Although most in-home care is provided by family & friends, there is a growing need to hire paid individuals or professionals to provide care. Full-time job obligations are making it more difficult for “traditional” caregivers to provide the level of care needed. In addition, for family members living a long distance away from each other, hiring professional care makes it possible to provide hands-on, long-distance care for a loved one. Respite Care is another area where caregivers can provide value. This traditionally means short-term care of a few hours or weeks for the convalescing, or those in recovery from illness or injury. Think of it as providing relief, or respite, to the regular caregiver, usually a family member.
Home Health Care or Skilled Nursing
When searching for in-home skilled nursing services, keywords to look for are health care or home health. To be considered health care, preserving someone’s physical and mental well-being has to be through the services offered by medical and allied health professionals. Allied health professionals (distinct from medicine, dentistry and nursing) cover a broad range of services ranging from diagnostic, technical and therapeutic to direct patient care. Examples include Occupational Therapists, Physical Therapists, Clinical Psychologists, Dieticians, Paramedics and Health Administrators. Non-medical Caregivers are not considered allied health professionals, so the term health care does not apply to their services.
What services can home health care provide? Some examples are physical therapy, wound care or medical monitoring (i.e. blood pressure or blood glucose levels). Anything that penetrates the body, such as injections, feeding tubes or catheters would be deemed medical, where someone who is properly trained or “skilled” is needed.
Medicare is the principle payer for home health care/skilled nursing services. These services are available under parts A and B. In order to qualify, a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician. Monies are typically provided for a period of up to 60 days. If the patient recovers sooner, then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.
For more information on how Medicare works with your specific case, you may contact the Elder Law & Advocacy Group. They give FREE Medicare and health insurance counseling here in San Diego through the California Department of Aging. You can set up meetings to speak to attorneys working pro bono as volunteers. They also can assist with areas such as setting up wills or advanced health directives. You can reach them at (858) 565-1392 or on their website at http://www.seniorlaw-sd.org. If you need a local San Diego attorney to do more specific work with estate planning, advanced directives, wills or help with probate, please call Scott Morrison at (619) 795-2217 or visit his website at http://www.morrisonattorney.com.
The plan of care ordered by the Physician usually includes limited custodial care (non-medical home care) services to help the care recipient remain in the home. These would include a home health aide for an hour or two a day to help with ADLs (activities of daily living); bathing, dressing, toileting and transferring. If additional hours are needed for areas such as safety supervision, incontinent care or medication reminders, professional caregivers from a home care (distinct from health care) agency, are used.
Non-Medical Home Care/Custodial Care or Private Duty Care
These providers allow people needing help with long-term care to remain in their home or in the community instead of going to a care facility. Their rates are much lower than home health care agencies due to the nature of their services. To hire a registered nurse to do meal preparation and laundry by the hour would be very costly.Assistance with ADLs (activities of daily living); bathing, dressing, toileting and transferring are some areas where a caregiver can help. They also offer transportation to and from medical appointments and the pharmacy. Caregivers can keep households in order by doing light housekeeping, laundry and meal preparation. The companionship and socialization provides a great value too. Non-medical home care agencies are different from home health care agencies in that they do not provide medical services or skilled services and they are not paid by Medicare.
What type of insurance covers home care? Most health insurance policies do not cover these services. In order to receive benefits for this type of service, people usually have been proactive and purchased supplemental insurance in the form of long-term care insurance, well before there is a need. Life insurance policies may have this supplemental coverage integrated into the policy as well.
A search on the Internet for “home care” will reveal a large number of providers in your area. When doing research on which agency to use, make sure that the provider directly employs its caregiving staff and that it pays for worker’s compensation insurance. This shifts the liability of workplace injuries to the agency, not you. The caregivers should not be independent contractors. Otherwise, you would be considered the employer and this liability would flow to you. Also, check for general and professional liability insurance, bonding (coverage for employee theft) and non-owned auto insurance (additional coverage to the caregiver’s or the cleint’s auto policy). Lastly, make sure that the agency is a Better Business Bureau accredited agency. You can see if they’re accredited and check their rating through the BBB’s website at http://www.bbb.org/. The BBB makes sure that agencies market themselves accurately and that their licensing is current and in place.
