IN HOME CARE What s available? Who pays for it? 1602 E. Ft. Lowell Road Tucson, AZ 85719 520.327.6351 email: care@catalinainhome.com www.catalina-in-home.com 1
MEDICARE HOME HEALTH Individuals are eligible for Medicare Home Health Services when: Enrolled in traditional Medicare or Medicare Advantage Homebound because of weakness unable to leave their residence without the assistance of another person Treatments are ordered by the physician Services are intermittent provided on a per-visit basis Services are skilled care provided by a Registered Nurse or a therapist Services Provided Primary: Nursing, Physical Therapy, Speech Therapy Secondary: Medical Social Worker, Occupational Therapy, Certified Nurses Aide Frequency of Visits When Provided May last from fifteen minutes to two hours May be scheduled from once a month to daily After being discharged from a hospital or nursing home To prevent hospitalization when a chronic condition becomes unstable Duration of Services Short term Discontinues when the individual s condition improves Discontinued when the individual s acute or chronic condition stabilizes Cost Services are paid 100% by Medicare Yearly limit of $1,500 for physical therapy services 2
PERSONAL CARE AND SUPPORT SERVICES When to Consider Personal Care and Support Services: Hospital or post-hospital care General frailty due to aging and chronic illness Unsteady when walking Needs some assistance with personal care Needs transportation to appointments or activities Complicated medication schedule Safety concerns related to forgetfulness Uninterested or unable to prepare meals Difficulty in managing housekeeping chores Family caregiver needs respite Feelings of isolation and loneliness End of life care Services Providers Light housekeeping Personal care Companionship Meal preparation Transportation Outings What to Look For in a Quality Care Provider: Service screens caregivers and caregivers are supervised regularly An individualized plan of care is developed with the client and family There is 24 hour on-call availability All payroll and payroll taxes are the responsibility of the provider Coordination of Services Services and schedules are customized according to the client s request and needs Services provided by Caregivers, Nurses Aides, Certified Nurses Aides Visits Cost May take place in the home, hospital, rehab, nursing home, assisted living, or retirement communities May last from 2 to 24 hours and be increased, decreased, or discontinued based on client s individual needs May be scheduled from once a month to daily and be short term, long term, or occasionally Fee for service that is most often paid for privately or by Long Term Care Insurance $17.95 to $23 per hour Community Resources Home Care Services: Yellow Pages (heading will be Home Health and Nursing) Pima Council on Aging (790-7262) AHCCCS (205-8600 or 800-824-2656) 3
MEDICAID MEDICAID and ALTCS Arizona Health Care Cost Containment System (AHCCCS) is a health care program for the low income. It is authorized and partially funded by federal law, but administered by each state. Federal regulations sometimes limit states and frequently require minimum standards, but much of the implementation of the program is left to each state. ALTCS Arizona Long Term Care System, a division of AHCCS (Arizona s Medicaid), provides care and support for individuals with disabilities, chronic illnesses, and frailty due to age. ALTCS pays for care for those who meet the medical and financial criteria. To qualify financially, individuals must have a monthly income of less than $2,200 and no more that $2,000 in assets. You may own your own home. Long term care paid by ALTCS can be provided in the home, assisted living homes, or in a nursing home. 4
IN-HOME CARE SERVICES Medicare MEDICARE HOME HEALTH CARE Medicare HMO s Insurance IN-HOME SUPPORT SERVICES Fee for Service Long Term Care Insurance VA MEDICAID ALTCS (Arizona Long Term Care System) part of AHCCCS (Arizona Health Care Cost Containment System) CRITERIA FOR PARTICIPATION Medically Necessary Skilled in Nature Intermittent: Visit to Visit Individual Homebound SERVICES Primary Nursing Physical Therapy Speech Therapy Secondary Occupational Therapy Medical Social Worker Home Health Aide CRITERIA FOR PARTICIPATION Fee for Service No Criteria Insurance Reimbursement Needs assistance with 2 to 3 activities of daily living: Bathing Ambulation Dressing Eating SERVICES AVAILABLE Personal Care Homemaking Meal Preparation Transportation HOME HEALTH Supportive Care Services State and Federal CRITERIA FOR PARTICIPATION Must Qualify Under State Programs Guidelines, Medically and Financially LENGTH OF SERVICE Short term to prevent hospitalization or after hospitalization AVAILABILITY Short & Long-term 4 to 24 hours per day Intermittent to daily Live-in FOR ELIGIBILITY REQUIREMENTS Call 520-205-8600 CAREGIVER LEVELS: Homemaker Personal Assistant Nurse Assistant COORDINATION OF CARE Same company provides: Nurse Initial Evaluation Nurse Continuing Home Visits Nurse on-call 24 Hours Per Day COST $17.95 to $23 per hour 5