• You do not have to be hospitalized to receive the benefits of home healthcare. Most people think this is the case, however, you need only receive an order from the doctor to take advantage of these services.

• You will need to schedule an appointment with the primary care physician for an evaluation. If the doctor believes that home healthcare is beneficial then it will be ordered. This might be assistance with activities of daily living, physical therapy, or nursing assistance for changing bandages, a daily shot, etc.

• Home health will send a nurse to assess the needs of the patient. You should plan to be present for the assessment.

• In-home healthcare is not permanent,  usually lasting a maximum of two to four months.

• Medicare pays for this service if your loved one is considered homebound. You do not make this decision. A home-healthcare nurse will complete the evaluation.

• Medicare does not pay for such non-medical needs as cooking, cleaning or bathing.

Services Included by In-Home Medical Health Care Are:

• Skilled Medical Care: The type of care and the frequency of visits vary depending on individual needs. Care may be provided by a variety of medical professionals, including speech and occupational therapists, registered dieticians, skilled nurses and social workers. Your primary-care physician will be able to guide this process.

• Personal Care: Home health staff sometimes assist with periodic personal-care needs, such as bathing and grooming; they may offer temporary help with eating or incontinence. You should not look to in-home health care to provide 24-hour care. This is NOT an option. If the elder needs round-the-clock care and you cannot afford outside help, you might have to seek other alternatives. The Care Company supports people aging in place as long as it is possible for the family and the elder.

What to Expect:

Weekly visits by a nurse are the norm. The nurse will assess the needs of the patient and provide treatment accordingly. Other medical professionals may be recommended and included in the care plan.

During the weekly visit, the nurse may:

• Provide an initial assessment to discuss the goals and how they will be achieved
• Make medical assessments and offer treatment
• Help with case management
• Make recommendations regarding specialists, who will also visit each week. Remember this is temporary assistance to help the elder become independent again. If no progress is made, then in-home healthcare will not continue.

Some Benefits:

There are clear benefits to receiving in-home health care, even if it is temporary. At The Care Company, we often speak about the importance of seeking help and the fact that help is everywhere. There will be periods of time when the elder requires extra care that requires a level of assistance that you are not qualified or able to do. That's when you need to seek help from the primary-care physician. Do not waste your time trying to get in-home healthcare without a doctor’s order.

Here's the good news: Your loved one can receive in-home medical healthcare even if s/he is living with a family member. During the initial assessment, be honest about all of the elder's needs and what you realistically can and cannot do effectively. Learn all the ways that in-home medical healthcare can help not only the elder, but you as well.

A doctor may make home visits. Depending on the agency assigned to your case, a physician might be available to make house calls. Check with the agency that your doctor recommended to you to see if this is possible. And remember: you do not have to use the first agency if you don’t like your initial point of contact.

If something doesn't feel right about the first agency, contact your PCP and ask for another referral. If your loved one is too weak to leave home and needs to see a doctor, a staff physician may be authorized to come to the home.

Home healthcare is available even if the elder is able to attend meals and activities in an assisted-living facility. Just because your loved one lives in an assisted-living facility does not mean that s/he does not qualify for home healthcare services. If the elder needs to have extra medical attention and is not able to leave the assisted-living facility, then the doctor may order in-home healthcare in the assisted-living facility. This is your loved one’s home. In-home healthcare is not reserved only for the elderly who are still living in their residence.

Summary:

• You must have a doctor’s order to receive in-home healthcare.
• In-home healthcare is designed for short-term needs, and the nurse will do an evaluation every 30-60 days.
• The patient must be homebound, meaning s/he is unable to leave the residence without assistance.  Your loved one does not have to be confined to bed to receive care. It means that it is extremely difficult for the elder to leave home safely.
  • The patient must need only part-time or intermittent care.
  • The agency providing the care must be certified by Medicare and meet Medicare’s standards. You should feel comfortable asking to see the agency’s certification.
  • Typically the in-home healthcare agency will bill Medicare.

After Home Healthcare

Many family caregivers experience anxiety and panic when home healthcare ends. This is when you need to stay calm, weigh your options, get clear about your boundaries, understand your limitations, and, as a family, evaluate the next steps. Hopefully, the elder’s condition was only temporary and things can get back to as much normalcy as possible. If, however, your loved has not improved enough to remain independent, then next steps must be taken. Evaluating those next steps is one of the most difficult things a family does. Take your time. Be clear about all your options. Avoid arguments and try to rise above any unpleasant family history.

