Long-Term Care Services from a Home Care Agency
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Having the right kind of health care help at home can make a significant difference in an older person’s quality of life and ability to remain in familiar surroundings. But the right kind of help is different for each person and is often hard to find. And for a person who values independence, accepting that help is difficult, even when the need is clear.
Studies show that families provide an estimated 80 to 90 percent of care at home. But when family care is not available or sufficient, you have the options of different types of services, different agencies that provide them, and different health and long-term care insurance coverage. You may pay privately for workers you hire on your own. Some public programs allow family members or friends to be paid to provide care.
Policymakers and researchers often distinguish between formal and informal services. In policy-speak, formal services are services provided through an agency and paid for by insurance or privately; informal services are those provided by unpaid family members or friends.
No data are available on the numbers of people who do not use an agency but who instead hire and pay home care workers directly. Even though these workers are paid, they would probably be considered informal help since they are not supervised by a home healthcare agency or public entity.
For Medicare and most private insurance, the threshold for eligibility for formal home care services is the need for skilled care. Skilled care is defined not by what it is but by who provides it. In other words, skilled care is provided by a nurse or a physical therapist or other professional. Some examples of skilled nursing care are IV injections, tube feedings, and wound care. Physical therapists work with you to improve mobility, balance, and strength.
The opposite of skilled care is not unskilled care. Home care aides provide care that is sometimes called “unskilled,” but that is an erroneous label. Home care aides do personal care like bathing and dressing, help people move from bed to chair, and generally help them do they things they used to be able to do but no longer can on their own.
Care provided by home care aides, especially if the person has dementia or cognitive deficits, is immobilized, or is uncooperative or verbally abusive, requires a high level of skill, not to mention patience and tolerance.
The language of home care policies and practice, however, recognizes only what professionals do as skilled. And even when you or a family member learn to do the same tasks as a nurse, the task is no longer called skilled care.