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CARE AT HOME
CARE AT HOME

Definition

Most people who are living at home with a serious illness receive some form of care and support. This is often provided by family members. If extra help is needed, daily care can be obtained by hiring a home health aide through a home care agency. This type of care may be needed on a limited basis or as much as 24 hours a day, 7 days a week.

Types of care include the following:
  • Skilled Care – short-term, intermittent visits and care from a nurse or physical therapist
  • Custodial Care – care for Activities of Daily Living (ADL), such as bathing, dressing, etc.
  • Other Support – additional services you may need depending on your situation
It is important to understand the difference between skilled care and custodial care so that you know where to begin to look for support and what is covered under your insurance. Skilled care services often include some support for custodial care, while custodial care does not usually include skilled care services. Both types of care can be arranged when you are discharged from the hospital, sub-acute rehabilitation facility or when you are living at home.

Medicare and other primary insurance providers will usually cover skilled services after discharge from a hospital or sub-acute rehabilitation facility. Policies differ, however, and services covered will be based on your level of skilled needs and expectation for recovery.

If you are a veteran, you may be eligible for skilled or custodial care through the Veterans Health Administration (1-800-827-1000).

Skilled Care at Home

Skilled care is a service to address a medical need. At home, it is provided by a Certified Home Health Care Agency (CHHA) or a hospice program. Skilled care with a CHHA includes the services of a:
  • Registered Nurse (RN)
  • Physical Therapist, Occupational Therapist, or Speech Therapist
  • Home Health Aide (HHA)
When a CHHA provides skilled care services, the purpose is to restore and maintain an individual’s optimal level of function and health. These services are provided instead of hospitalization, admission to a care facility, or going to an outpatient office.

Commonly, skilled care is provided for six to eight weeks and includes items such as wound care, injections, or therapy (physical, occupational, speech)directed at restoring or improving function. It may include medical equipment, such as an electric bed, specialty mattress, or respiratory support like oxygen and other devices.

During the time that the CHHA is providing services, the agency may be able to offer a Home Health Aide (HHA) to assist with Activities of Daily Living (ADL), such as dressing, bathing, and feeding, for a few hours a week. However, this is not the primary purpose of skilled care. When the CHHA’s skilled care services are finished, any added services end except for medical equipment, which will be provided for as long as you need it based on your medical situation and qualifications.

Medicare and private insurance usually pay for skilled care, although the insurance plan (Medicare and commercial insurance) determines the extent and level of care that is covered. Many people are surprised when they are not eligible for CHHA services, even when there are high levels of frailty or advanced stage of illness.

If you are on Medicare, learn more about your service needs and if Medicare will pay for them. If you have private insurance, you can contact your insurance company to learn what services are eligible. It is usually a good idea to ask for a case manager to be assigned to your case. The case manager will get to know you over time and can help advocate for your needs.

If you are at home and would like to receive services from a CHHA, you have two options:
  1. Call the CHHA directly; or
  2. Call your doctor’s office and request that services be ordered. Be prepared to specify what your needs are (for example, changing wound dressings, shots, IV medication, or occupational therapy).
Custodial Care at Home
Custodial care is often an important part of living with a serious illness.

Custodial care is non-skilled care delivered by a Home Health Aide/Attendant (HHA). Custodial care involves assistance with Activities of Daily Living (ADL), such as walking, cooking, cleaning, bathing, dressing, and using the bathroom. Help with these tasks is usually provided by a family member or HHA, not a Registered Nurse (RN).

Aides are not allowed to assist with medication preparation, wound care, catheter care, or suctioning devices. Aides who provide custodial care can be obtained through a Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA), or by privately hiring someone using recommendations from friends, family members, or an aging-in-place organization.

Aides have different levels of training, skills, and different titles. In New York State, a Home Health Aide/Attendant (HHA) usually has more training and skills than a Personal Care Aide/Assistant (PCA). Aides who have been trained abroad or outside New York State may be labeled differently and have different skills and levels of training.

Custodial care is not covered by Medicare or private health insurance unless the person is also receiving skilled care services. The cost of custodial care can be high over a person’s lifetime. Additional details on the How to Pay for Care at the Home page in The Guide.

