Home health care provides a beneficial alternative to living in an assisted living home, enabling people to age in place. Who are the best candidates to benefit from home health care, and what type of services are typically provided by home health care agencies?
Home health is a rapidly growing segment of the health care industry due to the demographics of an aging population and increases in chronic disease. These factors, further exacerbated by the pandemic, have created a greater need for comprehensive home-based care for people of all ages, including those in pre- or post-operative settings, or for those who need special attention, ongoing care, and assistance due to disability, frailty, age, or chronic illness.
“Trends are pointing toward people wanting to stay at home or age in place, particularly after the pandemic’s disproportionate impact on residential care settings,” said Jonathan Davis, founder and CEO of Trualta, a training platform for family caregivers.
Davis cited an AARP survey revealing that most over 50 adults —77% — would prefer to age in place and remain in their current home for the long term if possible.
Home health includes a variety of services for patients of all ages and conditions. Not all home health agencies provide all types of health services. Therefore, it’s important to research the various agencies to determine which services they are qualified and approved to provide, according to Joanna Fuller-Crawford, registered nurse, M.B.A., CEO and co-founder of Perfect Care Nursing, a home health agency providing personalized in-home care across metro Atlanta.
As compared to a nursing home or assisted living facility, where each caregiver may handle up to 20 patients, home health offers a much more dedicated level of care and undivided attention, provided you hire a reputable home health company. After a varied nursing career including stints in emergency care and kidney care, Fuller-Crawford enjoys seeing the benefits of one-on-one attention with her agency’s clients each day.
“We have some clients who have been with us for more than 10 years. I enjoy building the one-on-one relationships with our clients and seeing the outcomes we’re able to provide for people who need a special level of care.”
In addition to standard long-term care for patients of all ages who need assistance, home health may also offer the following types of care.
Pre- and post-operative care
Some home health agencies provide care for patients who have care needs on a pre-or post-operative basis. This typically requires additional training and certifications for the clinicians to be able to provide the level of care needed for a post-surgical patient.
Dementia care
Caring for a patient with dementia or Alzheimer’s can sometimes be accomplished via a home health agency or private home health provider. However, once the patient’s dementia has progressed too far, they may require a full-service assisted living facility with a memory care unit. According to Cloud Conrad, a metro-Atlanta-based Certified Dementia Caregiver Trainer and Mentor, and author of “The Dementia Field Guide,” many dementia patients require inpatient or onsite care, but if the following circumstances apply, home health may be a viable option:
- A home health assistant or loved one can be present to provide care coverage at all times.
- A loved one can be present regularly, if not daily, to monitor living conditions and quality of care.
- Resources such as groceries and household supplies can be provided regularly for caregivers to prepare.
- The person with dementia has been denied admission to assisted living/memory care based on violent or threatening behavior.
- The person with dementia has few or no health risks requiring acute care.
- Loved ones and unpaid caregivers need a periodic break from caregiving for vacations or other trips, work or volunteer commitments, or simple respite from the demands of dementia caregiving.
Respite care — short-term/part-time care
According to Fuller-Crawford, home health agencies can be a helpful resource for much-needed respite care, to give family caregivers a break from the rigors of caregiving.
“One important factor for selecting a service or facility for respite care is finding one that can provide consistency with the normal routine,” she said.
She cited one example of a client who didn’t want to take their loved one to a facility because they were concerned that he’d be over-medicated. By choosing home health for respite care, the patient’s family can more easily manage and oversee their loved one’s care and ensure that they are treated in a way that is consistent with their typical daily care.
Respite care can be provided in the home via a home health agency or private provider, or via a facility such as a senior daycare.
Additionally, home health agencies may provide a traveling caregiver to accompany your family on vacation so that you can take your loved one with you, and still maintain some flexibility to enjoy the trip.
“Some clients even ask us to attend to their family member while they are hospitalized,” Fuller-Crawford said. “They want their family member to have extra attention while they’re in the hospital, especially if they can’t be there with the family member. We can send a caregiver to the hospital to attend to the patient during their stay to provide personalized attention.”
