Nonprofit resources for home care • MN HomeCare Association: www.mnhomecare.org • Senior LinkAge Line: 800-333-2433 • Metropolitan Area Agency on Aging: www.tcaging.org/findinghelp/sll.html • PACER Center (advocacy group for children with disabilities): www.pacer.org • Disease management groups such as the Muscular Dystrophy Association (www.mda.org/), ALS Association (www.alsa.org/), Brain Injury Association of Minnesota (www.braininjurymn.org/), Autism Society of Minnesota (www.ausm.org/) • National Association for Home Care and Hospice: www.nahc.org Types of home care
Home care ranges from a onehour weekly visit to 24-hour livein care. It provides a one-on-one focus, which is difficult to obtain in hospitals or group facilities. Home care also respects cultural differences and ethnic diversities by assigning staff members not only by skill sets but also by language (from Spanish to Somali to sign) and behavioral criteria, such as not smoking or not consuming pork. In hospital settings, there is no choice as to who provides the patient care. Home care allows the patient to select the service provider upfront and provides care in a controlled setting. The checklist of questions above is designed to help physicians, patients, and families match the needs of the patient to home care provider skill sets. There are five basic home care service options: 1. Personal care assistants provide assistance with activities of daily living such as dressing, bathing, feeding, getting to doctor appointments, etc. They are not licensed by the state. This type of care typically is paid for by Medical Assistance, Minnesota’s Medicaid program. 2. Private duty care—basically private-pay care—provides assistance with nonmedical needs such as shopping, cooking, transportation, and companionship and involves household management services but no hands-on medical care. Some long-term care policies will cover such home care, but reimbursement terms and exclusion criteria vary. 3. Licensed home care agencies employ a variety of home health care professionals, including skilled nurses, ther-
apists, and home health aides. This type of care typically is paid for by private insurance, Medicare, and Medicaid. 4. Medicare-certified skilled home care typically is provided on an acute, intermittent basis, i.e., following an illness, injury, or change in disease status. Such services are physician-driven and reimbursement is contingent on the individual demonstrating progressive improvement while being homebound. 5. Extended-hour nursing offers high-level, one-on-one care, from four to 24 hours a day for patients with medically complex needs. Not all home care agencies offer this type of care. This is an intensive level of care provided for at-home patients requiring trachs, G-tubes, IV, and ventilation.
Finding the right match of patient needs, home care services Matching patients’ needs with home care providers’ skill sets is a primary consideration for physicians, patients, and families. These qualifier questions can help determine the optimal home care provider for any particular situation: 1. What process do you use to match employees with clients? 2. What type of training is given to your staff members? 3. Does your agency have licensed social workers on staff to address the emotional needs of clients and families? 4. How closely do your supervisors evaluate the quality of care provided? 5. How are problems addressed and resolved? 6. How do you manage scheduling? Is care available around the clock if needed? 7. What are the credentials of your employees who will be in the home? Can they provide individual references? 8. What procedures are in places in case of an emergency, such as a power failure or inclement weather? 9. Are all of your caregivers licensed in their fields? 10. Can you provide references, including doctors, hospital discharge planners, and clients? 11. How do you handle expenses and billing? Has your company ever been accused of fraud? 12. Will I receive a written care plan before service begins? rapidly moving from the periphery to the mainstream of patient care. The types of care now being handled at home are drastically different from care models even 10 years ago, and they will continue to evolve as technologies advance. Home is where families want their loved
ones to be, and home care supports the best quality of life for patients. Amy Nelson is founder, president, and CEO of Accurate Home Care, a provider of home care services in the Upper Midwest. AHC serves a wide range of medically complex pediatric and adult clients.
Who pays for home care?
Funding for home care is increasing. Many insurance companies now cover extendedhour nursing and care visits. A tracheotomy patient, for example, can be approved for 24hour-a-day care for one month and then be weaned into family care. Managed care companies such as Medica, HealthPartners, UCare, and Blue Cross and Blue Shield have come to understand that home care is safe, efficient, and cost-effective. Payment options for home care include self-pay, Medicare, Medicaid, Veterans Administration, community organizations, commercial health insurance companies, managed care organizations, CHAMPUS (military health plan), and workers’ compensation. Bringing it home
Home care is a critical component of collaborative care that is DECEMBER 2011
MINNESOTA PHYSICIAN
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