Finding someone to provide home care services was always a challenge. The ongoing pandemic made a bad situation worse.
Agencies that provide such services report great difficulty filling open positions, leaving many vulnerable health care consumers in the lurch. Many in the field abandoned their positions over fear of contracting COVID-19.
I've found a lot of frustration resulting from the lack of home care workers. Families often turn to the only resource they have available: unpaid caregivers, usually spouses or other family members, who undertake sometimes difficult situations, such as managing a chronic illness or taking care of a dementia patient. There is still a cost in the physical and emotional strains, along with lost work hours.
When you're trying to find home health care, it's a good idea to first know the rules of the road.
The main thing to know is that home care (unskilled private pay home aides that help with personal care) and skilled home health care are different.
If ordered by a physician, Medicare will pay for about eight skilled home health care visits per month, including nurses, physical therapists, occupational therapists and speech therapists. The recipient must be very motivated to do prescribed exercises even when the therapist isn't there. The patient must also be certified by their doctor as homebound -- no going out except for doctor's appointments.
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren't covered by Medicare, and how much you'll have to pay for them.
A Medicare-approved home health agency must also provide you a written copy of your rights as a Medicare recipient. You have the right to:
• Choose your home health agency (unless you have a Medicare Advantage plan that provides network agencies);
• Have your property and belongings treated with respect.
• Be given a copy of your plan of care, and participate in decisions about your care.
• Have your family or guardian act for you if you are unable.
Note that Medicare-covered services do not include help with "activities of daily living" (ADLs) or "instrumental activities of daily living" (IADLs).
ADLS include the ability to bathe, use the toilet, dress and move around. The IADLs are more complicated but also are important to a patient's well-being: preparing meals, transportation and shopping, companionship, household management and medication management, to name a few.
Most seniors living alone after major joint replacement surgeries will need such home care to help them around the house until they can take care of everything on their own safely.
In 2019, the average cost for nonmedical home care was $21 an hour, with a range of $16 to $28 an hour. In the Chicago area, according to the 2020 Genworth Cost of Care Survey, homemaker services for 35 hours a week cost more than $47,000 a year, and for home health aides it's more than $48,000.
And you will be responsible for 100% of the cost, unless you have a good long-term care policy. Check with your policy to find out what it will cover and when coverage will begin, as there may be a waiting period.
A private individual can be hired for less, but they will not have liability insurance or undergo background checks. If you are thinking about hiring a private caregiver, first consult an attorney. You will become the caregiver's employer, and there are laws you need to comply with as an employer, such as minimum wage -- in Illinois, $11 an hour.
If you or a family member will be needing home-based care because of illness or surgery, you can find assistance in a couple of places.
The Illinois Department on Aging (www.illinois.gov/aging) keeps a directory of coordination of care agencies, which can link you to home care agencies. The Illinois Department of Human Services (www.dhs.state.il.us) has home services for individuals under the age of 60 who suffer from severe physical or mental disabilities.
A patient advocacy agency can also provide assistance in finding care, along with medication monitoring, keeping an eye on finances and other services. To find an advocate, try resources such as www.advoconnection.com or the National Association of Health Care Advocacy (www.nahac.com). A nonprofit I helped start, SAGAS (Seniors Alone Guardian and Advocacy Services at www.seniorsalone.org) provides help to low-income seniors and disabled adults.
Long-term care, whether provided at home or in a nursing facility, is a challenge to set up, difficult to maintain and expensive to pay for. Don't be afraid to ask for help.
• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.
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August 28, 2021 at 07:04PM
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Home care is getting harder to find - Chicago Daily Herald
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