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Homecare
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New Home Care Model Bridges GapsSeptember - October 1999 - NCOA Networks
By Judith B. Clinco, R.N,
Most seniors want to live at home. But home health, the current medical model of home care, is under attack by federal regulators and HMOs.
Medicare’s home care provisions were designed to provide homebound senior patients with skilled, intermittent, short-term adult care, usually after a hospital stay or to prevent recurring hospitalizations. The program was not intended to provide long-term adult home care, though it was often used for this purpose until the Health Care Financing Administration revised its reimbursement rules in 1997.
Now, as seniors are exchanging their Medicare entitlements for HMO memberships, they often have fewer opportunities to use authorized home health senior services. Managed care providers often send their members to nursing homes for post-hospital care rather than provide skilled care in the home. Yet when these seniors leave the nursing home, managed care companies often expect family me-bers to provide all the needed services.Supportive Care: An Emerging Model
A new way to bridge the gaps in home health senior services is supportive care, which aims to help seniors stay independent and stable, promote their health and wellness, and support their quality of life. In this social model, a home care aide provides transportation and companionship, helps with personal care and hygiene, does house-keeping, and reminds the client to take medications.
Nursing supervision is included when a licensed adult home care agency provides care. The nurse’s duties may include making sure the patient’s chronic condition remains stable, setting up medication boxes, ensuring the aide is providing satisfac-tory care, and watching for sud-den changes in the patient’s medical status.
Supportive care is less expensive than nursing homes or home health. A home health visit costs about $75 to $100 and usually lasts from 15 minutes to two hours. Nursing home rates vary; Tucson-area homes; for example, charge an average of $125 a day.
By contrast, supportive care at $14 to $17 an hour can be a bargain. Services, which range from three or four hours a week to 24 hours a day,are sometimes paid for by long-term care insurance, Medicaid, or an equivalent state program. Sometimes the client or family pays directly for services.Easing the Transition
Healthcare professionals can be valuable advocates in helping seniors obtain supportive care. To make sure supportive care is appropriate, physicians and social workers can make referrals to home care agencies; most are glad to do an in-home evaluation.
Even HMOs may come to welcome supportive care once they see the savings made possible by improving nutrition and reductions in medication errors, accidents, isolation and depres-sion, and unnecessary hospitalizations. However it’s paid for, supportive care should not be overlooked. It’s often the best choice for helping seniors avoid hospital or nursing-home stays and live healthier, more inde-pendent lives at home.Judith B. Clinco, R.N., B.S., is president and CEO of Catalina In-Home Services Inc., a home care agency based in Tucson, Arizona. She is a delegate for NCOA’s Community-Based Long-Term Care Committee