Home care is a broad term used to describe many types of medical and/or personal care services provided in a person’s home. Multiple terms used for different types of care are often confusing, so be specific about your wants and needs when you discuss home care options. Medical home care often requires a doctor’s order and usually involves skilled nursing needs such as open wound care, checks of vital signs, or infusion care.
A home health aide (sometimes also referred to as a personal care attendant) is a person who is qualified to pro-vide “personal care,” such as assisting someone with bathing, dressing, and getting around. They most often work for a home healthcare agency and may also assist with light housework. A home health aide is not usually covered by insurance unless it is ordered in conjunction with a skilled nursing need. A home attendant (or home-maker care) is a person who can assist with shopping, house cleaning, doing laundry, cooking, and accompanying a person to appointments, and whose services are usually not covered by most insurance policies.
A common misperception among patients and family is that they will automatically have insurance-covered home care provided after their discharge from an inpatient hospital admission, particularly after surgery. Most insurance companies cover only skilled nursing needs, usually requiring a registered nurse, a physical therapist, an occupational therapist, or someone with other medical expertise. In addition to covering these skilled medical needs, policies sometimes cover a limited number of home health aide hours (most often fewer than 20 hours a week, if at all).
Patients and family may feel cheated if they were expecting more professional assistance to be covered by insurance. This is an upsetting situation that can be avoided with advance preparation. Contact the insurance carrier for your loved one and ask about home care coverage and what, exactly, is needed for coverage (for example, physician certification of a skilled nursing need).
Furthermore, it is important for patients and family members to understand the limits of home care and begin to make arrangements early for caring for the patient at home. This may entail family members helping the recuperating patient after discharge with cooking, cleaning and other needs, and/or pro-viding other types of assistance, such as transportation to follow-up doctor visits. Family members may also need to learn to do wound dressing changes, take care of drains, or manage other medical home equipment or needs.
If home care is ordered by the doctor and covered by a patient’s insurance, the discharge planning staff member (often a social worker or nurse case manager) will discuss the type of care the patient will receive and when the initial home visit will take place. Sometimes the home care agency will contact you directly to establish the details after the formal referral has been made by the discharge planning staff. Often a first visit from an intake registered nurse will take place one day to several days after discharge.
The nurse will assess the patient’s needs and the home environment to determine the type of care, the frequency of visits, and any equipment/supply needs that may be required. Be sure to accurately describe your loved one’s diagnosis, surgery, or other treatment side effects as well as any other concerns or questions you have about managing at home.
Before your loved one leaves the hospital, be sure to get the names and numbers of the discharge planner (or whomever you should contact at the hospital if you have problems with the home care that is ordered), the name of the home care agency, and whom you should contact in case of a medical emergency (even after business hours). This information should be located on discharge papers you receive the day of discharge from the hospital. Patients and family sometimes leave the hospital without these crucial contact numbers, which can cause added stress if they have a question later. If this information is not given to you, or if you misplace it, ask for it and keep it handy so that you can refer to it when needed.
In addition to medical home care and family or friend caregivers, you might also want to investigate community agencies that provide various services to a person’s home, such as Meals on Wheels (where low-cost, pre-pared meals are delivered directly to your home); senior centers; private nonprofit organizations that serve senior citizens or disabled individuals; volunteer agencies; and churches, synagogues, and other religious centers. Furthermore, there are long-term care policies, and supplemental insurance coverage may be available to purchase even after the cancer diagnosis. Contact your state’s insurance department for a list of companies that sell long-term care insurance or check with your current medical insurance provider for purchasing additional coverage.
If you feel that you and your loved one cannot manage safely or easily at home, discuss other options with your family and discharge planner. These can include private pay home care, nursing home placement, or assisted living options. New LifeStyles (see the Appendix) is a good resource for investigating the types of home care, facility placement, and other alter-native living arrangements (such as “assisted living”). We discuss facility placement options in Question 74.