecare is nonmedical care or assistance that is paid privately, by long term care insurance, or Veterans Administration benefits. It can be temporary, or long term, is not physician ordered, can be provided to any age or health status, and the patient or care recipient isn't required to be homebound. The goal of Private Duty Homecare is to help the care recipient remain as independent, and safe as possible with supportive services in the home, such as companionship, hygiene, light housekeeping, meal preparation, medication reminders, errands, and some agencies offer transportation.

Hospice is palliative or comfort care for patients diagnosed with a terminal illness. It is optional care that is physician ordered, paid for my Medicare, Medicaid, and most health insurances. Hospice does not require a patient to be homebound, and services involve the patient and family with support, comfort, education, emotional and spiritual support, as well as bereavement services for up to a year for the family following death. Hospice provides a nurse, and can provide a nurses aide, social worker, spiritual care, and volunteers. The hospice team makes visits but cannot provide 24 hour care, or care beyond the typical visit.

Private duty can be combined with either Home Health, or Hospice. Home Health and Hospice never provide services at the same time. A patient can move from one to the other but cannot have services from both at the same time, due to insurance guidelines and the types of services and goals both provide. The companies who offer home health and hospice services often have a "bridge" program that allows home health patients to move to hospice services if the need arises.

Here are some questions to ask yourself so you know which homecare services are right for you or a loved one. These questions primarily pertain to those 65 and older, but services are available for those under 65 years of age.

Home Health Care

  • Has the patient had an acute healthcare crisis such as an unexpected illness, injury, surgery, or diagnosis requiring very recent hospitalization?
  • Has the patient declined to the point they are homebound?
  • Does the illness, injury or diagnosis require treatment, or monitoring following hospital discharge?
  • Has the patient declined in functional status following hospitalization? Examples would be weakness, inability to walk or transfer safely, when they were fully functional prior to hospitalization
  • Is a chronic illness being managed poorly resulting in repeated hospitalizations, or emergency room visits?
  • Does the patient have a primary physician who could write an order for home health care?
  • Has the patient just been diagnosed with a chronic illness that needs careful management and education, such as diabetes?
  • Is the patient preparing to be discharged from a rehabilitation facility, and is still in need of therapy? Remember the patient must be homebound.

Private Duty Homecare
  • Have you or a family member had a recent illness, injury or surgery that left the patient less functional or independent?
  • Are you or a family member unsafe alone?
  • Do you have a family member experiencing noticeable memory loss or received a diagnosis of Alzheimer's or Dementia?
  • Do you or a loved one spend most of their time alone, inactive and socially isolated?
  • Have you or an elderly relative had to give up their driver's license yet still likes to get out to shop, visit friends and family, attend religious services, get their hair done, or go to events or activities?
  • Do you need someone to assist with grocery shopping, or getting medications?
  • Do you or an elderly loved one want to remain in your home rather than move to a long term care facility?
  • Is an assisted living where your loved one resides, telling you they are unable to provide the care the resident needs, and you will probably have to move them?
  • Are you a family caregiver who is exhausted, stressed out, and at the end of your rope?
  • Are you a family caregiver with no time for yourself, and need respite?
  • Are you a spouse or adult child facing being a family caregiver for the 1st time?
  • Do you need to take off work every time your elderly parent has a doctor appointment or medical procedure?
  • Do you have elderly parent who lives alone and is eating poorly or having problems taking the right medications at the right time?
  • Are you spending countless hours at the bedside of a hospitalized family member, without getting sufficient rest?
  • Would you like some extra help with an elderly family member for a special event, during the holiday's or so you can take a vacation?
  • Has a physician or other medical professional told you your spouse, parent or loved one is not safe alone?

Hospice
  • Have you or a loved one been diagnosed with a terminal illness that has no or limited treatment available?
  • Have you or a loved one completed cancer treatments without any improvement and have run out of options?
  • Do you have an aging relative that has been diagnosed with Failure to Thrive or are experiencing significant weight loss, or a significant decline without any explanation?
  • Has a physician told you or a loved one there is nothing else they can do?
  • Do you have an aging parent or spouse with Alzheimer's or dementia that has also experienced a significant injury or illness?
  • Is your family having a difficult time with a loved one's terminal diagnosis?
  • Is a loved one suffering in pain related to a terminal diagnosis?
  • Do you need equipment or medications related to a terminal diagnosis that are causing a financial burden?
  • Would you or a loved one with a terminal diagnosis prefer to remain at home or stop dealing with doctors, hospitals, procedures and treatment?
  • Is your loved one in the hospital, or long term care facility dying and uncomfortable?

If you have answered yes to any of the questions homecare is appropriate. Because Home Health and Hospice are physician ordered, you will have to ask your doctor for an order, or contact the company of your choice to assess and obtain the order. Private Duty Homecare is patient or family directed.

You can contact a Private Duty Agency of your choosing to ask about starting services. If you or a loved one is a Veteran or you have long term care insurance you will have to check your policy and contact the insurance company, or make an appointment with a Veterans hospital to request services.

Consumers can choose the homecare company of their choice. Home Health and Hospice is guided and certified by Medicare, and Private Duty is either regulated or unregulated by your individual state. If you are going to utilize long term care insurance or Veterans benefits, you will be required to choose from their approved providers, or speak with them to see if an outside agency of your choosing can be approved.

It is always beneficial to check out companies before you're in an urgent need, when it is not necessary to obtain services. Just because your physician or hospital prefers to refer you to a homecare agency within their medical system doesn't mean they are referring you the best company for your needs. Many times referrals within a system are financially motivated, and not motivated by patients needs or circumstances. Some patients prefer large companies that are part of the hospital system, other's prefer smaller companies who specialize in 1 or 2 services, and are able to provide more individualized attention. Just do your homework and make sure you're choosing a reputable company that will best meet your needs.

More than ever we are responsible to educate ourselves to make the best and most appropriate decisions for ourselves and/or loved ones. Physicians don't necessarily know what resources are available, and often don't even know the difference between home health and private duty Homecare.

Patients leave hospitals and physician offices all the time without sufficient education or resources. Social Workers and Discharge Planners can easily be overloaded with admissions and discharges leaving very little time for education. All 3 types of homecare agencies are all familiar with each other since we often work together.

If you recognize any homecare needs based on the questions in this article, and call an agency of your choice, they can help you with education and additional resources you may need for your specific situation.



Angil Tarach-Ritchey(RN GCM) has over 30 years of experience, and is a nationally known expert in senior care and advocacy. Angil is also the owner of Visiting Angels in Ann Arbor, Michigan.

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Original content Angil Tarach-Ritchey, the Alzheimer's Reading Room