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Home Care vs. Home Health Care & What Caregivers Do

wooden dummy with a face and question

Home Care: An Invaluable Resource

Mom has a fall and everything changes. If you haven’t had this experience, or one like it, chances are you will. Knowing available supports and resources can make a huge difference.  Home care can lessen stress, provide support, and hasten recovery. Home care can be your best friend.

The Terminology of Home Care

Non-medical home care goes by a couple of different terms. It is important to distinguish between non-medical home care and medical home health. Both can be critical to recovery and ongoing quality of life. Home care is also known by the terms: personal care, or private duty care. Medical home health typically goes by the term: home health.

What is Home Health Care?

Home health provides limited medical support covered by insurance. This includes nursing, physical and occupational therapy, speech therapy, aides and social work. A doctor’s order is required for home health to begin and certain criteria must be met.

When can you get home health care? Typically, a doctor will request home health under these conditions:

  • The person must be homebound. This means that leaving the home takes significant effort. If your parent or spouse is still driving, they probably will not qualify.
  • There has to be a skilled need such as nursing to manage medications, check blood sugar, blood pressure or provide wound care to name a few.

How much home health care can you get? There are defined limits on home health care, depending on your location and benefits.

  • Time is limited except in certain circumstances. Some neurological conditions can qualify for unlimited home health. Typically, home health can provide services for a 60-day period.
  • The skilled services offered by home health rarely exceed two to three times a week per discipline.

People who can benefit from home health may need help managing a chronic medical condition. Or they may need help recovering from hospitalization, injury or illness. Here is one example:


Daniel has Multiple Sclerosis and is confined most of the time to a wheel chair. He lives with his wife who does what she can to take care of him. Over time, he develops a pressure ulcer on his backside due to inactivity. This wound requires a stay in the hospital and short-term rehab where his wound is treated, but not healed completely.

Once he goes home he qualifies for home health care. A wound care nurse visits him every week. She makes certain that the wound gets appropriate treatment and that Daniel does not sit too long. Since Daniel has a chronic neurological condition, the nurse can keep seeing Daniel for as long as is needed. A physical therapist also visits Daniel. She teaches Daniel and his wife the importance of regular position changes throughout the day so that Daniel does not get another wound.


What is Home Care?

caregiver and senior

Home care offers non-medical assistance.

The terms are so similar, it is easy to confuse them. Home health care is medical and prescribed by a doctor, but home care is non-medical and does not require a doctor’s prescription.

Let’s take a look at a typical scenario where home care can be a critical layer of support and encouragement.


Betty is a 91-year-old woman in good physical shape. She doesn’t use a walker or a cane. One day she loses her balance and falls against the railing of the independent senior living community where she lives and breaks a rib. She goes to the emergency room and is sent home with pain medication. Her mobility is compromised, and she is confused about her medications. Her husband has his own medical problems and is of limited help. She is provided three home health visits each week.

But this is not enough support for Betty, so with the assistance of the social worker from home health, she calls a home care agency. The agency provides a caregiver in the morning and evening, seven days a week. The caregiver makes meals and does some light housekeeping. The caregiver also encourages Betty to walk, do her breathing exercises, and stands by while Betty is in the shower. The caregiver also reminds Betty to take her medications. These have been set up in a weekly medication box by the nurse from home health.


As you can see in this story, a home care caregiver helps Betty recover more quickly, and more safely.

What Tasks Do Caregivers Do?

Home care can be a vital lifeline. Although “home care” caregivers don’t provide medical services, there is so much more they can do:

Companionship and Socialization

Loneliness has reached epidemic levels in this country. Loneliness can adversely affect physical and mental health. A caregiver can help end loneliness by being a nurturing and comforting companion. A caregiver can also benefit people who have dementia. Research has shown that mentally engaging activities can have a positive influence on people’s mood and outlook on life.

