Ask the Interim HealthCare Team Question Archive

Hello. I need your help in finding a nursing home with rehabiliation services. My mother-in-law has been sick, in hopspital, for at least 3 months. She is now needing a nirsing home for consent care. She needs woound care. She can not stand to walk and is using a bed pan. Can you suggest such a place with her needs and take medicare? Thank you.
You are experiencing a very difficult situation that many people in your generation are now facing--making care decisions for a loved one. Several years ago Medicare recognized what a difficult time people were experiencing in making these decisions. Medicare now has a website available where you can search for nursing homes in your area. Not only does the website allow you to locate a nursing home, but it also compares the performance of the nursing homes in your area allowing you to choose just the right one for your mother-in-law's needs.

The website can be found at www.medicare.gov. The link to "Compare Nursing Homes in Your Area" can be found in the lower right corner area of the screen. It is not a difficult site to navigate, so you should be able to find all the information you need to make a good decision.

My mother is 52 years old and is mentally disabled. She is on a limited income but has trouble overtaking meds eating nutritional food (severe Diabetic). Are there services home health can provide, and around how much per month could we expect to pay?
How fortunate your mom is to have a daughter who wants to make sure she has adequate care. You should certainly be able to meet her needs at home with some minimal assistance.

You mention that your mother has some mental disabilities, but you don?t mention if she can walk, bathe and feed herself. If those abilities are intact, your mother probably just needs a level of care that can be provided by a homemaker/companion. A homemaker or companion is someone who can assist your mother in preparing meals, shopping, laundry, housekeeping. He/she also provides opportunities for socialization such as conversation, reading, playing cards, walking together, etc. A homemaker or companion may not provide personal care such as bathing or dressing?these tasks require a specially trained home care aide. Homemakers or companions also may not administer medications, including insulin.

Medication must be administered by a nurse or by a caregiver designated by the patient (for example, a family member). However, if your mother is able to administer her own medications, a companion or homemaker can remind her when it is time to take them.

Costs for in-home services vary widely from location to location as well as by type of specific service. For example, fees for a companion will be less than fees for a home care aide. It sounds as if your mother needs a homemaker or companion, but I can't determine that for sure given the small amount of information provided here.

You can call any home health agency in your area for assistance in determining your mother?s specific needs. They will be happy to arrange for someone to evaluate your mother for appropriateness for home care services. Home care agencies can be found in your yellow pages under "home care" or "home health"; or your mother?s physician may have a specific home care agency he/she has become familiar with.

Unfortunately, Medicare does not provide coverage for homemaker or personal care services--only for services that require a nurse or physical therapist. Does your mother qualify for Medicaid? Some Medicaid programs provide such services.

What is the criteria for a home companion , working with a person with mental retardation? Individual lives with elderly father and he is need of someone to assist her with bathing, fixing her lunch, etc...This is a non medical job.
Each agency that employs companions has different criteria for hiring and assigning. However, in general, companions are hired to provide companionship and socialization activities to adults, shopping, preparing nutritious meals or snacks, and light housekeeping related to the patients/clients.

Most agencies do not allow companions to perform any personal care or skilled nursing procedures or attend to children OR reconcile bank statements or endorse checks. In most agencies you must be at least a personal care aide to provide personal care (bathing, dressing).

The agencies in your area may also have additional requirements such as an age requirement (e.g., 18 years of age or older). And they may also have training or previous experience requirements, such as graduating from companion training in states where that is required Or six months of accumulated experience in a similar job classification Or 1-year verified life experience within the last year Or completion of a Federal or State approved companion-training program.

To find out for certain the requirements of the companion jobs in your area, I suggest you call several home care agencies and speak to the person in charge of hiring. That person will be happy to hear from you and can give you more specific information about the requirements in your area.

My parents only have medicare, they live on a very limited budget. They do own a small home, not worth, maybe $30,000. Dad is getting bad, he has dementia and is now wearing diapers, mom isn't that healthy, but she trys to take care of him. They are both around 80. We don't want to put him in a nursing home, for one thing it would leave Mom with very little money to live off of. We have talked about putting them a small home on our property and trying to get home health for them. What should we do. Thank you so much.
It is indeed a difficult situation when one's parents are in failing health. They are fortunate to have someone like you to assist them with their needs.

Your description of their situation indicates to me that they would benefit most from homemaker services to assist your mother with some daily tasks around their home as well as some personal care services for your father to assist him with his impaired activities of daily living, probably most specifically bathing and dressing.

