Use This Exclusive Guide To Understand Your Loved One’s Options for Health Services at Home
If your loved one is experiencing health challenges, you may not know where to turn. Your loved one requires care beyond what you can provide by yourself, yet you want them to stay comfortable and cared for at home. Your loved one may even have limitations on leaving the house to receive care.
This guide takes the confusion out of trying to find care. Whether your loved one is an aging adult or young child, many health care services are available to help them in the comfort of home.
What Is Health Care at Home?
Your choices for health care services can be home-based. You don’t always have to receive care in a clinical setting. This form of health care is provided by an agency certified to administer nursing and caregiving services in patients’ homes.
Many of these services are covered by Medicaid, Medicare, or private insurance, and some are paid for out-of-pocket.
As you read this guide, take note that services provided by insurance often require that your loved one meets certain qualifications to receive care. Your loved one may not be able to receive certain services without a doctor’s order. However, know that you always get to choose your provider of health care services at home.
Home Health Services
What home health care services provide: If your loved one has just received a new diagnosis; has a worsening condition; had a fall, injury, or surgery; is taking a new medication; or has had a dosage change, you don’t have to depend on a care facility for their healing and recovery.
Not to be confused with general health care offered at home, home health care services deliver skilled nursing and professional health care services at your loved one’s home, if they meet specific criteria. Services include:
- Nursing.
- Social work.
- Physical, occupational, and speech therapy.
These services help monitor, stabilize, and improve your loved one’s condition.
What you need to know: Your loved one’s physician determines whether your loved one can receive these Medicare-, Medicaid-, and private insurance-covered services. Your loved one qualifies when:
- They need intermittent medical care or services from a physical, occupational, or speech therapist.
- They are considered homebound, meaning they need assistance from a person or assistive device (such as a wheelchair or walker) to leave the home, or their medical condition prevents them from leaving home.
Benefits: Your loved one will feel more confident and independent with the help of a home health nurse. The goal of this service is not just expert care, but education and empowerment about your loved one’s condition, so they can learn to manage aspects of care on their own and potentially prevent repeat hospitalizations and reduce medical expenses.
Private Duty Care
What private duty care provides: Your loved one may not need nursing or other health care services at home, but they may require help with their day-to-day life.
If your loved one is able to leave the home with assistance for doctor’s appointments or social activities, but has difficulty taking care of tasks at home like personal grooming, meal prep, pet care, and medication reminders, consider private duty care.
A private duty caregiver gives help with the tasks of daily living, along with companionship and transportation.
What you need to know: Private duty care is typically an out-of-pocket expense that helps fill in gaps where your family isn’t able to help care for your loved one. Some long-term care insurance plans or VA benefits cover this service.
Private duty care is available in blocks of time (a minimum of two hours) or even 24/7 care.
Respite care is also available through private duty care. Respite care gives family caregivers a break, so they can rest, recharge, and focus on other responsibilities for a period of time. Many caregivers use respite care to protect themselves from exhaustion and stress or even to go on vacation.
Benefits: Your loved one may appreciate the companionship and support of a private duty caregiver. Knowing someone is at home caring for your family member gives you peace of mind about their safety and comfort when you’re not available.
Companionship from a caregiver is an effective way to reduce loneliness and isolation, while helping your loved one feel as independent as possible in their home. For certain conditions, like Alzheimer’s or dementia, having a caregiver with a structured plan for the day can make an impact on your loved one’s condition.
Home Hospice Care
What home hospice care provides: If your loved one has a life-limiting condition, they may decide that they no longer wish to seek treatment or visit the hospital or emergency room. Hospice care allows your loved one to remain comfortable at home to focus on their quality of life and pain management.
Hospice services include:
- Nursing.
- Medical equipment, medications, and supplies.
- Therapies, including physical, occupational, and speech therapy as needed.
- Support from social workers.
- Visits from a chaplain.
- Help from a home health aide.
- Trained community volunteers.
- Respite care for family caregivers.
- Bereavement services to assist you with grief.
What you need to know: Hospice is covered by Medicaid, Medicare, and private insurance. Your loved one’s doctor must first determine if they qualify for hospice. They must have a life-limiting condition that, without treatment, has a prognosis of six months or fewer.
Benefits: Hospice is a compassionate service that respects your loved one’s wishes to remain at home among family and friends. It addresses their physical, emotional, and spiritual needs with dignity during this critical phase of life, helping your loved one feel comfortable, loved, understood, and respected.
In-Home Medicaid Services
What in-home Medicaid services provide: Home- and community-based services (HCBS) through Medicaid help people of all ages receive care at home, instead of moving to a care facility.
In-home services can include:
- Personal care, such as grooming and bathing.
- Light housekeeping.
- Laundry.
- Meal preparation.
- Medication set-ups and assessment.
- Respite care.
- And more.
What you need to know: In-home Medicaid services differ based on your location, age, and specific care needs. An experienced provider of in-home Medicaid services can help you interpret your benefits and determine what services are available for you.
Benefits: If your loved one’s Medicaid benefits allow them to receive care at home, they may prefer this to a care facility where individualized and customized care may not be available. With in-home health care services, your loved one can remain in a place where they feel comfortable, safe, and independent, while still getting their needs met.
Consumer-Directed Home Health Services
What consumer-directed Medicaid services provide: With your support, your loved one can independently hire and direct their personal caregiver, so they can live independently.
