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Care in the Home

by Barbara Resnick, PhD, CRNP

People may need care in their home when they are frail or weak, particularly after they have been discharged from the hospital or a rehabilitation facility. Simple care is usually provided by family members, friends, or both. More complex care may require health care practitioners (such as registered nurses and therapists) and others (such as home health aides and social workers) to come to the home. Such care is usually coordinated by a home health care agency and supervised by a doctor. Care may be needed only briefly or for a long time. Medicare provides services if people are considered homebound, which typically means that they are able to leave their home only for doctors appointments or emergencies.

A nurse may be needed to change dressings or give injections of drugs.

A physical therapist may be needed to help people regain strength and balance or recover from a stroke.

A home health aide may be needed to help people with shopping, preparing meals, going out in a wheelchair, taking a walk, or bathing.

A social worker can determine whether people are receiving the services they need and recommend additional services if needed. A social worker may also help arrange for rides to and from medical appointments.

With home health care, communication among all of the people involved is important. Any changes in the person's condition should be promptly reported to the person's nurse or doctor.

What Services Can Be Provided in the Home?

Type

Service

Medical

Nursing care

Physical, occupational, and speech therapy

Respite and hospice care

Durable medical equipment such as commodes, wheelchairs, and walkers

Drugs given by vein (intravenously)

Dialysis

Feeding by tube or intravenously

A ventilator to support breathing

Diagnostic tests such as x-rays, electrocardiography, and blood tests

Other

Personal care such as help with eating, bathing, washing hair, using the toilet, and dressing

Help with housecleaning

Devices to signal for help (personal emergency response systems)

A security system that provides surveillance

Food programs such as Meals-on-Wheels

Sometimes the primary care practitioner coordinates a team of health care practitioners who work together to provide better care for people who live at home and have a chronic disorder or disability. This arrangement is called a patient-centered home.

Care in the home can reduce placements in a nursing home by 23% and is less expensive when visits by home health aides and nurses are scheduled appropriately.

Financial issues

Medicare covers home health care services that are classified as skilled nursing care, including wound care and monitoring of disorders such as heart failure or diabetes. However, the amount of and time frame for such coverage is limited (see Medicare). When people no longer need skilled care, they are usually responsible for the costs of any further nursing care. Long-term care insurance or Medicaid (for people who qualify) may cover home care services. Veterans may also qualify for home care services depending on their needs and disability rating.

For home health care to be covered by insurance, a doctor must certify that home health care is required and, for Medicare, that people meet Medicare's requirements for home care.

PACE

The program for all-inclusive care for the elderly (PACE) is a benefit provided under Medicare and Medicaid (see Medicare : PACE). This program is available only in certain areas of the United States to people who are at least 55 years old and who meet their state’s standards for requiring care in a nursing home. Services provided by the PACE program allow nearly all participants to live at home, although nursing home care is provided if needed.

PACE involves an interdisciplinary team including doctors, nurses, physical and occupational therapists, social workers, dieticians, and drivers. The services are typically provided in an adult day health center and are available every day. The program provides transportation to the center. Some services may be provided in the home.

The Department of Health and Human Services web site explains PACE and provides an up-to-date list of participating health care practitioners. See the Medicare website.

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