Nutrition, Hydration and Breathing

Nutrition and hydration are very important factors in recovery.  A caregiver can make balanced, appetizing meals. They can encourage adequate nutrition, track fluid intake, and shop for groceries. In some cases, they can check blood pressure and encourage deep breathing to prevent pneumonia.

caregivers-can-help-with-nutrition

Dressing, Bathing and Transferring

Imagine you have broken your arm, shoulder, hip, rib or leg. If you have had this experience you know how challenging it is to get dressed and to bathe. Not to mention cook, clean and drive. A caregiver can assist with helping someone get dressed and out of bed. They can help someone take a shower and monitor their walking. Home caregivers can also help someone transfer from bed or to the toilet.

Movement

Staying active can be one of the most important factors in recovery from illness or surgery. Studies have even shown that people with dementia can improve their mood with increased physical activity. Physical therapists provided by home healthcare can get people started on the right track. A caregiver can help reinforce and encourage physical therapy activities when the physical therapist is not there.

Recovery

Recovery for most of us means getting back to our previous level of functioning. There are numerous situations that can affect someone’s health: hospitalization, an illness, a rehab stay or general decline that results in frailty. Recovery in older adults generally takes longer. Returning to health can also be complicated by coexisting medical problems. A home care caregiver can be an invaluable support. A good care plan developed with the care manager, family and client can encourage a safe recovery. The example below shows how a home caregiver helps someone build confidence.


Carol has been in good health most of her life. She is independent and self-reliant, having learned to manage without her husband who died several years ago. One day she falls on the ice and breaks her hip. After surgery she is sent to rehab. Carol is terrified of going home even though she is doing well in rehab. She has a heightened fear of falling again. Home health is ordered by her doctor. The home health staff begins working with her once she is discharged home.

Carol’s daughter Brenda notices that Carol’s lack of confidence in her abilities is hindering her recovery. Brenda hires home caregivers for daily visits to her mother. These caregivers work with the physical therapist to learn the exercises that Carol has been doing. This way they can reinforce practice and take extra walks with Carol. The caregivers assist Carol in the kitchen with making meals and doing light housekeeping. In time, Carol gains back her independent and confident spirit.


Help with Medications

Medication mismanagement can be a big problem. This can include not taking some medications, missing doses, or taking medications at the wrong time. Professional home caregivers can give reminders and check the medication pill box for accuracy. Problems are reported to the family or the nurse from home health. Caregivers can also pick medications up at the pharmacy.

pill box

Transportation

Transportation is a vital part of being able to stay living at home. This includes doctor’s appointments, shopping, medication pick-ups, and other errands. Home caregivers can perform all of these tasks.

older couple at doctor's office

Specialty Care for Alzheimer’s, Dementia, Cancer and Parkinson’s

Alzheimer’s and other dementias can have a devastating impact on families. Caregiving in these situations is particularly challenging, time consuming and arduous. A hired caregiver can provide mental stimulation, help with bathing, eating, and activity. Many caregivers are trained in dementia care. They will engage a parent or spouse in mental and physical activities designed for people with cognitive impairment.

Many agencies offer caregivers who are familiar with the unique needs of people living with Parkinson’s or undergoing or recovering from cancer treatment or palliative care. In these cases, a caregiver can provide an added layer of care and companionship.

Primary Family Caregiver is No Longer Available

What happens when the primary family caregiver is no longer available? Sometimes a caregiving spouse or family member will no longer be able to fulfill their caregiving obligations. A home care provider can step in and assume these duties, keeping a parent or spouse safe and stable with respite care.

Paying for Home Care

In some circumstances, home care can be paid for through long-term care insurance, veteran benefits and Medicaid. Otherwise, home care is private pay.

How to Get Started

Arranging for home care is as simple as making a phone call. A physician’s order is not required. During the initial call you can describe the situation. Explain the needs of your parent or spouse, and the amount of time per day you want care. Whatever you arrange is flexible and subject to change based on individual needs. Home care staff can come to someone’s home, assisted living, memory care or a nursing home. It is flexible, supportive and tailored to meet your spouse or parent’s need.

About The Author

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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