Proper Care for the Elderly
Dear Readers: Being a good neighbor can be more complicated than it sounds, at least when it comes to finding financial help for the elderly who are seeking home care. That's what experts in the field have discovered, and I am very grateful that so many of them spelled out the problems and offered possible solutions for helping out. Here are two wonderful letters from experts in the field:
Dear Annie: As a longtime registered nurse and expert in home health care services, I am writing in response to the neighbor who was so kindly assisting her 90-year-old neighbor.
I want to provide some alternatives for her to seek out. A hospitalization for a social issue like this is not likely, and Medicare home health care requires that there is a skilled need for nursing or rehabilitation therapy. From my reading of this case, the 90-year-old is not likely skilled.
In addition, even if she did meet the skilled requirement, there is a national shortage of home health aides due to COVID-19, so there is little likelihood of her being able to get 24 hours of care per week.
Two things that the kind neighbor may try instead would be to call the local Area Agency on Aging and the 90-year-old's primary care provider. There is a provider through AAA in every state, and they have case workers and social workers who can work with the neighbor on available services. Service availability varies by state, municipality and region, so it is impossible to make a general statement about what is available, but they can certainly start the process to obtain services. The 90-year-old's primary care provider will also be familiar with the organization that is the best to call, and it may take the primary care provider to make a referral to start services.
I hope this is helpful. I am glad to answer questions. Thank you for your kind response to a wonderful neighbor. -- Liz Madigan, RN
Dear Annie: I love your column, but the information you provided in "How Can I Help My Neighbor?" is incorrect and misleading. I am a licensed clinical social worker in California with 20 years of experience working for a skilled home care department of a hospital.
Medicare does NOT cover 28 hours per week of in-home care. It only pays for skilled care, i.e., nurses, therapists (physical, occupational, speech), and home health aide and social workers. These are visits of 30-60 minutes for typically up to a few weeks. People who need "custodial care" must typically hire private help unless they have long-term care insurance, are very low-income (on Medicaid), or eligible for veterans' services. Custodial care, also known as "shift care," can help with bathing, dressing, meals and light housekeeping.
Medicare covers up to 100 days at a skilled nursing facility in rare situations and only after a "qualifying stay" at a hospital. The more likely range of time is 20 days. Many people living full time at a nursing home have exhausted their financial resources, and then Medicaid can become a reimbursement source.
My patients are often shocked to hear that Medicare doesn't pay for home health services. It's a shame people aren't better informed because then they are ill-prepared. The Medicare verbiage is bureaucratic and confusing.
The caring neighbors could contact Adult Protective Services and report self-neglect. APS could evaluate the eligibility for low-income or private hire services, or placement at a nursing home. They could call the distant family neighbors and explain the details. This is a tough situation and very prevalent.
Good luck responding in the future to this common situation. We are an aging society and the wave is just starting. Help people plan ahead with realistic expectations.
Thanks for your fine work. -- Mary McClain, LCSW
Dear Liz and Mary: Thank you for your very informative letters. You are helping many readers by sharing your expert advice.
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