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In-Home Care: Who Do You Call?

As a nurse practitioner making house calls during the coronavirus pandemic, I passed numerous homemade yard signs imploring us to check on our neighbors. I witnessed such altruism in action as folks left groceries on doorsteps or took pent up dogs for walks on behalf of those homebound.

home health worker pours milk into tea of elderly shut-in woman


By D. Dow Stick MSN, APRN, NP-C

The limiting or shutdown of in-person services because of the virus’ transmission risk compromised access to care for everyone but particularly for our older community members. When this population needs assistance at home, family and friends often fill in the gaps. It’s important therefore to identify who to call when someone’s care requirements change abruptly or surpass even our best neighborly efforts.

Home Health Care

Home health agencies send licensed or certified health care professionals to the home. These include skilled nurses, nurse aides and social workers plus physical, occupational and speech therapies. A life-altering event like a stroke, traumatic fall or chronic wound are just a few examples of what this team addresses.

Initiating this type of care requires a medical provider’s order and then the home health company bills a person’s health insurance. The services are not permanent and do not provide 24/7 caregivers but therapies can be re-ordered periodically as needs arise.

Home Hospice Care

Hospice is a Medical benefit that provides medical services at the end of life. Most private insurances also cover this type of care. A person must have a life expectancy of six months or less as determined by one’s medical provider(s). People often don’t elect hospice care until the last days of life when in fact the support can give life-affirming care for much longer.

The hospice team includes a registered nurse, licensed social worker, a chaplain, a nurse’s aide and even music therapy. The care is delivered wherever the person resides whether in a private home, group home, assisted living or skilled nursing facility. Hospice staff is available by phone 24/7 and if around the clock care is required, inpatient hospice units can offer this for a limited time.

Private Duty Care

For those with long-term care insurance or who can afford to pay out-of-pocket, there are private duty services. These agencies provide skilled nursing, certified nursing aides or personal aide/companion level care at an hourly rate. A registered nurse often does the initial evaluation to determine what is needed. A doctor’s order isn’t necessary nor is a specific diagnosis or condition required for enrollment. This care can be ongoing depending on a person’s funds. Regular health insurance does not typically pay for private duty care.

Geriatric care managers are an important example of privately paid, in-home assistance. Care managers are usually nurses or social workers by training and offer expert advice about local health care resources. They are invaluable in times of transition such as when an older adult is new to an area or has had a change in overall health status.

Area Agencies on Aging

Many cities and counties have collaborative councils committed to serving older adults. A wealth of programming exists through these agencies, and it is best to call or go online for specific information. An intake interview is usually free and may connect a person with local resources until a more comprehensive plan can be formulated with the person’s family, medical team or social services.

Department of Social Services

Community members should not hesitate to call upon Adult Protective Services or APS through their local Department of Social Services. These professionals are often experienced social workers who investigate cases of neglect or abuse that are threatening an adult’s safety and well-being.

Neighbors or family may fear they are “getting people in trouble” or that they themselves will be held accountable for the difficulties at hand, when in fact, exposing what is wrong may be the only way to improve a dire situation. Reports to APS can be made anonymously and caseworkers look to keep adults in their home. Examples of assistance include referrals to medical or mental health care, housing repairs, food programs and caregiver funds.

A sincere thank you to all organizations and professionals who provided and continue to offer in-person services and care despite the threat of COVID-19.

D. Dow Stick MSN, APRN, NP-C is a certified family nurse practitioner and freelance medical writer.


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