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Topic home health v. hospice Go to previous topic Go to next topic Go to higher level

By lurkingforacure On 2011.07.27 08:05
I have a loved one who doesn't have PD but does have hepatitis C (not on meds-too elderly and meds were deemed too horrible with side effects and success rate too low to justify taking them) and who has fallen several times in the last month for which she is currently in assisted living trying to recuperate (not going well). She's also had several UTI which we all know can make one appear to have raging dementia within days, it's so scary. As if that were not enough, she has a fistula which needs surgery but she is not a surgical candidate due to the above health issues. There has also been a ten pound weight loss in the past few months, which is not good at all either, I realize.

Our time in the skilled nursing place is limited by medicare, and I'm exploring options for what to do after she uses up her time there. She can't qualify for VA since she was divorced from her (briefly in the military) ex. I'm looking at hospice and home health but confused about them, here is what I've learned so far:

Home health:
Generally need to be improving or at least gaining improvement in function
limited to time even if improving, but I dont' know how long that is
attendant provided only if you get the "bundle" of services through home health agency (PT, OT, nurse visits, the whole works)

person must be not only not improving, but terminal, and yes, I was told by THE hospice worker that a doctor must certify the person has six months to live or less (doesn't mean she will actually die in that time frame, but a physician has to certify to this) I know there's been lots of discussion here about this requirement but I was told very clearly that unless a doc will so certify, you will not qualify for hospice
nurse comes once a week, crisis nurse available, some meds covered, some not
baths twice a week
physician available
no time limit, you can be on hospice for years
attendant not provided

My questions are:

what about when the person needs a companion to help clean, cook, bathe and dress them more regularly than once or twice a week, and just be there so they don't fall? I've been told that medicare will pay for an attendant only if you use home health as a package bundle, but that is based on the person improving AND it is ultimately limited in time even if the person continues to improve. What if the person is very weak, and/or mentally not stable to be left alone all day/night by themselves? I've been told that is private pay but that is horribly expensive and very soon one would simply run out of money to pay for that. Does anyone have any experience with either home health or hospice(or some other agency) covering an attendant/companion?

Also, this is crazy to me, but I was told medicare will pay for an attendance IF the person stays in a skilled nursing facility, but then you have to private pay the facility, as medicare won't pay for both. I understand not paying for both, but it would be much cheaper for everyone if a companion were covered when someone stayed in their own home, seriously. Then all medicare would be paying for would be the companion, and the person would be paying for his/her utilities, food, etc. associated with living in their own home. I can only assume the lobby for the nursing homes lobbied for this one, it makes no sense to me but I'm open to being educated! Thanks for any help or experience anyone has.

By susger8 On 2011.07.27 10:37
My dad has a live-in health aide, and we pay privately. As far as I know there's no way to get Medicare to pay for that. I wish!! All his savings (and Mom's) are flying out the window very quickly. But it's still cheaper than a nursing home.


By caregivermary On 2011.07.27 11:59

you are right-in order for home health coverage, the person needs to be improving and the coverage is limited. We have hospice right now and I do not get any attendent services from them paid by Medicare. However, they do have volunteers who will sit with the person who is ill. These volunteers will not provide any personal services or admin meds.

However, I am aware of services through the state level which help carry the burden for aides in the home. Unfortunately for me and others but fortunately for you it only applies to nonspouse situations. Also, I am not sure if it is available in Texas but it would be worth researching.

Finding good help is very challenging.

By karolinakitty On 2011.07.27 16:16
before my mother took ill, she was a home health companion, even though she was blind, she went to homes of those who were immobile. She would cook, straighten up, not clean, converse and just plain be ther 6 hours a day. Her pay was $2.75 an hour and it was through the department of aging. Now that was 10 years ago, but, the pay was down because of her social security and it was basically a volunteer service. Before Senator Heinz died, he awarded her the Companion of the Year award. I don't know what they might have in your state, but check it out....

By cmonge On 2011.07.27 17:33
I may have to look into home health because my husband just needs a reminder to take med give him that push in the morning to make sure he showers, brushes teeth, etc without getting hurt and remind him to eat. Since I am a teacher who works full time, getting this help is essential. If someone has any other suggestions, I would welcome them!

By lvmymom On 2011.07.27 18:11
Ask for Social Services to help you. That is their job to figure out how to manage. It is free and it is helpful. You will be pleasantly surprised.

Good luck.

By LOHENGR1N On 2011.07.27 19:13
Here in Massachusetts on the state level you can get Personal care assistants as long as you qualify and need more than 14 hours a week help. In some instances you can be married and still qualify. There are different agency's that you can go through I went through Ad-Lib here but I know United cerebral Palsy also handles getting people on. Check with it works in all states and will tell you what you might qualify for and the office address and phone number of those closest to your home. Take care, good luck and hang in there.

By sannph On 2011.07.27 22:23
We are in PA, and my husband qualified for state waiver program. United Cerebral Palsy did all the paperwork; they send someone twice a year to re-evaluate. For now we get help 16 hours a week; we had an option of having a UCP provided aide or hiring our own.

By oshroshr On 2011.07.29 18:01
We currently have home health for my mother in law and talk of moving it to hospice.

I have similar concerns but am lucky to have a good case nurse and doctor too.
I have been reassured that you can move in and out of hospice as deemed by doctor and yes you can be on it for years,
What makes mine more difficult is my husband, (her son) has pd and so things are complicated.

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