Home care

Home care:
Home care, (also referred to as domiciliary care, social care, or in-home care), is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living (ADL s) are met. In home medical care is often and more accurately referred to as home health care or formal care. Often, the term home health care is used to distinguish it from non-medical care, custodial care, or private-duty care which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel.
Home Health services help adults and seniors who are recovering after a hospital or facility stay, or need additional support to remain safely at home and avoid unnecessary hospitalization. These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. This care is provided by registered nurses (RNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, primarily through the Medicare Home Health benefit.
The largest segment of Home Care consists of licensed and unlicensed non-medical personnel who assist the individual including caregivers
and care assistants may help the individual with daily tasks such as bathing, eating, cleaning the home and preparing meals. Caregivers work to support the needs individuals and this work helps them stay at home versus a facility. Often non-medical home care is paid for by the individual or family. The term private-duty refers to the private pay nature of these relationships. Home Care has traditionally been privately funded as opposed to Home Health Care that is task based and government or insurance funded. These traditional differentiation in Home Care services are starting to change as the age worlds population has increased. Individuals typically desire to remain independent and use Home Care services to maintain their lifestyle. Government and Insurance providers are beginning to fund this level of care as an alternative to facility care. In-Home Care is often a lower cost solution to long-term care facilities.
For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance.
Professionals providing care
Professionals providing home care include licensed practical nurses, registered nurses, home health aides, physical therapists, occupational therapists and social workers. Rehabilitation services may be provided by physical therapists, occupational therapists, speech and language pathologists and dietitians
Professionals can be independent practitioners, part of a larger organization, or as part of a franchise.
Home care aides, Certified Nursing Assistant (CNA s), and caregivers are trained to provide non-custodial or non-medical care, such as helping with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals, accompany to medical visits, grocery shop, and a number of other errands.
Concept
"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. These phrases have been used in the past interchangeably regardless of whether the person required skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care (usually provided by a Home Health Agency) and "home care" (provided by Homecare Agency or independent home health aide or caregiver) meaning non-medical care
Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers deliver services in the client s own home. These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance.
• Activities of daily living (ADL) refers to activities, including bathing, dressing, transferring, using the toilet, eating, and walking, that reflect the patient s capacity for self-care.
• Instrumental activities of daily living (IADL) refers to daily tasks, including light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money, that enables the patient to live independently in the community.
While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar.
Estimates for the U.S. indicate that most home care is informal, with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home health care is generally paid for by Medicaid, Medicare, long term insurance, or paid with the patient s own resources.
Aide worker qualifications
The state department of health issues requirement for that state. Workers can take an examination to become a state tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.
Licensure and providers by state
California does not have licensure for non medical or custodial care services, and as such there are no entry requirements or minimum standards.
Full service agencies do reemployment background checks, including (criminal), department of motor vehicle, and reference checks. Full service agencies also train, monitor and supervise the staff that provide care to clients in their home.
There is a certification available for home care companies in California, administered by the California Association for Health Services at Home. Florida is a licensure state which requires different levels of licensing depending upon the services provided. Companion assistance is provided by a home maker companion agency whereas nursing services and assistance with ADL s can be provided by a home health agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.
Home care is care that allows a person with special needs stay in their home. It might be for people who are getting older, are chronically ill, recovering from surgery, or disabled. Home care services include
• Personal care, such as help with bathing, washing your hair, or getting dressed
• Homemaking, such as cleaning, yard work, and laundry
• Cooking or delivering meals
• Health care, such as having a home health aide come to your home
You can get almost any type of help you want in your home. Some types of care and community services are free or donated. Many other types you have to pay for. Sometimes government programs or your health insurance will help cover the cost of certain home care services.
Adult Day Care
Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.
The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: adult social day care and adult day health care. Adult social day care provides social activities, meals, recreation and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.
Seniors generally take part in the program on a scheduled basis and the services that are offered may include the following:
• Counseling
• Education
• Evening care
• Exercise
• Health screening
• Meals
• Medical care
• Physical therapy
• Recreation
• Respite care
• Socialization
• Supervision
• Transportation
• Medication Management
How Do Adult Day Care Centers Operate?
These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.
Who Can Benefit From Adult Day Care?
The following case study is an example of a senior who may need adult day care services, both for his own well being and that of his family caregivers:
Paul is 69 years old and recently suffered a stroke. He needs some care and supervision so he lives with his son and daughter-in-law, David and Kira. However, because David and Kira both work, they need help to care for Paul during the day. They found a solution to their problem by having Kira drop off Paul at the local adult day care center in the morning, and having David pick him up when he gets off work in the evening. The center monitors Paul’s medications and offers him lunch, some physical therapy, and a chance to socialize with other seniors.