These services are available from any home care agency in your area. Perhaps you even have an Interim HealthCare office near you. Most agencies are listed in your yellow pages under "home health care". Your father's physician may also be familiar with an agency that he/she feels comfortable with. At the very least, the agency should be able to send a nurse to your parents' home to fully assess their needs.

Unfortunately, Medicare does not provide coverage for homemaker or personal care services--only for services that require a nurse or physical therapist. I suggest you contact your local Area Agency on Aging to see if they might be able to direct you to some resources that may be able to assist your parents.

I have severe fibromyalgia. I am disabled and do not work. I am married but my husband is very busy. It is very difficult to do housework and it doesn't get done to a good degree. Is there a service with Interim that could help me? What are the rates? I have United Health Associates and United Healthcare.
I'm sure you certainly find it very difficult to maintain your household in the manner you would like. Many individuals who suffer from your condition have the same problems that you describe.

Interim HealthCare does indeed provide homemaker services. With so many locations all over the country, you can imagine that the rates vary from location to location. I suggest you contact the Interim HealthCare office in your area to discuss your specific needs. They can even work with you in approaching United Health Associates and United Healthcare to inquire about the home care benefits available under your health plan.

You did not mention where you live so I can not direct you to a specific office, but you can find our nearest location by checking our website at www.interimhealthcare.com. Or you can look in your local phonebook.

My mom had astroke in february. right now she is in a rehab center and she hates it she wants to go home .other that the stroke she has diabetis she can walk she baths her self and feed her self. if she could come live with me what kind of help would i be able to get, I work mornings and would need someone to be with her till i get home and i would also need someone to come in and give her insulin shots.
How fortunate your mom is to have a daughter who wants to make sure she has adequate care. You should certainly be able to meet her needs at home with some minimal assistance.

You mention that your mother can walk, bathe and feed herself. With those abilities intact, your mother probably just needs a level of care that can be provided by a homemaker/companion. A homemaker/companion is someone who can assist your mother in preparing meals, shopping, laundry, housekeeping. He/she also provides opportunities for socialization such as conversation, reading, playing cards, walking together, etc. A homemaker/companion may not provide personal care such as bathing or dressing. They also may not administer medications, including insulin.

Medication must be administered by a nurse or by a caregiver designated by the patient (for example, a family member). You may certainly hire a nurse to come in to your home and provide daily injections to your mother, but there are few insurance payors who would cover this activity. Medicare will cover this activity for a while but has the expectation that that the patient or a caregiver designated by the patient will learn to provide the injections independently. Once the patient or caregiver has learned to provide the injections, Medicare will no longer provide coverage.

I might suggest that you contact a home health agency in your area and request an assessment of your mother's needs. If you are not familiar with an agency in your area, your mother's physician or even the discharge planner from her rehab facility will be able to provide you with some names.

I am thinking about bring my dad home. He has had a case of the shingles, and has been in bed for four weeks. He is in a lot of pain, and can not walk to the bathroom on his own. He needs physhical therphy, and hosipatial bed, and i would have to find pain medication treatment for him. although i will need help, we will also help. Can you help us with a plan.
Indeed your Dad sounds like he could benefit from some home care services. Based on your description, he may need skilled nursing to assist with managing pain medication and physical therapy for strengthening and endurance exercises to assist him in regaining his strength after his hospitalization. He may also benefit from home health aide services to assist with bathing until he can do it himself again. A hospital bed would need to be ordered through a Medical Equipment company, but your home health agency should be able to assist you with that as well.

Obviously, you and I cannot determine his specific needs in an e-mail, but you can request a home health agency to assess your father for appropriateness for admission to home care. Your father's physician can give you the names of some agencies.

You did not mention what kind of medical insurance your father has. Most (but not all) insurance carriers as well as Medicare provide coverage for the services described above. Some Medicaid programs also provide such services. The home health agency of your choice should also be able to assist you in determining insurance coverage for the necessary home health services.

I need help. MY mother is bedridden, has a shattered spine and can`t move. My question ..it is 800.00 a week to pay the agency for bathing my mom. Is there any kind of assistance my dad can get? Medicare is so confusing, do you know a route I can take?
You are certainly correct when you say that Medicare is confusing. So let's try to apply the Medicare rules directly to your situation.