The leading association for home care agencies is the Home Care Association of America. All member agencies are employer-based, carry liability insurance and pay worker’s comp. You may use the following link to find an HCAOA Member in San Diego http://www.hcaoa.org/. An excellent resource for educating yourself more about home care and what you should consider before starting with an agency/caregiver is HELPGUIDE.org. Such a great resource and offers good advice on a host of other issues. Visit their website at: http://www.helpguide.org/elder/senior_services_living_home.htm.
The sponsor for this web page is San Diego Home Caregivers, a San Diego-based home care agency that is licensed, bonded and insured. They directly hire their caregivers and maintain all of the areas of coverage previously discussed. They have an “A+” rating with the San Diego Better Business Bureau. You may visit their site at www.sandiegohomecaregivers.com or call (619) 487-9000.
Services for Those with Financial Limitations
For those Californians who are facing rising medical expenses, the In-Home Supportive Services (IHSS) program through Medi-Cal is an option. If you are over 65 years of age, disabled (adult or child), or blind, IHSS will help pay for services provided to you so that you can remain safely in your own home. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities. For more information and to apply for these services, you can call (800) 510-2020, or contact your local county welfare office through the following link http://www.sandiegocounty.gov/content/sdc/hhsa/programs/ais/inhome_supportive_services.html. You may also contact California’s Department of Social Services for more information on this program though the following link http://www.cdss.ca.gov.
For short-term assistance, the Southern Caregiver Resource Center here in San Diego has a Respite Program where qualified families in need can access free home care. For example, if a family is planning on moving a loved one to a board & care facility, but need help in the interim with morning in-home care visits over the next few weeks, this program could benefit them with free services. You will have to demonstrate a financial need. The funds supporting this program are limited, mostly going toward families with emergency situations. You will need to first register a “Primary Caregiver” (usually a family member) with the SCRS. You can reach SCRS at (858) 268-4432. You may also visit their website at http://caregivercenter.org/.
Prescription Financial Assistance
For help with prescription costs, one great option is to contact the manufacturer of your medication directly. Most pharmaceutical companies have subsidy programs detailed on their websites that support low income families in need. Also check with the association specific to your condition. Many of them, like the Leukemia & Lymphoma Society’s Co-Pay Assistance Program at http://www.lls.org/#/diseaseinformation/getinformationsupport/financialmatters/copayassistance/, offer help with prescription costs. The Social Security Department also has a subsidy program for people who have Medicare prescription coverage through Part D. You can reach them by calling (800) 772-1213. Ask for an “Agent” when prompted for a selection, then ask the agent to transfer you to a Claims Representative with their Low Income Subsidy Program. You can apply over the phone.
Mental Health/Substance Abuse Services
If you are concerned about the mental health or substance abuse of a Senior here in San Diego, the not-for-profit Community Research Foundation (CRF) is an excellent resource for identifying issues and developing customized programs to address them. They will visit your home for free and follow up with helpful resources as well as additional visits. Please visit them at http://www.comresearch.org/ and look under “Services” for the program in your specific area of San Diego.
If someone is in need of immediate assistance with a mental health crisis, or just need mental health information or referral to mental health services, please contact the Access and Crisis Line provided by the San Diego County Health & Human Services Agency at 1-800-479-3339.
Home Care Equipment & Supplies
Located in Linda Vista, Eric’s Medical Supply has a large variety of home care equipment and supplies with discount pricing. They also rent equipment and have used equipment (i.e. wheelchairs and walkers).
For example, an electronic hospital bed rents for $175-$225 per month, based on the model selected. The process starts with a doctor’s order from your physician for the bed. You may then fax this order into PMS where they will handle all of the paperwork and then deliver the bed to your home. With a doctor’s order, Medicare will cover the expense of the bed. You can reach them at (619) 298-9640 or online at http://www.ericsmedicalsupply.com.
An excellent website from Weill Cornell Medical College, http://www.thiscaringhome.org, gives room-by-room safety recommendations and solutions to problems for seniors living alone in their homes and for the caregivers taking care of them. Great way to quickly see what helpful home care equipment you might be missing. For an elder care home monitoring system, I have to mention the following product, First Alert, on Sharper Image’s site. This doesn’t have a monthly fee and it’s $100 through the following link: http://www.sharperimage.com/si/view/product/First+Alert+Big+Button+Phone+With+Safety+Pendant/204022?trail=.
