By: Robin Donnelly, LPN, DCP
Most callers to our office automatically assume that the assistance they need at home, will be covered by Medicare, will be provided by a nurse and therefore think they are in need of 24-hour care. It isn't, it won't be and no, you do not.
The title "nurse" is used universally for anyone providing care. And the term "homehealth" is used interchangeably for any and all care provided at home.
However, there is the difference:
Homecare: Non-medical care at home that does not consist of a nurse caring for the person. Also called: "private duty care." This is not covered by Medicare. This is an out of pocket expense. These callers only require the assistance of a caregiver. That can be a Certified Nursing Asst (CNA), a State Tested Nursing Asst. (STNA), a Patient Care Asst. (PCA), or any caregiver who has experience from a facility or their own private duty experience, that can be verified. Different States use different titles and each homecare agency has its own requirements.
Homecare services are used when: the caller needs help with bathing, dressing, grooming, housekeeping, laundry, errands and shopping, companionship, supervision, meal prep, med reminders and transportation. The schedule is what the patient wants and what works best for their situation. This can be a few hours per day up to 24 hour live in care. It can be a long-term need or just enough to get the person rehabilitated. You are called the "client." If there is an emergency while we are on duty, we call 911 and provide EMS with your detailed careplan. Most times our caregiver accompanies the client to the ER and the office calls the family.
Homehealth care: Medical care at home that is billed to Medicare. These visits are short in nature and are done by medically trained individuals; therapists, wound care nurses, IV specialists, ostomy nurses, and/or nursing assts. that are certified to do medical procedures, ie: give medications, or who are IV certified.
Homehealth care services are used when: a patient has any "procedure" deemed medical by the state in which they live. Medical procedures usually consist of "anything that enters the body." These are tube feeds, colostomies, enemas, injections/IV's, and wound care. Think: Anything that has the potential to become infected or harm the patient should it not be done correctly.
These trained individuals have more than one visit that day, so the schedule can vary from visit to visit. They usually will not cook a meal, ambulate someone, bathe someone or provide any nonmedical type of care during that visit because they don't have time. They need to do the procedure they came to do and leave. You are called a "patient." If there is an emergency, let's hope it's while they are on duty so they can call 911.
Let's use the example of Hospice and how we work with them:
Hospice (healthcare): Nurses who manage pain meds and provide grief counseling to the family of a dying patient. Hospice refer these families to non-medical care, because they understand the need for their patient to have around the clock care from an experienced caregiver, and the grieving family to have respite when Hospice can't be there. The non-medical caregiver can bathe, turn, and keep comfortable a dying patient, so the family can spend the time they have left with their family member as a companion, not as caregiver.
By providing experienced caregivers familiar with death and dying, we provide comfort to the patient as well as to the family by calling hospice with any changes in condition, and for on-going support.
Hospice does at times provide an aide who comes in to bathe a patient. Those visits are usually once a week, and sporadic in the time of the day.
This, among other reasons, is why most families opt to include the use non-medical homecare services in addition to the medical services hospice provides. On hospice cases, we call hospice, not 911 in the event of a change in condition and the nurse managing that person's care, comes as fast as she can.
Although people use the term "homehealth" to describe help at home, there is a difference. We all work together in tandem and respect each other's limitations to rehab patients or work with hospice to pick up where one leaves off.
Regardless of who does what, we all agree that we all do one thing well: that together we keep people in their cherished home, where people do better, recover faster, and feel more comfortable. Hope this helped!
Robin is a Licensed Practical Nurse, a Certified Dementia Care Provider through the Alzheimer's Foundation of America, and a Certified CPR, First Aid and AED Instructor with the Red Cross.
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