Many seniors and families are unaware that home-based medical care options exist, and that some services may be covered through a number of insurance plans including Medicare, Medicaid, veterans benefits or commercial insurance plans.
The goal of home health care is to help patients recover from an illness, injury, surgery or manage a chronic medical condition. These services are typically short term and often last between 30 and 60 days, such as a physical therapist to help a patient regain mobility at home after a hip replacement.
Home care is not only for the elderly, but supports people of all ages — from post-surgery recovery to chronic condition management and disability support.
HCR Home Care is one home care company out of many that helps people age in place. HCR serves Delaware, Otsego and Schoharie counties, as well as 22 other counties across New York state. It’s employees have provided home care for 48 years.
Its regional office for central New York is at 107 Winney Hill Road in Oneonta’s West End, inside Westgate Plaza. The company is headquartered in Rochester and serves the Finger Lakes, Central New York and the North Country. HCR employs about 700 people statewide.
Tracy Vander Veen, a community outreach specialist and licensed practical nurse with HRC, attended a senior resource fair for people older than 55 at The Gathering Place in Oneonta April 24. The Otsego County Office for the Aging was among the nearly 20 vendors at the fair.
The terms, home health care and home care, are often used interchangeably. Home health care, however, includes skilled services such as physical therapy and wound care, while home care refers to personal care such as bathing, grooming, meal preparation, light housekeeping and medication reminders.
HCR Home Care President Suzanne Turchetti said that many families are surprised to learn that there are often more options available than they realize when a loved one begins to need additional care.
One of the biggest misconceptions among older adults is that moving into a nursing home is the only option when health challenges make living independently more difficult. In reality, many people qualify for services that allow them to receive care safely at home.
Understanding what is covered and what services are available can help seniors and their families make informed decisions about care. HCR, for example, has provided home care services to veterans since 1978.
“A health setback doesn’t automatically mean someone has to leave the place they know and love,” Turchetti said. “With the right support, many individuals can continue living safely and comfortably at home.”
Short-term solution
Home health care provides skilled medical services in the home under a physician’s order. These services are delivered by licensed clinicians and may include skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work or home health aide services when part of a skilled care plan.
Diabetes care management is an example of a chronic condition that in-home care traveling teams help to treat. According to HCR’s website, patients can receive training to monitor glucose levels with the help of glucometers, continuous glucose monitors and ketone testing.
They also receive education on how food, stress, exercise and illness affect sugar levels throughout the day. How to recognize and treat both hyperglycemia (high blood sugar) and life-threatening hypoglycemia (low blood sugar) is another lesson patients receive.
“For nearly 50 years, HCR has been privileged to assist patients and families during some of life’s most challenging moments,” Turchetti said. “Our role is not only to provide care in the home, but also to help people navigate a complex health care system and make informed decisions that honor their goals for aging.”
Medicare and Medicaid
Many seniors are surprised to learn that Medicare may cover certain home-based services when specific requirements are met.
In most cases, Medicare and many commercial insurance plans require that the patient be considered homebound, meaning it is taxing and difficult for them to leave home. The patient also must require skilled services that are ordered by a physician.
Insurance companies typically require prior authorization and may place limits on the number of visits covered, HCR’s corporate communications department said.
It is important to understand that every insurance plan is different. Subscribers are responsible for understanding their individual benefits, coverage limitations and whether providers participate in their insurance network.
Medicaid eligibility is based primarily on income and financial qualifications.
Unlike Medicare, Medicaid recipients may not need to be homebound to qualify for services. Depending on their situation, they may be eligible for skilled services or personal care assistance that helps them remain safely at home.
Medicare Advantage Plans
In some New York state counties, there may be more than 65 different Medicare Advantage plans available. Comparing benefits, provider networks, prescription coverage and out-of-pocket costs can be overwhelming and confusing.
Many people do not realize that independent Medicare navigators and community resources are available at no cost. These professionals can help compare plans based on medical conditions, current medications, preferred physicians and health care providers or individual health care needs.
Because they receive similar commissions from participating insurers, their role is to help consumers find the plan that best fits their needs rather than steering them toward a particular company.
Options other than nursing homes
Many families assume that when a loved one experiences a major health setback, such as surgery, a fall or a hospitalization, a nursing home is the only long-term solution. In reality, there are often multiple options available.
Every situation is unique and should involve discussions among the patient, family members, caregivers, physicians and care coordinators.
Important considerations include the individual’s medical condition, safety within the home, available family and caregiver support, financial resources, insurance coverage and community resources and support programs.
In many cases, a combination of professional home care services and family support can help individuals remain safely at home for longer than they may have thought possible.
Understanding the difference between skilled home health care and personal care services is often the first step toward making informed decisions. Before assuming a move to a nursing facility is necessary, it is worth exploring all available resources and speaking with health care professionals who can help determine the safest and most appropriate care plan.
Help with activities of daily living are often needed for a longer period of time than in home skilled medical treatment. Home care services can vary from a few hours of assistance each week to comprehensive, round-the-clock care.
“We believe everyone deserves the opportunity to age in place whenever it is safe and appropriate, and we’re proud to help make that possible,” Turchetti said.