What Should I Look for in an Adult Day Care Center?
All states do not license and regulate adult day care centers. There may be a great deal of difference between individual centers; therefore it is important to learn more about each of the centers near you. You will probably want to visit the centers closest to you, and talk with the staff and other families that use the centers to determine if the facilities and programs available meet your individual needs. You may want to find out if your state has an Adult Day Care Association.
Hospice care might be an option if you or a loved one has a terminal illness. Understand how hospice care works and how to select a program.
If you or a loved one has a terminal illness and you ve exhausted all treatment options, you might consider hospice care. Find out how hospice care works and how it can provide comfort and support to you or your loved one, as well as your family and friends.
Hospice care is for people who are nearing the end of life. Hospice care services are provided by a team of health care professionals who maximize comfort for a terminally ill person by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support.
Unlike other medical care, the focus of hospice care isn t to cure the underlying disease. The goal of hospice care is to support the highest quality of life possible for whatever time remains.
Hospice care is for a terminally ill person who s expected to have six months or less to live. This doesn t mean that hospice care will be provided only for six months, however. Hospice care can be provided as long as the person s doctor and hospice care team certify that the condition remains life-limiting.
Hospice care isn t just for people who have cancer. Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease.
Hospice care has been shown to make people who have incurable illnesses feel better and live longer. Enrolling in hospice care early might help you or your loved one develop a strong relationship with the hospice staff, who can help with preparation for end-of-life needs.
Most hospice care is provided at home — with a family member typically serving as the primary caregiver. However, hospice care is also available at hospitals, nursing homes, assisted living facilities and dedicated hospice facilities.
Keep in mind that no matter where hospice care is provided, sometimes it s necessary to be admitted to a hospital. For instance, if a symptom can t be adequately managed by the hospice care team in a home setting, a hospital stay might be needed.
If you re not receiving hospice care at a dedicated facility, members of the hospice staff will make regular visits to your home or other setting to provide care and other services. Hospice staff is on call 24 hours a day, seven days a week. A hospice care team typically includes:
• Doctors. A primary care doctor and a hospice doctor or medical director will oversee your or your loved one s care.
• Nurses. Nurses will come to your or your loved one s home or other setting to provide care. Nurses also are responsible for coordination of the hospice care team.
• Home health aides. Home health aides can provide extra support for routine care, such as dressing, bathing and eating.
• Spiritual counselors. Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family.
• Social workers. Social workers provide counseling and support. They can also provide referrals to other support systems.
• Pharmacists. Pharmacists provide medication oversight and suggestions regarding the most effective ways to relieve symptoms.
• Volunteers. Trained hospice volunteers offer a variety of services depending on your needs, from providing company or respite for caregivers to helping with transportation or other practical needs.
• Other professionals. Speech, physical and occupational therapists can provide therapy, if needed.
• Bereavement counselors. Trained bereavement counselors offer support and guidance after the death of a loved one in hospice.
Medicare, Medicaid, the Department of Veterans Affairs and private insurance might pay for hospice care. While each hospice program has its own policy regarding payment for care, services are often offered based on need rather than the ability to pay. Be sure to ask about payment options before choosing a hospice program.
To find out about hospice programs, talk to doctors, nurses, social workers or counselors, or contact your local or state office on aging. Consider asking friends or neighbors for advice. The National Hospice and Palliative Care Organization also offers an online provider directory.
To evaluate a hospice program, ask questions about the services offered. For example:
• Is the hospice program Medicare-certified? Is the program reviewed and licensed by the state or certified in some other way? Is the hospice program accredited by The Joint Commission?
• Who makes up the hospice care team, and how are they trained or screened? Is the hospice medical director board certified in hospice and palliative care medicine?
• Is the hospice program not for profit or for profit?
• Does the hospice program have a dedicated pharmacist to help adjust medications?
• What services are offered to a terminally ill person? How are pain and other symptoms managed?
• How are hospice care services provided after hours?
• How long does it take to get accepted into the hospice care program?
• What services are offered to the family? What respite services are available for the caregiver or caregivers? What bereavement services are available?
• Are volunteer services available?
• If circumstances change, can services be provided in different settings? Does the hospice have contracts with local nursing homes? Is residential hospice available?
• Are hospice costs covered by insurance or other sources, such as Medicare?
Remember, hospice stresses care over cure. The goal is to provide comfort during the final months and days of life.