The fact is that more and more people are living to be a ripe old age and we are not all that healthy.

Playing tennis at 90? Golf at 95? I don’t think so. For every one healthy individual over 75 there are many who are in need of assistance with their activities of daily living.. their washing, bedding, eating, and mobilization.

Medicare has changed the way it pays for home health care since the passing of the Balanced Budget Act by President Clinton. Now, agencies are paid on an aggregate and not on a per visit episode. This creates an atmosphere of holding back visits whenever possible. It was designed to cut back on wasteful spending. Assisting a 95 year old that cannot get out of bed himself with no other acute needs was considered wasteful by Medicare standards. The home healthcare benefit was initially set up for acute needs. The impeding needs of our elders has changed. The home health care benefit under Medicare was accommodating the needs in some ways until the law took affect in 1999.

What do we do with all of the chronically ill patients out there? How do we administer custodial care when the patient does not have a skilled need (that REQUIRES the service of a registered nurse or therapist)(the only way Medicare will pay for home health care for a limited amount of time)? What about younger patients not on Medicare? Other insurances, especially HMO’s are very frugal with home health care allowances.

For many, it is a matter of paying for the services themselves. At $14-$21 dollars an hour the weekly bill for a patient receiving just 4 hours of serves a day, 5 days a week at $16./hr. = $320.00. That’s $1280.00 a month. Many elders can afford this and many cannot. There are also those that need many more than 4 hours a day. There are a few solutions.

First, you MUST plan. Your children &/or caretakers are going to decide on your long term care if you have not planned for it. This can be overly stressful for them and for you.

Your choices consist of (1) private pay home health aide care in you home, (2) long term care insurance (very fair and generous)paid home health care services, (3) nursing home services (both privately paid and paid by Medicaid)(care varies widely and admission is sometimes delayed for months creating a home health care need during this lag time), (4) assistance from city/county aging corporations (in Philadelphia there is Philadelphia Corporation for the Aging that has programs for those that are financially needy (or not, at times) but the waiting list can be up to 4 years long….PLAN AHEAD! CALL AS SOON AS THE NEED IS ARISING. DO NOT WAIT UNTIL THE LAST MINUTE).

The other issue with care in your home is finding the right caregiver. Home health aides vary. There are many who are excellent and then there are those who are not so good. There are agencies that are more experienced with a certain type of patient (pediatrics, cancer/hospice , Alzheimer’s disease). This is a matter of trial and error and can be very frustrating. Be patient. Call the agency to discuss your concerns early on and remember even the best situations aren’t perfect. Try to be flexible. Your foremost concern should be safety. I think the second concern is the quality of care provided (not if the aide has a nose ring, long nails or has the wrong color hair)(unless their is a health concern). Is the patient safe at home when there is no caregiver there? Address issues. Medic-alert bracelets/necklaces are a help, neighbors, frequent visits by family & friends, meal-on-wheels and even sitters to fill in between aide services all help.