San Diego Home Care Blog

When I am out in the community talking about hospice care, many people ask “What’s the difference between hospice care and in-home care?” It can be very easy to get the two services mixed up, but the differences are significant.

Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support for patients and their families affected by a life-limiting illness. Hospice care is usually provided in a patient’s home or wherever a patient calls “home” such as a skilled nursing facility or assisted living facility. Care is provided by a team of healthcare professionals all working together with the patient, the patient’s physician, and the patient’s family members. The team makes intermittent visits to a patient’s home, depending on the needs of the patient and family members. And hospice care is very affordable, as it is covered under Medicare, Medi-Cal (Medicaid), most private insurance plans and HMOs. The goal of hospice care is to help the patient live the best quality of life possible, for as long as life lasts – whether that’s weeks, months, or years.

In-home care services in San Diego are available for those in need of assistance with activities of daily living (ADLs), or for family caregivers who may need a break, or additional help, in caring for their loved one. Non-medical home care agencies provide assistance with ADLs, which require no medical intervention. These activities include supervision and assistance with personal care, such as bathing and dressing, feeding, companionship and light household tasks. It’s important to note that non-medical home care (also known as Companion Care) is not covered by Medicare or other commercial insurance policies (i.e. PacifiCare, Secure Horizons, etc). Generally, agencies in the San Diego area can range from $13 to $20 per hour. If your loved one needs assistance 24 hours per day, sometimes known as a “live-in” home care, prices may range from $150 to $250 per 24-hour period. Some services may be covered by long term care insurance, review your policy for details. Medicare, Medi-Cal and private insurance usually cover the cost of visits from a Physician, RN or therapist (if ordered by a Physician). Services must be provided by a Medicare certified Home Health agency.

The main difference is that hospice care team members visit patients on an intermittent basis – they do not “live-in” with the patient or stay with the patient all day (except in cases where the level of care is determined to be continuous care, based on the medical needs of a patient). And services provided by the hospice team are usually covered by insurance. In-home care workers provide non-medical care, can stay as long as needed (depending on the service agreement between the in-home worker and the patient), and services are usually not covered by insurance.

To determine which type of care is best, talk with your doctor or call a San Diego hospice provider for more information.

-by Melissa DelaCalzada

This post is part of San Diego Hospice’s series, sharing the stories that reflect the experiences of those impacted by, or living with, a serious illness. This series will be updated monthly. Feel free to share your thoughts with us.

With the recent World Hospice & Palliative Care Day on Saturday, October 8, and the upcoming National Hospice and Palliative Care Month in November, what better time than now to take a moment to reflect on all of the positive things hospice and palliative care has to offer.

In honor of these recognition events, San Diego Hospice and The Institute for Palliative Medicine invites you to join the global hospice and palliative care community to share your supportive stories, thoughts and memories about hospice and palliative care through a global conversation online using the hashtag #WeAreHospice to connect via Twitter.

The goal is to spread positive awareness and encourage a sense of community among peers, patients and caregivers, bringing everyone together to remember what we are ultimately here for in the end.

This is the start to many opportunities down the road to spread the good news about hospice and palliative care. You can find us online @SanDiegoHospice and @PalliativeCare to join the conversation about why #WeAreHospice.

We all hear about Medi-Cal but many of us may not fully understand its benefits. But for caregivers, particularly during these economic times, it is important to know exactly who can apply for this program and what is offered to those that qualify.

Medi-Cal (known as Medicaid outside of California) is a public health insurance program that is financed by the state and federal government. It provides health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, and pregnant women. Medi-Cal also provides health care services to low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS.

Although Medicaid is a National program, each state sets its own guidelines regarding eligibility and services. The general premise remains the same, but certain state-specified requirements must be met in order to be eligible to receive the Medicaid benefits. In addition, the rules for counting income and resources vary from state to state and from group to group and there are special rules for those who live in nursing homes and for disabled children living at home.

For those living in California, below is the Medi-Cal eligibility criteria.

Medi-Cal Eligibility Criteria:

If you are enrolled in one of the following programs, you can get Medi-Cal:

SSI (Supplemental Security Income)/SSP (State Supplemental Payment)
CalWorks (AFDC)
Refugee Assistance
Foster Care or Adoption Assistance Program
In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

65 or older
Blind
Disabled
Under 21
Pregnant
In a skilled nursing or intermediate care home
On refugee status for a limited time, depending how long you have been in the United States
A parent or caretaker relative or a child under 21 if:
The child’s parent is deceased or doesn’t live with the child, or
The child’s parent is incapacitated, or
The child’s parent is under employed or unemployed
Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

One of the caregiver tools we recently wrote about on The Caregiver’s Corner blog, the BenefitsCheckUp website, can help you see if you or someone you are caring for may be eligible for Medi-Cal or a variety of governmental programs.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups. Even if you are not sure whether you qualify, if you or someone in your family needs health care, it is recommended that you apply for Medicaid and have a qualified caseworker in your state evaluate your situation. For more information, visit California’s Department of Health Care Services website or call your County’s Medi-Cal office. In San Diego County, contact the Dept. of Health and Human Services Agency toll-free at 1-866-262-9881.