Hospice care
Hospice care is an entirely different type of care that is provided as a patient nears the end of their life. While some home health agencies may also provide hospice care, hospice care is typically provided by a health system, hospital, or an agency that specializes in end-of-life care. Hospice care can be provided at home, in a hospital, or in an inpatient hospice facility. Hospice does not provide life-sustaining treatment, but provides comfort and hygiene during a terminal patient’s final days, weeks, or months of life.
Hospital at home
Hospital at Home, or HaH, is another separate model of in-home care that is designed for more acute patients. Hospital at home is a newer, emerging model of home-based care that brings hospital-level care into the patient’s home. Most typical home health agencies do not provide Hospital at Home services, which are provided by agencies and services that specialize in hospital-level, HaH care.
“Home health and Hospital at Home... are different models of care and serve different needs,” said Rami Karjian, CEO and co-founder of Medically Home.
“Hospital-at-home provides hospital-level care in patient’s homes often using resources not — typically — used in Home Health (such as) X-ray, EKG, IV Infusions all at home. Hospital-at-Home care is a studied model used around the world to bring hospital-level care for patients with serious or complex illnesses, (which is) different than home health support for chronic, non-acute conditions, to patients in their homes. These patients otherwise would have required a bricks-and-mortar hospital admission to receive the needed care,” Karjian said.
Getting started — do your research
The options of agencies and caregivers can be overwhelming — how do you know if you’re hiring a reputable home health agency to care for your loved one? Fuller-Crawford said that checking reviews and references is a good first step. She also recommends checking with the state board to make sure that the agency is in good standing and properly licensed to provide home health care services and confirm that the agency’s license hasn’t been suspended or revoked for any reason.
For dementia home care you may want to seek specialized experience with dementia patients, according to Conrad.
“When looking for a dementia caregiver for the nonmedical aspects of home health care, those with any kind of certificate from an evidence-based dementia training program might be given preference over others,” she said. “First-hand experience caring for a loved one or working in a memory care unit is also a plus, but doesn’t guarantee the applicant has received evidence-based training.”
Conrad added that evidence-based dementia care training is available locally through the Virtual Dementia Tour offered through Second Wind Dreams, headquartered in Roswell, which helps caregivers learn what it’s like to live with dementia through virtual reality simulation technology.
Research is also important for budgeting purposes. Be sure to research all the options for reimbursement from health insurers, as well as government programs.
“The state of Georgia provides several waivers for in-home care for children and adults which can help minimize your out-of-pocket costs for care,” said Fuller-Crawford. These programs include Georgia Access Point and Structured Family Care.
Whether your insurance will help cover home health care depends upon your circumstances and your health insurance plan. Fuller-Crawford said she has some clients who are paid for via Medicaid and Medicare, some who are paid for in part by private insurers, and other clients who are self-pay. Home health costs range from $25-$27 per hour, according to Fuller-Crawford, and can be structured around your budget and the hours needed. Before hiring home health care, be sure to research your insurance coverage as well.
In addition to government aid or insurance coverage to help with the cost of home health care, Fuller-Crawford advises families to work out a schedule that involves a rotation of family members alternating with hours served by professional home health care. Not all families have the availability to help with the care, but if your family does, this will reduce the cost by allowing family members to cover as many shifts as possible, and decrease the number of hours you have to pay for home health care.
Comprehensive care plan
Once you’ve decided upon a home health service that’s right for you and your family, your home health agency will work with you to devise a comprehensive care plan to cover the hours, schedule, services, preferences, and needs, within your family’s budget. Every home health agency should have at least one RN on staff to oversee the caregivers and provide supervision when necessary, according to Fuller-Crawford. This RN or a medical director or other senior clinician should be involved in developing the care plan for your loved one.
The care plan will help determine which type and level of caregiver is needed for your case, which will depend upon the level of care required. The services provided range from basics such as dressing, assisting with meals and feeding, rotating or repositioning, and hygiene and bathing, to providing medications, wound care, or tracheostomy management. The level of care needed will dictate whether you need an RN or licensed practical nurse to provide a higher level of care, or if a certified nursing assistant, patient care assistant, home health aide, or companion-level of professional will suffice for the care needs of the patient.
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