In-home and Community Care
In-home care is a simple phrase that encompasses a wide range of health and social services. These services are delivered at home to people who are recovering, aged, disabled or chronically or terminally ill. Services include medical, nursing, social, or therapeutic treatment, and/or help with essential activities of daily living. Programs help pay for in-home services for those who are eligible. These programs help older adults stay safe and independent in their own home. They supplement care already provided by a family caregiver.
Who can benefit from home care?
A person who:
- can be discharged from a hospital or nursing facility, but needs additional care at home.
- needs short-term help at home because of outpatient surgery.
- needs additional help to live independently due to illness, disability, or aging.
- has a chronic condition such as heart disease or diabetes.
- is terminally ill and wants to spend his or her remaining time in the dignity and comfort of home.
Generally, home care is appropriate whenever a person prefers to stay home, but needs ongoing care that cannot be provided by family and friends alone. Most people prefer this option over institutional care, if possible.
Activities of Daily Living
What are ADLs and IADLs?
Activities of Daily Living. These include: bathing, dressing, grooming, walking, getting in/out of bed, chair or tub, eating, and using the toilet.
IADLs are Instrumental Activities of Daily Living. They include: shopping, meal preparation, house cleaning, heavy chores, laundry, telephoning, transportation, handling legal or financial matters, and managing medication.
To determine whether a person is eligible for home care services, agencies such as Council on Aging measure a person's ability to perform ADLs and IADLs. To enroll in COA home care programs, a person must be impaired in (need help with) ADLs and IADLs.
Types of home care services
Services fall into two categories: 1) skilled and 2) home support or custodial care.
Skilled Services
Skilled services are a higher level of care. They are usually provided by trained medical professionals. These services include: skilled nursing services, physical, occupational, and speech therapy
Home Support/Custodial Intermediate Care Services
Custodial care does not require specialized training or services. Custodial care may include any of the following:
- Companion Services - provides socialization
- Chore or Environmental Services - pest control, waste removal and heavy cleaning
- Emergency Response Systems - 24 hour a day protection for emergency response and medication administration
- Home Medical Equipment and Supplies
- Home-delivered Meals
- Home Modification and Repair - safety-related repairs and modifications, such as grab bars, ramps or dead bolt locks
- Homemaker Services - help with meal preparation, shopping, light housekeeping, and laundry
- Independent Living Assistance - assistance with finances, personal business and telephone support
- Nutrition Counseling - diet and nutrition instruction
- Personal Care Services - help with bathing, dressing, and grooming
- Respite for Caregivers - time off for the primary caregiver.
- Social Work Counseling - dealing with issues and problems
Who provides home care?
Click here for a checklist to help you choose a home care agency.
Health Agencies (HHA): People who need skilled home care services usually receive their care from a Home Health Agency. The term Home Health Agency often indicates that a home care provider is certified by Medicare, but this is not always the case. A Medicare-certified agency has met federal minimum requirements for patient care and management and can provide Medicare and Medicaid home health services.
Homemaker and Home Care Aide Agency: These agencies employ homemakers or home care aides and companions who provide meal preparation, bathing, dressing, and housekeeping. Some states require these agencies to be licensed and meet minimum standards established by the state. Ohio has no licensure law for these agencies. Some agencies receive certification (not licensure) from the Ohio Department of Health. These certified agencies can bill Medicare and Medicaid for the care they provide.
All home care providers that have contracts with Council on Aging (COA) must comply with Conditions of Participation in order to provide service for COA clients. COA providers are also surveyed once a year to determine how well they comply with these quality standards.
Home Medical Equipment Company: These companies provide home care clients with products such as wheelchairs, walkers, catheters, and wound care supplies. Home medical equipment and supply companies are required to meet federal minimum standards if they are paid through Medicare.
Hospice: Hospice care involves a team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for terminally ill patients and their families. Hospice care also provides related medications, medical supplies, and equipment. It is based primarily in the home, so it helps families stay together. Most hospices are Medicare-certified and licensed according to state requirements. Payment for hospice care is available as a benefit under Medicare, Medicaid and most private insurance companies. Click here for more information about hospice and a list of hospice providers. Or, call Council on Aging at 513-721-1025.
Pharmaceutical and Infusion Therapy Companies: These companies specialize in the delivery of drugs, equipment, and professional services for people who need intravenous or tube feedings. These companies employ pharmacists who prepare solutions and arrange for delivery to patients. Some pharmaceutical and infusion therapy companies are home health agencies, certified by Medicare. In addition, some states require these organizations to be licensed.
Resolving a home care problem
If you invest some time and find out about home care agencies before beginning services you will most likely receive high-quality home care that is safe and effective. If a problem develops or you would like to file a complaint, notify the home care agency's manager. You may also contact the regional Long-term Care Ombudsman.