Patricia McGinnis has six brothers and sisters who help her take care of their 89-year-old mother. Though their mother is alert and able to live on her own, she is blind and has balance problems that have led to several falls, for which she has received care.

It takes all of the siblings working together to help their mother stay at home. But every day, as president of the California Advocates for Nursing Home Reform, McGinnis deals with people who don’t have that choice and must live in nursing homes because they lack the financial resources or social support to remain at home as they age.

Home-based care is increasingly seen as a legitimate and less costly alternative to nursing home care. The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, includes provisions to assist people who want to stay in their homes longer.

“I think it’s probably one of the most important reforms to long-term care since Medicare and Medicaid went into effect in 1965,” McGinnis said. “This is imperative, so I am really excited about it.”

About 1.5 million people live in nursing homes in the U.S., according to the Centers for Disease Control and Prevention. And more than 10 million Americans — mostly people 65 or older — need long-term services and support to help them with daily activities, according to the Kaiser Family Foundation.

Elinor Ginzler, senior vice president for livable communities at AARP, said the organization is always fighting for more funding to help people stay in their homes longer.

“Nursing homes are not a first choice,” she said. “People like where they are living. We surveyed the 50-plus population and found that 86% of them want to stay in their homes.”

One of the main reasons is financial.

The cost of staying at a nursing home ranges from about $40,000 to $85,000 a year, according to a recent report by John Hancock Financial Services Inc., an insurance and financial services company. The average cost of a home health aide, on the other hand, is about $37,000 a year.

A long-term care insurance policy McGinnis purchased some time ago pays for most of her mother’s healthcare at home. But not everyone has that kind of insurance. “If you look at the baby boomers coming up, I wonder how we are going to pay for all of this,” she said. “The average retirement savings of people 55 or older is $29,000 a year.”

New provisions of the Affordable Care Act should help. The most ambitious part of the act to do with long-term care is the Community Living Assistance Services and Supports Act, or CLASS — a voluntary, consumer-financed insurance plan to cover long-term care expenses.

“It is a really different and new way of looking at the delivery and financing of long-term care in the U.S.,” said Dee Mahan, deputy director of health policy at FamiliesUSA, a nonprofit healthcare advocacy organization. “I think the program is really, really important.”

The insurance plan is similar to those currently available in the private market, but there are a few major distinctions. First, the program will be administered by the government. Second, any working adult age 18 or older will be able to enroll, regardless of any preexisting medical condition, and benefits will be good for as long as someone needs long-term care.

A new study conducted by a team of experts on caregiving and aging shows that profes­sional, in-home, non-medical care for seniors improves the quality and quantity of care they receive and enhances quality of life for both seniors and their family members.

The “Value of Caregiving at Home,” a research project commissioned for the Home Instead Senior Care® network, suggests that home care plays a vital role in a continuum that otherwise consists of more “formal” clinical care, espe­cially among those who are older or need more-intensive care. Seniors getting paid home care typically receive much more care than those who do not, some 87.9 hours per week versus just 35 hours.

Those seniors using home care in this study also reported having fewer physician visits compared with those not using home care: the difference was about 25 percent, comparing 12.5 visits per year to16.6 visits. Overall, family caregivers who participated in the study gave the quality of care received by their seniors a higher ranking when paid care was included.

The benefit to family caregivers was evident as well. The study showed that 71 percent of family caregivers using home care were employed, 51 percent full-time. Caregivers using home care did 25 percent better in maintaining their prior income levels when changing jobs to accommodate caregiving responsibilities than did those without home care.

The findings are significant, given that the senior population is aging in re­cord numbers, according to Paul Hogan, co-founder and chairman of the Home Instead Senior Care network. By 2030, some 72 million Americans will be age 65 and older, according to the U.S. Census Bureau.

“This study confirms what our in­dustry consistently sees – that in-home care has a major, positive impact for se­niors and their family caregivers,” Hogan said. “As many in our field can testify, non-medical home care, which provides for such services as companionship, meal preparation, light housekeeping and medication reminders, is vital to keeping many older adults at home. The study showed that professional, in-home, non-medical care for seniors improved the quality and quantity of care they received and enhanced quality of life for both seniors and their family members. The challenge now is to ensure that home care is viewed as a bona fide part of the care continuum for seniors.”

