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Nursing home care or home care? If in the doctor's opinion, the patient's condition is
such that there is a need for medical care or medical supervision
that is not available at home, the only alternative is a nursing
home. Other common reasons for admission to nursing homes are cognitive
impairment and behavioral problems.
During the course of long-term home care there may be
relapses, resulting in a hospital stay. At the time of hospital
discharge the patient is re-evaluated as to whether his/her future
care should be at home or in a nursing home. Assuming the patient's
health has not deteriorated, satisfactory past home care
"performance" -- by the attendant (s), patient and possible
outside family supervision (which is a plus), could support a
recommendation for continuing home care.
At this point, if the doctor thinks it appropriate,
Medicare may provide a visiting nurse and/or a physical, occupational
or speech therapist, but usually for a limited time. As I stated at
the outset, it is preferable to have family supervision close by but,
lacking that, partly or altogether, the patient's capacity to manage
the household independently becomes a key factor.
I have seen examples of unbelievable ability by
physically incapacitated persons, wheelchair-bound or walking with
difficulty, but with the capacity to take care of their households,
including medical care (scheduling doctors and transportation,
managing medication and breathing equipment etc.). They usually need
help with paperwork. So many of my non long-term clients also have
physical disabilities -- walking in with one or two canes (a shopping
cart I was told, gives better support than canes), as well a lady in
a power-driven wheelchair, who is still working. I am in absolute awe
of my peers -- many more heroines than heroes, I might add. The point
I am making is that home care can be viable because many of the
seniors and the under-65 disabled are truly profiles in courage.
On the other hand, there are individuals who, for any
number of reasons, are not "candidates" for home care. An example
-- someone who, over time, becomes "dead weight" and cannot
be handled by one attendant. So the question "nursing home care
or home care" is a definite unknown at the time of long term
planning, and the cost of a live-in, 24-hour home attendant, hired
directly, would usually be less than a nursing home. This last point
is important in considering the daily coverage of the insurance
policy.
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