If You’re Leaving the Hospital, Here’s What to Know About Home Care

What do you do if you’re discharged from a hospital, want the right home health aide, and have to figure out how to pay for it? On July 9, State Senator Liz Krueger–of the Upper East Side–hosted a presentation on the matter, which condensed the maze of options seniors face into a digestible menu.

The presentation was spearheaded by three professionals affiliated with the nonprofit Concerned Home Managers for Elderly Home Care (COHME): Sharon Goodstine, Laura Redensky, and Jamie Meconi.

Goodstine, an adjunct at Brooklyn College and a licensed social worker, kicked things off. She advised seniors to begin thinking about their treatment plan from the “very get-go,” which often means well before they are discharged. “Sometimes decisions are made very precipitously by the treatment team or by the doctor, and they say ‘oh you have to leave tomorrow,’” she said.

Patients might already have a long-term care insurance policy, which can ease planning, Goodstine said. People with certain conditions may also want to consider joining illness-related societies, such as those for cancer or Parkinson’s, because they can help with planning and other needs.

Goodstine then elaborated on how two federal insurance programs, Medicare and Medicaid, determine home care. Under Medicare, she said, being a “home-health aide is not considered a skilled service.” Instead, home health care is classified by Medicare as an “adjunct therapy to assist in your recovery from your medical issue.” What this means is that Medicare insurance will cover home care if it’s related to, say, related rehab work that a patient is already undertaking. It’s not effective when it comes to covering comprehensive home care in-and-of itself, in other words.

“Medicaid is the provider of choice for any long-term care need,” Goodstine continued. Medicaid, which is income-based rather than age-based, covers the managed long-term care programs that seniors may be looking for; this can include “housekeeping, shopping, and accompaniment to appointments.”

Since Medicaid has certain income cutoffs, seniors may need to seek financial assistance, Goodstine said. Pooled trusts, for example, are nonprofits that can hold onto assets that put seniors above eligibility for Medicaid. This way, they can enroll in Medicaid after paying a fee to the trust, while remaining sure that those funds can be directed towards costs such as bills.

When seniors actually enter into a managed long-term care plan, they can expect to receive five hours of home care per day, on average. People that need more than 12 hours of care per day will need an additional physician’s assessment, Goodstine noted.

If a patient is at the point where they decide they need hospice, or home care at the end of life, they’ll have to promise to not seek care in the hospital if they want continued coverage. Goodstine did note, however, that hospice will come with 24/7 availability from a doctor. Besides, she said, “it is not sometimes possible to decide if somebody is gonna live one month, or six months. People can always hope that they can do better.”

Redensky, who is COHME’s Executive Director, then took over from Goodstine to explain what patients can expect from their health aides. Having a licensed practical nurse, who work for licensed home care agencies overseen by the state’s Department of Health, will occasionally be required by a care plan. Providers can be found on the DOH’s website. Redensky then advised seniors to make a call, or compose an email if a call is not possible, to the desired agency.

Approval for these care plans often depends on how many daily activities patients need help with, Redensky added. Licensed agencies have back-up staff, and have to “have nurses available 24/7,” she said. Nonetheless, there are staffing shortages due to COVID burnout and the challenging nature of the work, not to mention an aging workforce. Redesnky also wants patients to know that LPNs cannot explicitly administer medication, although they can provide medication reminders. Crushing medication and putting it in food is a no-go, as well, ensuring patient autonomy and consent.

If patients struggle with either their insurance or licensed providers, or if they want to create bespoke care, they can always take the private care route. Meconi, a social worker, said that private patients should be aware of whether they want hourly or live-in care. They should also understand what the minimum shifts requirements are for certain private providers; Meconi specified that some shifts “can’t be broken up, [with the nurse] coming in the morning for two hours and in the evening for three. It needs to be a continuous shift.”

An intake process for a private provider will often involve an assessment of the patient’s apartment, Meconi said. This may involve making sure that necessary items such as a bed is in place for an overnight nurse, for example. A service agreement is often signed. Some nurses can’t work for patients with pets if they have certain allergies.

The three presenters aptly concluded that the home care system in the U.S. is “complicated,” and that paying for long-term care is expensive. With some preemptive planning, however, home care that fits your individual needs can be acquired.