Services from a personal caregiver include:
- Housekeeping.
- Dressing.
- Meal preparation.
- Errands and transportation.
- Assistance with personal hygiene and toileting.
- And more.
What you need to know: Directing your loved one’s personal care without agency support is challenging. However, some teams that offer health care services at home are certified to give administrative help, including training on choosing a caregiver, assistance with background checks, and other paperwork.
Benefits: With consumer-directed services, you and your loved one feel empowered to make your own choices about caregiving, while an experienced administrative team relieves the burden of those tasks. After you’ve arranged these services, your loved one gets the care they need, so they can live as independently as possible.
Department of Mental Health Services
What Department of Mental Health (DMH) services provide: Home health care service providers may offer home-based mental health services that are available through Medicaid. These services support people with specialized needs, including developmental and intellectual disabilities, cerebral palsy, anxiety and mood disorders, autism spectrum disorder, and more.
Services can include:
- Therapy.
- Exercise.
- Meal preparation and feeding.
- Grooming and hygiene.
- And more.
What you need to know: Services can also be customized depending on your loved one’s unique needs. Each state has different requirements and service offerings. Check with your state’s social services department to understand what is available for your loved one.
Benefits: Mental health services are designed to provide for your loved one’s essential needs, so they can thrive at home. These services give relief to family caregivers, like you, so the responsibility of caring for your loved one isn’t entirely yours.
Comprehensive Disease Management: An Innovative Home Health Service
What comprehensive disease management provides: Comprehensive disease management (CDM) helps patients, including children, with chronic illnesses and life-limiting conditions to take advantage of the many medical services and community resources.
A CDM nurse creates a clearly defined individual plan of care for your loved one, so there is always an organized approach to how care decisions are made. A patient can receive CDM services at any stage of their health care journey.
Your CDM nurse can also help you fill out a durable power of attorney (DPOA) and advance directive paperwork. Making important decisions in advance leads to peace of mind for you and your loved one as they continue their health care journey.
What you need to know: CDM is also known by other names, including chronic disease management and palliative care. Comprehensive disease management includes a palliative care component to manage your loved one’s symptoms, provide relief from pain, and reduce stress when they’re struggling with their condition.
Benefits: Research into CDM shows that these programs reduce hospitalizations, medical costs, and stress associated with the complexities of navigating the health care system. With CDM, your loved one will always have a point of contact and an individualized plan, even as their condition evolves.
Can Children and Young Adults Receive Health Services at Home?
Pediatric home care services are available for children and young adults with special needs. These services allow your child to receive care at home, as opposed to a facility. There are two major home health care services for children and young adults:
- Pediatric private duty nursing
- Personal care services
Pediatric private duty nursing and personal care services are both covered by Medicaid to provide comprehensive support for your child’s needs.
Pediatric Private Duty Nursing in the Home
What private duty nursing provides: Also known as pediatric home health care, private duty nursing delivers skilled care at home for your child’s specialized needs, along with therapies, and assistance with medical appointments, school, summer camp, and the Special Olympics.
Private duty home health nurses provide specialized medical care, including:
- Tracheostomy care.
- Cough assist.
- Ventilator management.
- IPPV treatments.
- G-tube feedings.
- Injections and IV therapy.
- Medication administration and management.
- Blood draws.
What you need to know: Pediatric home health nursing is covered by Medicaid. After a physician’s order and state approval, a home health agency assigns a private duty nurse, who visits your home to care for your child.
Benefits: Pediatric home health has been shown to reduce the risks of hospitalization and improve health outcomes, including mental health. This service also allows parents to play a role as mom or dad, instead of constantly playing the role of caregiver. Families often form a unique bond with their assigned pediatric home health nurse, who becomes an honorary member of the family.
Medicaid Personal Care for Children and Youth
What Medicaid-provided personal care offers: Personal care services for your child help them thrive at home, while receiving support for challenges that are common among young people with special needs, such as:
- Help with all aspects of their daily life, including meals and dressing.
- Personal care tasks, including bathing and toileting.
- Assistance with devices and procedures related to bodily functions (e.g., colostomies, tracheostomies, or G-tubes).
What you need to know: Covered by Medicaid, this service is delivered by a dedicated caregiver who is trained to work with children and young adults.
Benefits: Receiving help with your child’s day-to-day life allows you to fulfill the role of parent, instead of having to intervene as a caregiver. When your child receives assistance with personal care, you get to focus on experiencing and deepening the relationship between you and your child.
How To Find a Home Health Services Team
Finding a home health care service provider is your first step to getting your loved one the care they need. When you contact a leading team, they will help you understand which services you qualify for and determine if they’d be a good fit for your loved one.
Your loved one deserves excellent care at home. Look for a team with these qualities:
- Expertise. A team with experience can advise you about what service is best, offer help with navigating and interpreting benefits, communicate with your loved one’s medical team, and set your loved one up for success.
- Patience, honesty, and compassion. The team you choose should be empathetic, understanding, and effective at communicating with you and your loved one.
- A patient-centered approach. Your provider should exceed expectations and do everything in their power to ensure comfort and care.
Learning all your options for how to help your loved one with home health allows you to make faster decisions, so that care can begin when it’s needed. The sooner your loved one begins receiving assistance from one of the many home health services available to them, the sooner they’ll experience the benefits of these excellent options for care.