According to the research, 75 per­cent of the recipients of home care were at least 80 years of age. The care recipients were often sicker as well with 61 percent reporting mobility problems, 29 percent with Alzheimer’s disease, 43 percent with dementia and 22 percent with the after-effects of stroke. Nearly half (48 percent) were dealing with frailty, defined by the American Geriatrics Society as a condition characterized by three or more conditions such as muscle weakness, slow walking speed, exhaustion, low physical-activity levels or unintentional weight loss.

“This study clearly demonstrates the importance and value of home care to a large number of older persons and theirfamily caregivers,” said Dr. Peter Boling, a geriatrician at Virginia Commonwealth University and lead advisor for the study. “It should inform policy makers looking to improve the quality and reduce the cost of care for older Americans, espe­cially those with Alzheimer’s disease.”

The study builds on other research that shows seniors prefer to “age in place” at home and that paid, in-home, non-medical care saves as much as $25 billion per year in the U.S., primarily in high hospital payroll costs.

METHODOLOGY

This Home Instead Senior Care-commissioned research project—entitled the “Value of Caregiving at Home” study—examined the perceptions and ex­periences of U.S. caregivers for seniors by conducting a survey among adults (aged 18 and older) who were providing and/or arranging care for an older adult (aged 65 or older). Six-hundred and ninety-seven caregivers with paid in-home non-medical care completed surveys, along with 934 caregivers who were not using paid in-home non-medical care—yielding a total of 1,631 study respondents.

The purpose of this web page is to help educate San Diegans as to the difference between home health care/skilled nursing services and non-medical home care, basically home health care vs. home care, which can get a little confusing.

Although most in-home care is provided by family & friends, there is a growing need to hire paid individuals or professionals to provide care. Full-time job obligations are making it more difficult for “traditional” caregivers to provide the level of care needed. In addition, for family members living a long distance away from each other, hiring professional care makes it possible to provide hands-on, long-distance care for a loved one. Respite Care is another area where caregivers can provide value. This traditionally means short-term care of a few hours or weeks for the convalescing, or those in recovery from illness or injury. Think of it as providing relief, or respite, to the regular caregiver, usually a family member.

Home Health Care or Skilled Nursing
When searching for in-home skilled nursing services, keywords to look for are health care or home health. To be considered health care, preserving someone’s physical and mental well-being has to be through the services offered by medical and allied health professionals. Allied health professionals (distinct from medicine, dentistry and nursing) cover a broad range of services ranging from diagnostic, technical and therapeutic to direct patient care. Examples include Occupational Therapists, Physical Therapists, Clinical Psychologists, Dieticians, Paramedics and Health Administrators. Non-medical Caregivers are not considered allied health professionals, so the term health care does not apply to their services.

What services can home health care provide? Some examples are physical therapy, wound care or medical monitoring (i.e. blood pressure or blood glucose levels). Anything that penetrates the body, such as injections, feeding tubes or catheters would be deemed medical, where someone who is properly trained or “skilled” is needed.

Medicare is the principle payer for home health care/skilled nursing services. These services are available under parts A and B. In order to qualify, a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician. Monies are typically provided for a period of up to 60 days. If the patient recovers sooner, then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.

For more information on how Medicare works with your specific case, you may contact HICAP, the Health Insurance Counseling and Advocacy Program. They give FREE Medicare and health insurance counseling here in San Diego through the California Department of Aging. For an appointment, call (800) 434-0222. There are also free legal services for senior citizens through the same program. This is very helpful if you have questions about powers of attorney and estate planning. For an appointment, call the metro office at (858) 565-1392.

The plan of care ordered by the Physician usually includes limited custodial care (non-medical home care) services to help the care recipient remain in the home. These would include a home health aide for an hour or two a day to help with ADLs (activities of daily living); bathing, dressing, toileting and transferring. If additional hours are needed for areas such as safety supervision, incontinent care or medication reminders, professional caregivers from a home care (distinct from health care) agency, are used.

Non-Medical Home Care/Custodial Care or Private Duty Care
These providers allow people needing help with long-term care to remain in their home or in the community instead of going to a care facility. Their rates are much lower than home health care agencies due to the nature of their services. To hire a registered nurse to do meal preparation and laundry by the hour would be very costly. Assistance with ADLs (activities of daily living); bathing, dressing, toileting and transferring are some areas where a caregiver can help. They also offer transportation to and from medical appointments and the pharmacy. Non-medical home care agencies are different from home health care agencies in that they do not provide medical services or skilled services and they are not paid by Medicare.

