Posted by Frank Gagnier

Dana McCoy, RN

Angel Watch "Home Health Care"

 

Home Health vs Private Duty

 

 

What are Skilled Care Services?

Nursing and Therapy Services are provided in the home either after a hospital stay or by doctor referral. 

The patient must be homebound.

Services Provided:

   ◦Nursing

   ◦Physical Therapy

   ◦Occupational Therapy

   ◦Speech Therapy

   ◦Certified Nursing Assistant

   ◦Medical Social Worker

 

Dana explained that a person is considered homebound if they have an illness or injury that restricts their ability to leave their residence except with the aid of supportive devices (canes, wheelchairs and walkers), special transportation or another person. Having a condition for which leaving home is medically contraindicated is also considered homebound and that, “leaving the home is a considerable and taxing effort."

 

Who Pays for Skilled Care:

Most patients are on Medicare – if a patient is on Medicare, there is no out of pocket expense.

Insurance companies (e.g. United Healthcare, BC/BS of Florida, Aetna, etc.).

Veterans Administration (there are qualifications that must be met).

Private pay.

 

What are Private Duty Services?

In home support to help the elderly stay independent as long as possible

Services include:

   ◦Fall prevention

   ◦Medication adherence

   ◦Assistance with activities of daily living

   ◦Light cleaning

   ◦Grooming

   ◦Proper nutrition

   ◦Shopping, Dr. appointments, errands

   ◦Companionship

 

Who pays for private duty services?

Primarily paid out of pocket.

Long Term Care Insurance (LTC).

Veterans Administration (VA).

 

 

Dana listed these Reasons for having Private Duty Care:

Tired caregiver

   ◦Spouse with dementia

   ◦Elderly person up at night

Parent or grandparent slowing down

Recent health issue or hospital stay

Just need a little extra assistance

Anything but the nursing home!

 

The people who need skilled care are those who are going in for a medical procedure and will be homebound after the procedure.  Typical procedures would be hip or knee replacement, open heart surgery, a chronic condition that requires monitoring like diabetes, congestive heart failure or COPD.

 

Now here is the big news of the day:

Medicare advantage just announced their plans will start covering Private Duty care in 2019.  This paves the way for large insurers to pay for Private Duty services.  The purpose is to compensate for physical impairments and reduce avoidable emergency and health care utilization.

Consolidation of companies to provide a larger breadth of services from a single entity such as Aetna & CVS and Humana & Walmart.  Even Amazon is getting into the mix of helping people "Age in Place" campaign.

 

In closing, Dana suggested we know what is available and to keep up with the changes and have a plan ahead of time to prevent a crisis down the road.

 

United Healthcare Complete is a Medicare Advantage policy.  For more information, you should contact Nancy Dervaes who is our local United Healthcare, Medicare Licensed Representative at 904-624-0160 or nancydervaes@gmail.com 

 

Along with being a Rotarian, Dana McCoy is the Director of Operations for Angel Watch Home Care.  She has been an RN for over 25 years.  In that time, Dana has worked in a variety of nursing roles and environments including post-op cardiovascular surgery unit, cardiac rehabilitation, clinical management, Medicare claims auditing, home health care and parish nursing.  Dana has a special place in her heart for the elderly and has always done everything in her power to deliver high quality and caring service in their times of need.  Dana has deep roots in the Amelia Island/Fernandina Beach community.  Her family has lived on the island for over 100-years and more than anything, she wants to make sure there is a caring local company available to meet the home health care needs of our community.  Dana has been married to her husband Kevin for 29 years and has two children, Megan and Brett, who are working as an OTA and PTA respectively.