1 the California Home Care guide How to navigate your home care options to find care for your loved ones Created for our clients by the team at:
2 Orange County Home Care Guide:: How to find care for your loved ones 2 Feel free to republish excerpts from this report, as long as you link back to for attribution. And, it s also okay to share this report in its entirety with anyone who you think might be interested. Copyright 2013 Alta Home Care. Some rights reserved.
3 Orange County Home Care Guide:: How to find care for your loved ones 3 UNDERSTANDING THE DIFFERENT TYPES OF CARE Page 4 :: Navigating Your Options Page 5 :: Home Care Defined Page 6 :: Home Health Care Page 7 :: Hospice Care Page 8 :: Residential Options Page 9 :: Independent Living Page 10 :: Residential Care Homes Page 11 :: Assisted Living Page 12 :: Nursing Homes Page 13 :: Sub-Acute Options Page 14 :: Rehabilitation Hospital Page 15 :: Skilled Nursing Facility UNDERSTANDING WHO PAYS FOR WHAT Page 16 :: Who Pays for What Page 17 :: When Medicare Pays Page 18 :: MediCal 101 Page 19 :: When MediCal Pays Page 20 :: When Insurance Pays Page 21 :: Helpful Questions to Ask HOW TO FIND A CARE PROVIDER
4 Orange County Home Care Guide:: How to find care for your loved ones 4 NAVIGATING YOUR OPTIONS When you need help at home, you want someone you can trust and who understands your specific needs. Thankfully, there are many choices and different levels of care available. However, making sense of the types of care, payment options and what you can expect from a provider can be tricky. Home care includes three common types of services: Home Care Home Health Care Hospice Care Your best option will depend on your healthcare needs, desired frequency, your financial situation and your doctor s orders. Take time to familiarize yourself with the options available, the requirements of each, and how to determine the kind of service best suited to meet your needs.
5 Orange County Home Care Guide:: How to find care for your loved ones 5 HOME CARE Home Care, or Non-Medical Home Care, offers clients the opportunity to remain in the comfort of their home and maintain independence. Not limited by regulations that restrict frequency of care, care can be provided daily, weekly or around-the-clock. Non-medical care services may include: Homemaker services (meal prep, light housekeeping, etc.) Companionship Medication reminders Bathing assistance Respite and live-in care Home care agencies provide peace of mind to their clients by assisting them with activities of daily living. This assistance preserves the client s independence.
6 Orange County Home Care Guide:: How to find care for your loved ones 6 HOME HEALTH CARE Home health care involves skilled nursing care performed in the client s home or place of residence. Because care can be paid with public funds, home health care companies must comply with quality guidelines and are closely regulated. Medicare, MediCal and most private insurance plans cover some medically necessary home health care if the client meets certain conditions including: the care must be doctor-ordered, must be because of medical needs, and the client must be homebound.
7 Orange County Home Care Guide:: How to find care for your loved ones 7 HOSPICE CARE Hospice refers to care for terminally-ill patients, usually those who have been diagnosed with six months or less to live. Hospice neither prolongs life nor hastens death, but aims to help clients live out their days in the comfort of their own homes. With a focus on pain control and treating physical, spiritual and emotional conditions for both patient and family, hospice provides an integrated, team-managed approach. Services may include pain management, massage therapy, spiritual counseling and bereavement support. Medicare, MediCal and many private insurance plans provide hospice coverage. Additionally some hospices operate as non-profits and will provide service regardless of an individual s ability to pay.
8 Orange County Home Care Guide:: How to find care for your loved ones 8 RESIDENTIAL OPTIONS Some people may want to move. They may relish the idea of living in a vibrant community of seniors. Or, they may want to downsize into a senior apartment. There are hundreds of residential options for seniors. Regardless of how much care they need, seniors can find a wonderful residential option. But, when they turn to you and ask which one you would recommend, it s best to first know which type of residential option for them. There are three main categories of residential senior care options.