If you have a senior that has Alzheimer’s, the ALZ Store is a wonderful online store to get some ideas about things that would make there days brighter. Take a look at http://www.alzstore.com.
Senior Transportation Services
Are you able to safely walk yourself to the nearest bus stop? If not, San Diego’s public transit system has a program, MTS Access, that provides transportation for a nominal fee ($4.50 each way) to transit riders whose disabilities prevent them from using standard bus or trolley services. To become certified for MTS Access, prospective passengers are required to complete an application for ADA certification, which can be obtained by calling the ADARide offices at (877) 232-7433 and requesting a paper application. Applications may also be completed online at http://www.adaride.com/.
ElderHelp of San Diego has a service called Senior A Go Go where there is no fee, but they ask for small a donation to help fund the program – based on what you can afford. Learn more at http://www.elderhelpofsandiego.org/programs-and-services/seniors-go/.
Sharp Healthcare offers free, non-emergency transportation services to senior and disabled patients. Vans are available for medical appointments near their San Diego hospital locations. Services are also available for physician appointments at some of their locations. To schedule an appointment, call (619) 740-4288.
AAA Transport has an affordable senior appointment driving service covering central San Diego at $2.20 per mile with a $22 minimum. They can be reached at (760) 801-4694.
Senior Care Communities including Skilled Nursing, Assisted Living, and Memory Care
Lise Marquis is a Certified Senior Advisor with Elder Answers and offers a referral service helping families find the best senior care available in San Diego. Lise covers all of San Diego County and has extensive knowledge of all of the available options in your specific area. Her assistance is FREE to families as the senior communities, homes, and services reimburse her for her assistance. Lise can be reached directly at (619) 538-9155 and her email address is firstname.lastname@example.org.
Cool Zones – From June through the end of October, there is a Cool Zone program in San Diego for seniors and people with disabilities to escape the extreme heat. There are over 115 locations throughout San Diego. They are designated, air-conditioned buildings, identified by a Polar Bear Cool Zone logo. Caregiver Jobs San Diego has a good blog article including a list of all the locations at: http://www.coolzones.org/. If you don’t have access to a computer, call Aging Independence Services at (800) 510-2020, and press “6.”
Veteran’s Aid & Attendance Benefit
The Veteran’s Aid and Attendance Benefit is designed to provide monetary assistance to Veterans that are in need of aid or assistance with ADL’s (activities of daily living). This aid or assistance can be provided at home, in an assisted living facility, or a nursing home. Single veterans are eligible for up to $19,736 annually or $1644 per month. Married veterans are eligible for up to $23,396 annually or $1949 per month.
This benefit is meant to help Veterans protect their assets, such as their home and auto, from being depleted due to medical expenses. To qualify, you must have served during wartime, show a medical need for assistance and have an income level that demonstrates that medical expenses are consuming most, if not all, of your financial resources. For more information on this benefit, contact Scott Langhoff, District Service Officer for the Joint Outreach to San Diego County’s Veterans and Survivors. He works with the Veterans of Foreign Wars and an Elder Law attorney to help families understand and maneuver through the process. His office is here in San Diego and you can reach him by phone at (619) 365-8263 or by email at email@example.com. He does not charge a consultation fee, so this is a great resource to see if you qualify for the benefit.
Home Care Services Consumer Protection Act and the New Home Care Aide Registry
As of January 1st, 2016, the new Home Care Services Consumer Protection Act requires all home care agencies, or “Home Care Organizations” to be licensed and creates a public online registry for Caregivers as “Home Care Aides”, who have been background checked through the new Caregiver Background Check Bureau. This law is intended to provide consumer protection for elderly and disabled individuals who hire caregivers to come into their homes and provide assistance with activities of daily living.
The Home Care Services Bureau oversees the licensing and oversight of all Home Care Organizations in California. This bureau also handles the application process for all Home Care Aides and the maintenance of the statewide Registry. The Caregiver Background Check Bureau handles all the criminal background checks. For more information on the Act and how these state entities are structured, please visit: http://www.ccld.ca.gov/PG3654.htm.