Regardless of payment or coverage, every individual approaches the situation of hiring a home health aide differently. Understanding your needs and abilities is a good starting point. Whether you are speaking with an agency or hiring someone privately, you may consider the following:
  • How many hours of help do I need, per day or per week?
  • What activities of daily living support are needed?
  • What additional care do I require?
  • Can the aide or agency provide references?
  • Who will coordinate the schedule of the home health aide?
To work well with an aide, it is important to identify and clearly communicate your needs, how you like things done, and any other important issues that need to be understood. The amount of time you spend with a home health aide can be long and includes social time together. It is important to discuss shared activities, such as watching TV, reading, and mealtimes, and to explain what you want from the beginning.

In the final analysis, your choice of aide will be based on a balance of your needs, your financial situation, and the aide’s training, experience, and personality.

Other Support Services
If you are living with a serious illness, often needs go beyond skilled and custodial care in your home. Depending on your situation, you may want to explore other services and resources, including the following. 

Adult Day and Night Care

Adult day care programs can be helpful for individuals with serious illness who need skilled and/or custodial support services in a place away from home during part of the day (or during the night). Many programs also offer respite for family caregivers. Westchester County government divides adult day care into medical, psychiatric, and social programs.

There are a few questions you may want to ask before deciding on an adult day care program. Learn more about when adult day care is appropriate, and the questions to ask when selecting an adult day care program.

Aging-in-Place Organizations 

Aging-in-Place organizations are grassroots, membership organizations, formed by area residents rather than by government agencies or social service providers. While they differ based on the needs and resources of each community, most Aging-in-Place membership groups provide a mix of social support, health care, and home maintenance services, including referrals to local service providers and agencies for in-home and personal support. They can sometimes provide volunteer transportation for personal care and medical appointments, as well as cultural and social activities. Individuals and couples pay yearly dues to join a local Aging-in-Place organization. In Westchester, the annual dues can range from $50 to $400.

Illness-Specific Resources

Many organizations in Westchester offer support to individuals and families with specific illnesses. These organizations provide a range of services, including care consultations and helping you understand your choices, accessing available services suitable for your illness, organizing your daily life, and accompanying and driving you to medical appointments. They also have support groups, can help you find funding for your care, and occasionally offer financial gifts for specific purposes. 
Illness-specific support organizations in Westchester, including ALS, cancer, Alzheimer’s, and dementia.

Veterans Health Administration

If you have served in the United States Armed Forces, you may qualify for veterans’ benefits and services that can ease your life with a serious illness. Your entitlements are determined by the length of your military service and service-connected disabilities, as well as your financial needs. Among the benefits are disability compensation and pensions, access to medical care, and long-term care facilities through the Veterans Health Administration (VA) health care system.

It is important to understand that in order to obtain services from the VA for skilled or custodial care you will need to be seen by a VA provider. This does not mean that the VA provider needs to be the primary provider of your care. You continue to use your local physician and/or specialists and only see the VA provider if it is required to access services.

Information about VA contact information in the Bronx and Hudson Valley.

Westchester Government Services

The United States and the New York State governments offer a number of programs and services for individuals who are living in their homes and need additional support. Westchester County government administers many of these federal and state services for its residents. For Medicaid-eligible individuals, these include medical assistance in combination with Medicaid and NY Connect. Medicaid information in Westchester.

Individuals who are not Medicaid eligible and want to remain at home can apply for Expanded In-Home Services for the Elderly Program (EISEP), which assists older New Yorkers who need help with activities of daily living (e.g., dressing, bathing, personal care) and instrumental activities of daily living (e.g., shopping, housekeeping, cooking). Case managers help elders and their families decide what assistance is needed and arrange for services that may include non-medical in-home services, non-institutional respite services for caregivers, and other related services available in the community. EISEP supports and supplements care provided by families and friends. Participants whose incomes are above 150% of poverty share in the cost of the services, according to a sliding scale. 
Additional information from Westchester County Office for the Aging.

Westchester government also administers and advises about other support services, including Elder Caregiver Support Programs, Eldercare Locator for Westchester, Home Care Services, Housing Assistance, and various Long-Term Care Services. Eligibility for these programs varies. You can contact Westchester government offices to discuss if you qualify for these services or speak with an Elder Law attorney. 

Contact information for Westchester County offices for Social Services, Health Department, Mental Health, and the Department of Senior Programs and Services.

Transportation

Some aging-in-place organizations, illness-specific organizations, and social service agencies have volunteers who can help you with transportation needs. RideConnect is an initiative of a private, not-for-profit and nonsectarian agency that offers volunteer transportation and information about transportation resources. WestFair Rides is another transportation agency in Westchester.
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