What type of insurance covers home care? Most health insurance policies do not cover these services. In order to receive benefits for this type of service, people usually have been proactive and purchased supplemental insurance in the form of long-term care insurance, well before there is a need. Life insurance policies may have this supplemental coverage integrated into the policy as well.

Other services offered may include:

■Companionship
■Grooming and dressing
■Recreational activities
■Incontinent care
■Teeth brushing
■Medication reminders
■Bathing or showering
■Light housekeeping
■Meal preparation
■Respite for family caregivers
■Errands and shopping
■Reading email or letters
■Overseeing home deliveries
■Dealing with vendors
■Transportation services
■Changing linens
■Laundry and ironing
■Organizing closets
■Care of house plants
■24-hour emergency response
■Family counseling
■Phone call checks

A search on the Internet for “home care” will reveal a large number of providers in your area. When doing research on which agency to use, make sure that the provider directly employs its caregiving staff and that it pays for worker’s compensation insurance. This shifts the liability of workplace injuries to the agency, not you. The caregivers should not be independent contractors. Otherwise, you would be considered the employer and this liability would flow to you. Also, check for general and professional liability insurance, bonding (coverage for employee theft) and non-owned auto insurance (additional coverage to the caregiver’s or the cleint’s auto policy).

The leading association for home care agencies is the National Private Duty Association. All member agencies are employer-based, carry liability insurance and pay worker’s comp. You may use the following link to find an NPDA Member in your area http://www.privatedutyhomecare.org/sections/consumers/locator.php.

The sponsor for this web page is California Home Caregivers, a San Diego-based home care agency. This is an agency that directly hires its caregivers and maintains all of the areas of coverage previously discussed. You may visit their site at www.calcaregivers.com.

Services for Those with Financial Limitations
For those Californians who are facing rising medical expenses, the In-Home Supportive Services (IHSS) program through Medi-Cal is an option. If you are over 65 years of age, disabled (adult or child), or blind, IHSS will help pay for services provided to you so that you can remain safely in your own home. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities. For more information and to apply for these services, you can call (800) 510-2020, or contact your local county welfare office through the following link http://www2.sdcounty.ca.gov/lu/county_Directory/listing.asp?portal=0&alpha=W&selector=&listby=program. You may also contact California’s Department of Social Services for more information on this program though the following link http://www.cdss.ca.gov.

For short-term assistance, the Southern Caregiver Resource Center here in San Diego has a Respite Program where qualified families in need can access free home care. For example, if a family is planning on moving a loved one to a board & care facility, but need help in the interim with morning in-home care visits over the next month, this program could benefit them with free services. You will have to demonstrate a financial need. You can reach SCRS at (858) 268-4432. You may also visit their website at http://caregivercenter.org/.

Home Care Equipment & Supplies
Located in El Cajon, Professional Medical Supply has a large variety of home care equipment and supplies with discount pricing. They also rent equipment and have used equipment (i.e. wheelchairs and walkers).

For example, an electronic hospital bed rents for $175-$225 per month, based on the model selected. The process starts with a doctor’s order from your physician for the bed. You may then fax this order into PMS where they will handle all of the paperwork and then deliver the bed to your home. With a doctor’s order, Medicare will cover the expense of the bed. You may visit their website at http://www.professionalmedicalsupply.net/ or call them at (619) 449-0400.

Researching Senior Care Communities including Skilled Nursing, Assisted Living, and Memory Care
Lise Marquis is a Certified Senior Advisor with A Place for Mom and offers a free referral service helping families find their best senior care options. Lise covers all of San Diego County and has extensive knowledge of all of the available options in your specific area. Her assistance is FREE to families as the senior communities, homes, and services reimburse A Place for Mom for their service. Lise can be reached directly at (866) 691-2427 and her email address is lisem@aplaceformom.com.

Veteran’s Aid & Attendance Benefit
The Veteran’s Aid and Attendance Benefit is designed to provide monetary assistance to Veterans that are in need of aid or assistance with ADL’s (activities of daily living). This aid or assistance can be provided at home, in an assisted living facility, or a nursing home. Single veterans are eligible for up to $19,736 annually or $1644 per month. Married veterans are eligible for up to $23,396 annually or $1949 per month.

This benefit is meant to help Veterans protect their assets, such as their home and auto, from being depleted due to medical expenses. To qualify, you must have served during wartime, show a medical need for assistance and have an income level that demonstrates that medical expenses are consuming most, if not all, of your financial resources. For more information on this benefit, contact Jesse Lipscomb. He works with the Veterans of Foreign Wars and an Elder Law attorney to help families understand and manuever through the process. His office is here in San Diego and you can reach him by phone at (619) 280-2700 or by email at jesse@financialcpr.net. He does not charge a consultation fee, so this is a great resource to see if you qualify for the benefit.