• If partial care is still needed in the way of personal-hygiene assistance, light housekeeping, driving, errands, etc., you might consider hiring an outside caregiver for a few hours a day. You will have to clearly evaluate the finances of this option. What financial resources are available to you?
• If you cannot manage this, if coordinating these daily duties feels impossible, or if you live across the country, you have a couple of options. You can always consider having the elder move in with someone in the family. This is not the norm in our country, but if financial resources are limited, it might be your only option.
• Option 2 is an assisted-living facility. You should be aware, however, that such facilities are not free or even inexpensive. Medicare does not pay for them, and the elder must be able to do almost all ADL by him or herself. Once the elder requires more personal care, the cost really increases.
• If 24-hour medical care is needed, you might have to consider a skilled-nursing facility.
• If the elder’s condition is terminal, you have some serious decisions to make. It is a good idea to meet as a family, include the elder in the discussion, (providing cognitive ability is not impaired), and discuss what the future looks like. What are the options? What does the senior want? As difficult as this is, most people, when faced with terminal illness, are very clear about their wishes. Perhaps hospice care becomes an option (See The Care Company Store for our E-book on Hospice Care.)

It is critical that you involve as many family members in these decisions as possible. You cannot and should not take this decision on independent of others. Even if you have been the primary caregiver, it is important for your emotional stability that you reach out and ask for help. These are very difficult decisions. This is one area where a couple of coaching sessions with The Care Company might help you get clarity. You don’t have to have all the answers, and it’s OK if you need help.

The Power of Attorney is a legal document completed by one person to give another person legal authority to act on her behalf. A Power of Attorney can transfer one legal privilege or several, or give the agent the power to do everything that the elder person once did. It might cover simple tasks, such as writing or endorsing checks, or more complicated matters, like selling real estate or making legal decisions. Your attorney will be able to help the family understand how to tailor the Power of Attorney to fit the elder’s wishes and needs.

Choosing the Agent
A person can give Power of Attorney to anyone. The agent does not have to be an attorney. Choose someone who is a trusted family member or friend. Choose someone who will be gentle and patient with the senior or the infirmed person. Choose this person carefully. Be sure to have your lawyer draw up the necessary documents. (You can complete these documents yourself, but make sure that someone qualified looks them over.) If you are doing this for an elderly person, you must reassure him that the person who is being granted the Power of Attorney will not be taking over, but will, instead, provide a second set of eyes and an opinion emanating from concern and trust. The Power of Attorney may be revoked at any time.

Types of Powers of Attorney
There are four types of Powers of Attorney. The one you choose will depend on several factors: the specifics of the situation and how much authority the person wants the selected agent to have; when the agent should begin acting on the person’s behalf; and when, if ever, the Power of Attorney comes to an end. The Power of Attorney gives a person the legal right to act on behalf of the incapacitated person. This documentation must be prepared while the individual is competent. Again: do not wait to do this.

Limited Power of Attorney — Through a Limited Power of Attorney, an individual is authorized to do specific things, and generally for a limited amount of time. This document is often used when a person is incapacitated for some time because they have undergone surgery.

General Power of Attorney – A General Power of Attorney gives the agent the authority to do anything the individual is not able to do for himself. This is a powerful document that requires careful consideration.

Durable Power of Attorney for Health – A Durable Power of Attorney for Health authorizes the chosen person to act as agent for another person after that person becomes incapacitated, but the arrangement ends upon the person’s death. It becomes effective as soon as it is signed. Before preparing this document, you must have a conversation with the person for whom you are assuming responsibility and be clear about specific end-of-life care and decisions.

This conversation requires you to listen well and communicate clearly to be sure that you and the senior on the same page. Seniors’ wishes are often ignored because families think they know best. Remember: health decisions are personal and need to be respected, especially by the person who is chosen to act as agent on the senior’s behalf. Don’t take on this responsibility if you are in conflict with the senior’s wishes or worry that you might be later. This is such an important document because it ensures that the senior retains his dignity by receiving the type of treatment he wants.

By law In the United States, the medical practitioners MUST do everything in their power to treat someone who is in the hospital. The procedures performed in fulfilling that duty are often invasive and do not take quality of life into account. Having a POA for health-care decisions is key to ensuring that your loved one has a say in her personal care. This responsibility is difficult for many people, so we recommend that you enter into this agreement very carefully.

Springing Power of Attorney – This document can be written so that it goes into effect only if an individual becomes incapacitated. With this Power of Attorney, you must be very careful to define precisely what qualifies as a “springing” event.

* We have NOT included Power of Attorney forms on this site, because we strongly believe that you need to seek legal advice before completing the forms. We are not attorneys and it would be irresponsible of The Care Company to include generic forms. Enter into this action carefully and with knowledge.