9 Orange County Home Care Guide:: How to find care for your loved ones 9 INDEPENDENT LIVING Some people may not need any help with activities of daily living, but don t want to spend time maintaining their own home. They are capable of keeping a schedule and monitoring their medications. And, they are interested in spending time with people of their own age. Independent living communities are apartment communities for people over a certain age, usually 55. While they don t provide any direct care, they do provide meals and senior-friendly activities. Other health services, like Caregivers and Home Health, can be utilized in Independent Living. These communities are paid for privately. Summed Up No Care Lot s of activities and meals Private paid
10 Orange County Home Care Guide:: How to find care for your loved ones 10 RESIDENTIAL CARE HOMES Residential Care Homes, also known as Board & Care Homes, are a middle ground between professional caregivers and assisted living communities. They are small private homes that have between 3-8 residents who socialize and share meals. They also have caregivers who assist with bathing, dressing, and medications. Residential Care Homes are typically more expensive that assisted living communities. Other health services, like Caregivers and Home Health, can be utilized in Residential Care Homes Summed Up: Help with bathing and medication management Small group of seniors live together Paid for privately or with long term care insurance
11 Orange County Home Care Guide:: How to find care for your loved ones 11 ASSISTED LIVING Assisted living communities are for your clients who are interested in leaving their home because they need help with activities of daily living. People who live in assisted living have their own apartments and have help with important tasks like bathing, dressing, and managing medicines. People who live in assisted living can often choose how much care they receive, based on their needs. Like independent living, assisted living communities provide meals and senior-friendly activities. Other health services, like Caregivers and Home Health, can be utilized in Assisted Living. Summed Up: Help with bathing and medication management Senior-friendly activities and meals Paid for privately or with long term care insurance
12 Orange County Home Care Guide:: How to find care for your loved ones 12 NURSING HOME Some of people have chronic or ongoing health conditions that necessitate long term care. The most common venue for long term is the Nursing Home. Nursing Home is for people who need around the clock skilled nursing care. Unlike Independent and Assisted Living, Nursing Home rooms are not like apartments. They are often shared rooms or suites with shared bathrooms. While there are activities, Nursing Homes do not have the vibrant senior community feel of the other residential options. Nursing Homes are healthcare entities and they feel like it. Some Nursing Home residents utilize Hospice Services. But, since Nursing Home residents have skilled nursing care built in, it is extraordinarily uncommon for them to utilize Caregivers or Home Health. Summed Up: For people who need around the clock nursing care Often shared rooms Paid for by Medicare or Medicaid Includes meals and activities, but not comparably to the other options
13 Orange County Home Care Guide:: How to find care for your loved ones 13 SUB-ACUTE OPTIONS After a stay in the hospital, it s common for people to need sub-acute care. This is the type of care that s somewhere in between the hospital and home. The two most common types of sub-acute care are Rehabilitation Hospital and Skilled Nursing Facility. If your clients need either of these types of care, it will be prescribed by their physician. The definitions on the following pages are provided by the good folks at VCU Medical Center.
14 Orange County Home Care Guide:: How to find care for your loved ones 14 REHABILITATION HOSPITAL Defini&on Intensive ( at least 3 hours a day, 5-7 days a week of at least 2 different types of therapy, like speech, physical, or occupa>onal), interdisciplinary services performed on a discrete, licensed unit either within a hospital or a free- standing hospital. Criteria Individuals who meet all the following criteria are appropriate for inpa>ent rehabilita>on: have an acute disability that prevents them from returning home with family care medical or surgical condi>ons are sufficiently stable to allow par>cipa>on in therapies demonstrate the ability to par>cipate in at least 1 hour of therapy two >mes a day demonstrate the ability to make progress in the acute care therapies have a social support system that will allow them to return home ager reasonable improvement of func>on receive financial clearance from their insurer. Funding Almost all insurers have inpa>ent rehabilita>on benefits, however there are different procedures needed to receive clearance. Pre- cer>fica>on is almost always required, except for Medicare (non- managed care).
15 Orange County Home Care Guide:: How to find care for your loved ones 15 SKILLED NURSING FACILITY Defini&on Low to moderate intensity ( hours a day, 5-7 days a week of 1 or more therapy types), interdisciplinary services provided on a discrete unit or within a nursing home (also called a "Skilled Nursing Facility" or SNF). Criteria Individuals who meet all the following criteria are appropriate for subacute rehabilita>on: have an acute disability have medical or surgical condi>ons that may not be sufficiently stable to allow full par>cipa>on in therapies, but do not require inpa>ent hospitaliza>on demonstrate the ability to par>cipate in at least 1 hour of therapy a day acceptance of fiscal responsibility by insurer and/or pa>ent Funding Most insurers have subacute rehabilita>on benefits within a nursing home (skilled nursing facility or "SNF"), including non- managed care Medicaid, non- managed care Medicare Part A, and most private insurers. Subacute rehabilita>on in an acute rehabilita>on unit or acute hospital is only occasionally covered by insurers. Medicaid reimbursement for SNF level care specifically directed at rehabilita>on (as opposed to medical) needs is rare.
