There are several ways to be pained in health. One is the physical pain that could land you in a hospital. Another pain could be the road to recovery. Yet another is the pain of finding reputable, dependable providers that will take care of your needs without emotionally and financially draining you. When healthcare transitions from the hospital to the home, new challenges present themselves. Who will come to your home to care for your loved one? How do you select a provider? Who will pay for their service?
Last May, Mayor Muriel Bowser signed the Caregiver Advise, Record and Enable (CARE) Act of 2015 into law. The CARE Act requires that hospitals provide patients with an opportunity to select a caregiver after hospital admission, and that hospitals record contact information for the caregivers and consult with them about the patient’s care plan after discharge.
The good news is that hospitals will help examine care beyond their walls and work with families to determine the next steps. The anxiety-inducing news is selecting the right care provider. Many times family members are the caregivers, and they do the best that they can. But when the care becomes more nuanced and the family is not skilled in providing that kind of service for an ill loved one, they must rely on a third party for help.
Palliative Care and How to Select a Provider
Palliative care is the relief of symptoms from advanced illness. Conditions such as congestive heart failure, COPD or lung disease, cancer, HIV, kidney disease, or stroke may result in physical discomfort and change in overall life trajectory. Unlike hospice care, palliative care assists individuals with symptom management and being more comfortable as they recover. Once the patient is cleared to go home and the attending physician has certified that home healthcare is necessary, the search begins.
According to the National Association for Home Care and Hospice, there are a few key points to look for when selecting a provider, things like:
- How they supply and explain literature such as the Patient Bill of Rights
- How long they have been serving the community
- The inclusion of family members in developing a care plan
- Documenting the care plan and clearly establishing everyone’s responsibility in carrying it out
- The process for accountability to ensure that a supervisor is overseeing the workers
- Detailed procedures for handling matters such as financial affairs and emergencies, particularly after business hours.
- The protocol for voicing concerns and filing complaints
Above all, be sure to get things in writing and ask as many questions as necessary to feel assured.
Where to Get Care
Capital Caring (www.capitalcaring.org) has been providing palliative and hospice care for 40 years around the DC area. It customizes the care around medical orders from physicians. Its palliative care is a fee-for-service program, so it would need to start building a plan around a symptom from a chronic illness. Capital Caring offers a wide range of home medical services. The care plan is built from a doctor’s orders and includes the family caregivers so that they can assist with recovery.
Capitol Hill Village (www.capitolhillvillage.org), located on Eighth Street in Southeast, is a nonprofit, volunteer organization that helps individuals live long and comfortably in their own homes. It provides referrals to fee-for-service home healthcare providers in the area. It also provides help with safeguarding homes to prevent falls and other accidents.
Amedysis Home Health Care (http://amedisys.com), located on H street in Northwest, offers recovery and management for people living with chronic conditions as well as rehabilitation therapy, wound care, and psychiatric care for those living with dementia and Alzheimer’s. Amedysis deploys a team of professionals such as physical and occupational therapists, home healthcare nurses, and medical social workers to provide comprehensive care.
MedStar Visiting Nurse Association (www.medstarvna.org) also offers an assembly of therapists, nurses, and social workers to meet home healthcare needs. Working from a doctor’s order and a plan for care, MedStar VNA workers visit homes two or three times a week on average. They also offer ostomy care and education for individuals so that they can learn to care for their ostomy pouch independently.
Americare in Home Nursing (www.ameri-nurse.com) has been providing home healthcare since 1974. Located in Falls Church, Va., its staff provides care for people in DC, Maryland, and Virginia. Along with the traditional services, Americare offers oncology services, fall-prevention evaluations, and joint replacement therapy.
Why is home healthcare preferred over hospitalization? Research shows that people recover quicker at home, and with appropriate customized care they can prevent readmission. Dr. Cameron Muir, executive vice president of quality and access and chief medical officer for Capital Caring, explains why palliative is preferred among patients. “People living with an advanced illness want to be at home. That’s the human answer to that question. On the other side, 50 percent of people die in hospitals and another quarter of Americans die in nursing homes. So Capital Caring provides palliative consulting in many hospitals, nursing homes, and assisted living facilities. We do outpatient clinics. We also see people who are homebound and really cannot get to the office.”
How to Afford Care
DC’s Medicaid has a program called the Elderly and Disabled Program, or EDP. It offers a waiver to cover the costs of most supportive in-home services. The program offers assisted living help, personal care aide services, case management and respite care, and more. In order to qualify, individuals must be 65 years old or over, or between 18 and 64 years old and living with a disability. They must also be eligible for DC Medicaid and require assistance with daily living. The cutoff for income requirement has just recently been lowered to $2,200 a month.
Medicare will only pay for a certain number of hours of part-time, skilled, intermittent home healthcare. Most people who are eligible for Medicaid are also eligible for Medicaid waiver programs. Shane Johnson, senior director of health policy at TDP Consulting Inc. in Silver Spring, explains that the waiver programs can alleviate some of the financial burden. “The beauty in that is that people would have access to an array of services that wouldn’t be covered under traditional plans. States have greater flexibility to those who need it the most. Medicaid waiver programs will pay for attendant care and custodial care as long as they meet medical necessity criteria and the healthcare team can demonstrate a need for those services.”
Commercial (private) insurance rarely covers custodial or attendant care. There are cases where people can get the coverage, but medical necessity must be proven, which can be difficult. Individuals can still apply for Medicare and Medicaid, but the commercial insurance will be the primary contributor.
For more information about DC Medicaid services and to see if you qualify for financial assistance, visit the DC Department of Health Care Finance page at https://dhcf.dc.gov/.
Candace Y.A. Montague is the health reporter for Capital Community News.