Your mother is obviously homebound and she is in a personal residence (not a nursing home or rehab facility), so she meets the Medicare requirements in this regard. However, there are several other requirements she must also meet to determine if she qualifies for home health care under Medicare.

She must be under the care of a physician who would oversee her home health plan of care. I'm sure she has a physician who is treating her fractured spine, so she meets this criterion as well.

Finally, and this is the tough one, does she have a need for skilled nursing care or physical therapy? It sounds as if she might need some services regarding managing pain medications or improving mobility in bed or progressing her mobility from bed to transferring to ambulation (or use of wheelchair). If she has any of these needs, then, yes, she qualifies for home health care under the Medicare benefit. Once she qualifies for the benefit, then she is also eligible to receive home health aide assistance for bathing as long as she is receiving services from a nurse or therapist.

Obviously, you and I can't determine her need in an e-mail, but you should be able to contact a home health agency near you and request an evaluation for home care. If you do not know a home health agency that provides Medicare services, your mother's physician will be able to give you some names.

my grandmother is completely bed ridden she is at home but under the care of hospice.hospice provides her with a nurse to come by now 3 times a week and a lady to bath her.i feel she needs a home care aide to look after her in the morning til early afternoon will medicare cover something like that for her?
Your grandmother is very fortunate to have a granddaughter who cares so much about her and wants to make sure she has the best care possible.

Your grandmother's hospice services are currently paid for by Medicare, and she is likely receiving the maximum benefit allowed. Medicare also offers a home care benefit, but beneficiaries cannot receive the hospice benefit and the home care benefit at the same time. Your grandmother's needs are probably best met by hospice at this time rather than by home care.

So, no, Medicare will not pay for additional home care aide services. I suggest you discuss your grandmother's needs with the hospice who is providing her care to explain your concerns. They may determine she needs additional care.

If your grandmother has coverage under another insurance carrier or Medicaid, you may be able to obtain the services through them. Or you may want to negotiate with a local home care agency for a price that the family can afford to provide some additional care.

My great aunt has a long detailed medical history, but most recently has compression fractures in her lower spine and today she fell and broke two ribs. Her mobility is comprimised at this time due do these injuries, what services would you recommend and are any of them covered by medicare?
Medicare has a few criteria that must be met before homecare services are covered:

1. The patient must be homebound, that is, unable to leave the home without considerable taxing effort. Your great aunt could probably meet this criterion if she is unable to walk very far due to the pain from her fractures.
2. Care must be provided in the patient?s place of residence. It's OK if the patient is staying in someone else's residence, but not if she is in a nursing home.
3. The patient must be under the care of a physician, and the physician must order the homecare services only if he/she thinks they are medically necessary.
4. The patient must have a need for Skilled Nursing, Physical Therapy, Speech Therapy or Occupational Therapy. Although it doesn't sound like your aunt needs nursing care, she does sound like she may need Physical Therapy. As long as she has a need for Physical Therapy, Medicare will also pay for a home health aide to assist her with bathing if she is unable to bathe herself.

Of course a home care nurse must assess your aunt to determine conclusively what her needs are and whether she meets Medicare's home care criteria as explained above.

If you feel your aunt meets these criteria, I suggest you speak with her physician first. He/she may be able to assist you to find a home care agency in your area.

My husbands parents live on the farm and are refusing to have anyone come in for help. She can;t remember to take her meds and won't let anyone help. We put them in assisted living but he refused to stay. We are at our wits end on this. They both are 86 and they most certainly need our assistance or someone who can do it. They refuse to let us do anything.
You are certainly in a difficult position--one that many adult children find themselves in. You want to respect your parent's need for independence, but you see that they surely need assistance on a day-to-day basis.

Often, a family meeting will help in resolving these issues. Having a trusted third party (such as a minister or family friend) be a part of the meeting may be helpful as well.

I suggest you follow this link http://www.aarp.org/life/caregiving/ to the AARP website. At this site there are listed a number of articles regarding caregivers of older parents. Scroll down to the bottom of the page to the article titled: Talking to Older Parents About Independence. I think you will find these resources helpful in working with your parents to find the best resolution for them.

My father who is a diabetic recently had to have both of his legs removed. He is in a nursing home for rehab at this time but only can stay about 1 more month. We would like to bring him home to live with my mother who is 80 years old. I live down the street but I work full time. They will need help transferring him from the bed to the wheel chair and to the toilet.He has a motorized wheelchair and can get around fine in that. He does not need help with medications or cleaning or cooking as my mother is able to do that. We need someone 24 hrs because of the bathroom situation. Please tell us what is availble for us.
Thank you,
Your parents are fortunate to have someone who cares about them to live so close. It is very difficult to be an adult child of elderly parents who need so much care.