16 Orange County Home Care Guide:: How to find care for your loved ones 16 WHO PAYS FOR WHAT? The first question you might be asking is, who s going to pay for this care? The chart below gives you a quick visual guide to who pays for care and approximately how much it costs. Keep in mind, there are exceptions to every rule. But, these costs and payment guidelines should give you and your clients a big head start. Type of Care Medicare MediCal Long Term Care Insurance Veteran's Benefits Private Pay Approximate Cost to the Client Caregiver Services x x x x $18 - $25 / Hour Medicare Home Health x $0 Medicare Hospice x $0 Independent Living x $1,500 - $3,500 / Month Residen>al Care Home X X X $5,000+ / Month Assisted Living x x x $2,500 - $6,000 / Month Nursing Home x x x x $5,000 - $8,000 / Month
17 Orange County Home Care Guide:: How to find care for your loved ones 17 MEDICARE PAYS IF Medicare does not pay for Home Care, but it can pay for Home Health Care and Hospice Care IF Services are determined medically necessary and ordered by a physician. The patient is homebound because of illness or injury. The patient needs part time or intermittent nursing care, physical therapy, speech-language pathology, occupational therapy, medical social services home health aide (i.e. personal care) services are covered only if the patient is also receiving skilled care. Routine medical supplies Up to 100 of your home health care visits will be covered under Medicare Part A (Hospital Insurance) if you have a hospital or skilled nursing facility stay of at least three days within the past 14 days. If you require more than 100 visits or have not had a qualifying hospital or skilled nursing facility stay, your home health care visits will be covered if you are enrolled in Medicare Part B (Medical Insurance). There are no copayments. If you have only Part A or Part B coverage, all of your home health visits will be covered by the Part you have.
18 Orange County Home Care Guide:: How to find care for your loved ones 18 MEDI-CAL 101 Medi-Cal, (California version of Medicaid) is a combined federal and California State program that covers most home health care costs for those who have low incomes or whose resources have been depleted by health care costs. Who Qualifies? An individual who is over age 65 with a low income and little savings or other assets. In addition, those who are enrolled in the following programs can automatically qualify: Supplemental Security Income (SSI) In-Home Supportive Services (IHSS) California Work Opportunity and Responsibility to Kids(CalWORKs) Refugee Programs Foster Care or Adoption Assistance.
19 Orange County Home Care Guide:: How to find care for your loved ones 19 MEDI-CAL PAYS IF Medi-Cal pays for health care services which meet the definition of "medically necessary." Services include: physician visits adult day health service some dental care ambulance services some home health X-ray and laboratory costs, orthopedic devices eyeglasses, hearing aids Medi-Cal will pay for hospice care provided by a Medicare-certified agency that is authorized to participate in the Medi-Cal program. To be covered, hospice care must be approved in advance by the Medi-Cal office.
20 Orange County Home Care Guide:: How to find care for your loved ones 20 PRIVATE MEDICAL INSURANCE Employer or union-offered group medical coverage and individual health insurance policies may cover home health services. Many long-term care insurance policies will pay for care at home, and some base qualifications on functional rather than medical need. Each insurance plan should be reviewed for specific coverage information.
21 Orange County Home Care Guide:: How to find care for your loved ones 21 QUESTIONS TO ASK HOME CARE PROVIDERS When seeking home care, there are some important questions you should ask of a prospective service provider. These questions will help you determine your legal rights and responsibilities and what you can count on from the provider. 1. How long have you been providing Home care services? 2. What types of insurance and public forms of assistance do you accept as payment? 3. Do you provide backup service in the event a caregiver is sick or doesn t show up? 4. Are you licensed, bonded and insured and do you carry workers' comp? 5. Is there a care professional who, along with the client and family, develops an individualized plan of care? 6. How often are caregiver services monitored? 7. What kinds of training do you require of your caregivers? 8. How do you screen and select caregivers prior to an assignment? 9. Are reference checks, criminal background checks and drug screens conducted on all employees? 10. Are your caregivers your employees? If not, who is the legal employer of the caregiver and who pays the mandated taxes and withholdings?
22 Orange County Home Care Guide:: How to find care for your loved ones 22 Get a free consultation AltaHomeCare.com/free-care-consult Click the link above and access a free consultation with one of Alta Home Care s local home care experts.