Home Aging in Home Planning ahead Appropriate Levels of Home Care Resources

Appropriate Levels of Home Care Resources

home care nurse

Home care resources vary depending on your needs. It is important to understand the types of home care providers and different services that are available to you. There are basically two types of home care services.

The most common type of provider you think of, is in the industry is known as “skilled” home care.  This service is provided by a Medicare certified agency. The services or care provided requires and order from a doctor for specific needs. These services are provided intermittently and for a specified length of time, usually less than 28 hours per week. The services are not needed longer than 21 days.

home care nurse

The care is provided by professional and licensed nurses, and therapists. The aides providing care by the “skilled” home care agency must be certified. This means they must have some specialized training to perform the duties required of the position.   

In order to qualify for the services of a “skilled” agency, you must be home bound and have special medical needs such as wound care, physical, occupational or speech therapy. By Medicare definition, “homebound” means you are not able to leave the house for any purpose other than to see you health care provider or attend religious services.

In most cases, insurance will cover ‘skilled” services, if you meet the qualifications for the benefits under your policy. It is always important to check with your insurance carrier about your financial responsibility and the co pays amounts for visits that you receive.

“Skilled” home care services may supply an aide to come in and assist with bathing and dressing. This is generally covered by the cost of the home care services only if it is part of the care needed and an aide is available from the home care agency. Many managed care insurance companies will not approve payment for those services and therefore the home care agency is unable to offer home health aides as an option.  

There is a little known Medicare only benefit that is utilized very little, but is a benefit to those with dementia. Again, you must have Medicare. There is a chronic care program under the Medicare program that very few home care companies may even be aware exists.

It is a great benefit for those individuals that have dementia. The rules are very clear cut; a case can be open forever with a nurse coming weekly to monthly visits to see a home bound patient. The key to this is that the nurse’s presence is to prevent hospitalizations. Under this program the patient would be eligible for home health aides, and even therapy if needed.  So if you have someone with dementia with other diagnoses, and they have Medicare and supplemental insurance, and you would like to prevent hospitalizations, this program is something you should investigate.

The other type of home care is known in the industry as “custodial” care. This provides services such as companionship, personal care, light housekeeping and shopping.

Home care services that are considered “custodial” are usually paid by some long term care insurance policies, private pay and through some Medicaid waiver programs. Your local area on aging is a resource for you to learn more about the services available in your area.

 When considering dementia home care services some things to investigate and ask:

  • How long has this particular branch or agency been in business?Does the agency provide a written plan that details services specific to dementia that can be provided by each caregiver?
  • Do they provide documents about financial arrangements before service begins? Do they provide documents when there is an increase or decrease in level of   services?  This is important because you do not want any misunderstandings about the levels of service and cost that is being provided.
  • Are the individuals providing care, insured and bonded?
  • Does the agency perform a criminal background check prior to employing each staff member?
  • Is there ongoing dementia training for the staff? Is it mandatory?
  • Is there any dementia training available to the family?
  • Is worker’s compensation a benefit provided for the staff?  This is an important question because you do not want to be responsible for any injuries that occur on the job.

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  • Are there procedures in place for emergencies? Are staff members available for coverage if a caregivers calls out? Is there a supervisor on call and available to speak to on off hours and weekends?  Is there a staff member to speak to 24/7?
  • Is there a policy in place for addressing and resolving issues and concerns? Who do I contact in the agency regarding any requests, questions or complaints?
  • Is there an agency requirement that a primary caregiver be available as a condition of qualifying for services?  If so, can you tell me what are the requirements of the family members?
  • Ask the agency to provide references from doctors, hospital discharge planners, social workers and former customers of the agency.
  • Do I have an opportunity to interview potential aides and make a selection?
  • How will I know who will be coming to the house? Will there be regularly scheduled staff so that there is continuity of care being provided? Will you provide me a list of specific duties?
  • Is there a professional nurse that will identify and provide a plan of care? How often does this nurse visit and revise the plan of care?
  • Will the family and the client be included in developing and making changes to the plan?

Choosing the right home care services can feel stressful and even overwhelming.  For those providing care to someone with dementia, trying to keep someone at home as long as possible, this is time well spent. Having help and feeling in control over some part of your life, realizing you have choices as a caregiver, is invaluable. Dementia care at home makes that possible.       

Here is a checklist to determine if you need any home care resources

Considering home health care? Here is a checklist on things to consider

You want to have outside help come into the home, but have no idea where to start. Here is a checklist to help you get started:


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