Based on the description you provide of your father's needs, it sounds like he would require the services of a personal care aide, that is, someone who is trained in providing assistance with activities of daily living (bathing, dressing, transferring, toileting). However, to be sure, you would want to have someone from a home care agency provide an assessment of your father to make a specific determination of his actual needs.

You can find a home care agency in your area in a number of ways:

• You may have friends who have used the services of a home care agency before. Listen to their recommendations.
• Your father?s physician may know some agencies who provide good care. Ask the physician for a referral.
• The discharge planner of the hospital or the rehab facility where your father was a patient will know local agencies who can meet your father?s needs. Call them and ask for suggestions.
• You can find home care agencies listed in the yellow pages of your phone directory.

Can a relitive of an elderly person join your team of health care giver and then go to work to care for their own elderly person there by caring for them and receiving training and earn a salary ??? e.g. a daughter needing a job and a mother needing home care. can they get togther for their special needs?
Most payers (HMOs, insurance, Medicare, etc.) do not permit family members to provide care and then get reimbursed for the care they provide.

Although these payers will not pay any family members to provide care to their relatives, there may be a chance that the Medicaid program in your state allows such a practice. To find out, you will need to contact your local Medicaid program. Perhaps your case worker can direct you to the right person to speak with.

Interim HealthCare has specific hiring guidelines that require each employee to be previously trained and have previous experience before hiring.

My 76 year old mother in law who is diabetic needs in home help with bathing, lunch time insulin, and preparing lunch three days a week. What kind of help do we need? Nursing? Home health aid?
From your description, it sounds as if your mother certainly could benefit from home health aide services at least several times a week. She may also benefit from some nursing services to assist her in learning to become independent in administering her insulin.

If your mother in law is a Medicare beneficiary and she is homebound, some or all of the necessary services may be eligible for coverage under the Medicare home health benefit. If she is a member of an HMO, the HMO should also be able to provide her with the services.

To obtain a specific assessment of your mother in law?s needs, contact her HMO to request an assessment. Otherwise, you can find a home health agency in the yellow pages and contact them directly for an assessment. Your mother in law?s physician may also be able to provide you with a name of an agency in your area.

My wife is currently in a rehability care unit. I wish to bring her home and want to provide the proper medical,personal,and safety care for her. I need to knowexactly what will be needed to fill this criteria? The doctor at the center said he would release her if I guaranteed all of her needs would be met. She is a diabetic ,before going to the hospitalwe were able to fullfill all of her needs on this issue. What I need to know is what she needs so I can put all phases of her needs in place before bringing her home. I see every visit that she is becoming instituionalized. I do not want this nor does she. We have discussed the issue and she also wants to come home.Please advise.
REv. Ralph Burwell
Home care can often provide a more appealing alternative to institutionalization for many families. Although your wife seems to have many needs, it is possible that those needs can be met through home care.

It seems your wife's needs include intermittent skilled nursing plus some home health aide services. She may also benefit from some physical therapy and/or occupational therapy. Until a nurse assesses her in person for appropriateness for homecare, however, anything that I may say is merely a guess.

You may want to discuss your wife's situation in detail with several home care agencies in your area. You can find them listed in the yellow pages. Your physician may suggest several agencies that he/she is familiar with as well.

I'm inquiring on behalf of my parents who need home health care very soon, my mom took sick recently and is bedridden with my dad looking after her as best he can-I help several times a week, as well as my aunt and cousin...please send me some info on where to start with this project. Thanks,
Renee' Kirby
Your parents are fortunate to have such a caring family around them. Caring for and worrying about ailing family member can be very difficult.

It certainly sounds like your family could benefit from some help at home--certainly home health aide services and perhaps skilled nursing services. An assessment of their specific needs can really only be determined by a home care nurse in person. I suggest you call a home care agency in your area and discuss having a nurse come to your parents' home to assess their needs.

You can find home care agencies list in your yellow pages. Your parents' physician may also be able to provide you the names of several agencies he/she is familiar with.

If your mother is a Medicare beneficiary and is homebound, she may qualify for home care services under the Medicare home health benefit. If she is a member of an HMO, she may be eligible for some services as well. Contact her HMO for a home care referral.

