An elderly man lives with his daughter and her family. Up until recently, he has been able to get out of his bed or a chair independently. Because of a chronic lung condition and worsening arthritis, he must now ask for assistance from his family to rise to his feet. Right now he is able walk with his walker, but his daughter is fearful that he will continue to deteriorate. Because he is reluctant to ask for help, he stays in his chair most of the day. She can see that he seems weaker and slower these days. He is also complaining of increased pain in his joints.
Since he can no longer rise without assistance, the family must ensure that someone is home with him at all times. The daughter and her husband both work, so managing this dynamic is proving to be problematic. She is able to obtain some assistance from extended family and her church members for now, but she is afraid those resources may soon disappear.
While the daughter wants her father to remain in her home, she is struggling to provide him with all the care he now requires.
Typical home health response:
Skilled nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:
- Identify any possible underlying causes for the increased weakness, such as a worsening of a previously stable lung condition, and report those findings to the physician.
- Assess the client’s pain management regimen, establish effectiveness and facilitate improved pain management
- Instruct family on risks associated with impaired mobility and methods to prevent complications
Physical Therapy/Occupational Therapy could be implemented to address the clients decreased mobility and functional status, with the goal of returning him to independence with bed/chair transfers and ability to safely walk with his walker throughout his daughter’s home.
Home Health Aide could be implemented, if indicated, to assist caregivers with personal care to ensure that client does not develop skin complications related to his immobility.
Result: With home health assistance, it is determined that the client’s deterioration is related to low blood oxygen levels and increased joint pain. A physician’s order is obtained for pain medication and home oxygen. With the help of therapy and nursing services, the client shows drastic improvement. His pain is controlled, his strength improves and he is once again able to rise to his feet independently and walk throughout the house. Because the client is now able to be left alone safely, the daughter is confident that she will be able to keep her dad with her in her home…where she feels he belongs.
A elderly woman is having frequent headaches and goes to see her physician. He tells her that her blood pressure is quite high and starts her on two new medications. A few days later, she begins to notice that she is lightheaded and weak in the mornings. She often feels the need to lay down for a nap before noon, which is unusual for her. This continues for another two weeks. The woman begins to attribute these changes to her new medications and decides to stop taking them. Although it is difficult for her to get to the doctor, she makes a followup appointment to see him in a week. At that appointment, the physician tells her that her blood pressure is still too high. The physician changes the woman’s medications yet again.
Typical home health response:
Skilled nursing could be implemented. This would give a nurse the opportunity to perform such interventions as:
- Assess the client’s blood pressure frequently and notify the physician of her response to the new medications.
- Assess underlying dietary considerations, such as a high sodium diet, that could be negatively impacting the client’s health status and instruct the client on healthy alternatives.
Result:With home health assistance, the client experiences fewer adverse effects from her medications and is able to take them as ordered. This compliance, along with the regular blood pressure reports he receives from home health staff, allows the physician to determine whether or not the medication prescribed is effective. The client’s blood pressure stablizes and she becomes more knowledgable about how her dietary choices can negatively impact her health status.
An elderly woman has congestive heart failure. Her condition has worsened over the past few years and she requires frequent trips to her physician to obtain lab work and manage her illness. She knows her son must miss work to take her to doctor appointments and she worries that she is becoming a burden to him. Because of these feelings of guilt, she ignores her symptoms and postpones seeking care.
Typical home health care response:
Skilled nursing could be implemented. This would allow the nurse an opportunity to perform such interventions as:
- Assess the client’s understanding of how to successfully manage her heart failure and instruct her on techniques to promote wellness.
- Assess the client’s physical status and report symptoms or complications to the physician before they become severe. Doing so can drastically decrease the need for nonroutine physician visits and reduce dependence on overburdened caregivers.
- Obtain any required labwork, such as monthly fingerstick PTcINR’s.
Result: With the assistance of home health, the client becomes more knowledgable about how to manage her heart failure. This results in an improvement in her condition and fewer unscheduled doctor visits. This, along with home health’s ability to obtain her monthly labs, decreases how often the client’s son must take off work to take her to the physician.
A normally active elderly gentleman notices he is becoming weaker and more unsteady on his feet. He used to be able to go to the Senior Center three times a week for lunch and to play cards with his friends. Now, he is beginning to stumble somewhat and is afraid he may fall. He is also so exhausted when he comes home from the Senior Center that he is reluctant to attempt the outing at all. The change in his life routine is leaving him feeling vulnerable, isolated and fearful that his deterioration is an inevitable part of aging. His wife notices that he is becoming withdrawn and less likely to participate in family events.
Typical home health care response:
Skilled Nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:
- Identify any possible underlying causes for the increased weakness, such as a worsening of a previously stable cardiac condition, and report those findings to the physician.
- Identify any symptoms of situational depression and facilitate treatment, if indicated.
Physical Therapy could be implemented to address the client’s decreased strength and balance issues, with the goal of returning the client to his prior activity level.
Result: With the assistance of home health, it is established that the gentleman’s heart is stable. His decline in strength and balance eventually led him to experience an overall deconditioned state. Because of his home health physical therapy program, he was able to regain his strength and return to his previous active lifestyle. In addition, he was taught a home exercise program that will help him maintain this lifestyle on a long term basis. He feels like himself again and resumes his outings to the Senior Center.