My son returned from the hospital this week after having surgery to have a large, infected lesion removed from his thigh. He is a 50-year-old, Type I obese diabetic, (390 lbs.) and is suffering from poliomyelitis and dangerously low potassium levels. He has a permanent tracheotomy, and has had to close his law practice because he is disabled and lives alone. What home care would you suggest to help?
Our first recommendation would be for your son to have a comprehensive assessment in his home by a Joint Commission accredited or Medicare-certified home health agency. Both the Joint Commission and federal government perform on-sight surveys to ensure that home care agencies deliver a certain standard of care. This would be a "marker" for you and your son to select an agency.

In view of the scope of his medical problems, we would recommend that a nurse perform the assessment. The nurse will be able to answer key questions that will determine the type of home care your son needs, for how long and how safe he is to live alone. Questions the nurse can answer include:

1. Does he need help in managing the wound?
2. Does he need additional information to assist him in managing his diabetes?
3. Is he able to bathe, dress, groom, toilet, walk, and get in and out of chairs with or without assistance, or does he need help from someone or equipment to do these activities safely?
4. Is he able to shop, prepare meals and perform housework independently?

Once his needs are established, then he will need to consider what insurance coverage or other financial or community resources he has to meet these needs.

The agency you select to perform the in-home assessment may be able to offer the entire scope of services or help your son coordinate with other organizations to meet all of his needs. Central to this whole process will be your son's doctor. With your son?s permission, the agency nurse should be in contact with your son?s doctor to ensure they know about his needs once he is home. This way they can actively work with the agency to restore your son's health and ensure that he is safe at home.

If you are willing to share what city your son lives in, we may have an Interim HealthCare location in that city that can do the assessment, or we may be able to direct you to other agencies in the area.

We know that this is a real burden for a mother to face with her son and we hope that we have been helpful.

My sister-in-law lives in the Phoenix area and has recently been released from the hospital and sent home with hospice care. She has throat cancer and is in her early 50's. My brother earns a good income but this illness is taking its toll financially and emotionally. They are having difficulty arranging home care and finding a consistent provider would be so helpful, but they seem to be getting a bit of a run around from these agencies. Any advice?
Thank you for your questions, our heart goes out to you and your family facing your sister-in-law's illness. Based on the information that you provided, we recommend the following.

You state that your sister-in-law left the hospital and "was sent home with hospice care." First, we want to know that your sister-in-law and brother understood and agreed to hospice care. In most instances, hospice care indicates that your sister-in-law's prognosis is six months or less, and that both had agreed to certain limitations on outstanding
life-saving intervention.

Second, if they agreed to these provisions, then they should have been referred to a licensed and in most cases Medicare-certified or JCAHO-accredited hospice. We bring up the issue of certification or accreditation from a consumer perspective. As health care professionals, we would want to know that the hospice caring for one of our family members has met certain national standards of care. It?s a bellwether that the hospice "works." Although, your sister-in-law may not be Medicare-eligible, if the hospice is Medicare-certified, it means that an outside reviewer from the government has been to the hospice to ensure it follows specific standards of care and processes to help protect vulnerable patients and their families. Or, the hospice may be accredited by the JCAHO, which is a nationally recognized organization that sends reviewers on-site to the hospice to review them against national standards of hospice care. Both act as a "seal of approval" and can also be responsive to consumer or patient/family complaints should that be an issue.

If your family has been referred to a hospice, we are confused about the reference to problems in arranging for home care or having a consistent provider. Hospices by definition offer both home care and inpatient care and the coordination of care and of care providers. Home care should be arranged and coordinated by virtue of the fact that they are being cared for by a hospice. These are issues that would be reviewed by either the government or by JCAHO as noted above. Also, Phoenix has a long tradition of outstanding hospices dating back to the early 70's when the concept was introduced in the US. So begin by ensuring that your sister-in-law and brother are receiving care from a hospice. If they are receiving "hospice-like" care from another provider; there is a different set of issues.

If you determine they are receiving care from a hospice and are willing to offer more details about the nature of the problems, we will be happy to walk you through the critical questions to ask the hospice and help your family set expectations for the delivery of care. If it is not a hospice, then we can consider what the needs are for your
sister-in-law and brother, and try to determine what type of provider or providers can best meet those needs. Outside of a hospice, we may need to "patch" together resources or different types of providers to meet their needs.

We hope this provides you with a starting place, and we would be pleased to answer follow-up questions.