An elderly woman is becoming more and more forgetful. Her daughter, who works full time and cannot see her mother but once a week, fears that her mom is no longer taking her medications correctly. The daughter is also noticing that her mom is losing weight, she is sleeping more than usual and her personal hygiene is deteriorating.
Typical home health care response:
Skilled Nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:
- Identify possible underlying causes for the decrease in her mental status, such as infection, and notify the physician of findings.
- Assess the client’s ability to manage her medications effectively and implement strategies to promote as much independence as possible with the task.
- Assess nutritional status and implement strategies to increase client’s food/fluid intake.
- Establish the level of assistance required to keep the client safely in her home and coordinate care with the staff, family or alternate caregivers to ensure her needs are being met.
Physical/Occupational Therapy Evaluations could be implemented to identify and address any functional deficits, with the goal of increasing the client’s ability to remain safe and independent in the home setting.
Home Health Aide services could be initiated to assist patient with bathing, dressing and other personal care, until the client demonstrated an ability to safely perform the task independently.
Medical Social Work Evaluation could be ordered to establish which community resources, such as meals on wheels, are available to the client.
Result: With assistance from home health, the client’s medications are successfully managed, her mental and nutritional status improve and she begins to become more active and take better care of herself. Her daughter is taught to fill her mom’s med minder once a week and to identify signs and symptoms of complications that could indicate another deterioration in her status. The medical social worker established meals on wheels and identified a benefit available to the client through a long term care policy she purchased years ago. A referral was made to a private caregiver service and the client now receives 12 hours of sitter services a week. Because home health care was able to identify and coordinate care with all available resources, the client is able to remain safely in her home.
Please contact Renew Home Health. We will discuss your specific situation and provide guidance to you regarding whether home health is a good option for you. If it is, we will obtain your information, verify your home health benefits and request an order from your physician for a home health evaluation.
Once our intake staff has received the physician’s order for home health care, you will be contacted and your home health evaluation visit will be scheduled.
We hope this information has been helpful to you in determining whether or not home health care is the right choice for you. If you have any other questions or concerns, please do not hesitate to call.
There are times when a patient’s needs are too great and home health is not an appropriate choice. The availability of a willing and capable caregiver is the most important factor to consider in cases such as these. For example: An individual, who lives alone and has no available caregiver, becomes significantly confused and begins to wander outside the home. While home health staff would be able to make regularly scheduled visits, those staff members would only be in the home for thirty minutes to an hour…depending on what is required. This would leave the client unattended for the rest of the time and put his safety in jeopardy.
A similar example that demonstrates when home health care could be an inappropriate avenue: A post surgical patient is sent home. She lives alone and is unable to get out of a bed or chair without assistance. Because of her immobility, she is unable to perform the simple tasks that we often take for granted – such as making a meal, dressing ourselves or going to the bathroom. The home health staff could assist her while they were making their scheduled visits but that would leave her unattended several hours a day.
Once again, home health care does not provide 24 hour care or sitting services. Because of this limitation, it is crucial that prospective clients either be able to meet their basic needs safely or have a family member or other caregiver available to them that can do so. If that is not the case, then an inpatient facility – such as a rehab or skilled nursing unit – would be a better choice….at least temporarily. Once the individual has recovered to the point of being able to safely stay alone, home health services could begin and help them transition safely back in to their home setting.
Upon admission, the physician will establish a 60 day plan of care. Towards the end of the 60 days, a RN will reevaluate your need for further home health care. If you continue to require services, you can be recertified for another 60 day period. Traditional Medicare does not have a limit on how long you can receive home health care. If you meet traditional Medicare criteria, your home health services can continue for as long as you need them.
Once again, If you have a Medicare replacement or private insurance policy, you will need to refer to your policy for any preauthorization needs or benefit limits.
Your services will end when your goals are met, you no longer have a skilled need and/or you are no longer homebound. The agency will give you a minimum of 5 days discharge notice. Of course, you or your physician may request discharge at any time.
Traditional Medicare does not require preauthorization for home health care and all the services provided are covered at 100%. That means no deductible, no copay and no out of pocket expense for the traditional Medicare recipient. If you have traditional Medicare, you will not receive any bills from Renew Home Health or Medicare regarding your home health services. It is also important to note that traditional Medicare imposes no limit to your home health benefit. Therefore, there is no need to worry that using your home health care benefit now will prohibit you from receiving home health care services in the future.
If you have a Medicare replacement or private insurance policy, you will need to refer to your policy to establish any deductibles, copays or maximum benefit amounts that may apply.
Many Medicare replacement and private insurance policies also require preauthorization for treatment. In these cases, the agency will provide a report to your insurance provider and request authorization for your care. Unfortunately, insurance companies do not always agree with the physician’s recommendations for home health care services. In those cases, the agency will do everything we can to provide you high quality care within the service limits imposed by your insurance provider. If you wish to receive care outside of those service limits, we can provide that care to you at your cost.
While home health services require that a client be “homebound”, that does not mean that a client is unable to leave the home. It simply means that, because trips outside the home require assistance and are a taxing effort for you, they are infrequent and of short duration. Medicare understands that there are times that clients need to leave the home….such as to obtain food and medications, attend physician visits, church services or special family functions. These trips are perfectly acceptable and do not keep you from qualifying for home health. Also consider that many times a client’s “homebound” status is temporary. While they may normally go outside the home frequently and with little effort, a hospital stay or recovery from an acute illness can change that…..if only for a few weeks. If you have any concerns about whether or not you would meet the “homebound” criteria, please contact us for further information.
