Home and Community-Based Services

Home- and community-based services refer to the whole array of supportive services that help older persons live independently in their homes and communities. Often, such services are provided by not-for-profit organizations sponsored by religious or fraternal groups or other community organizations.

There are a variety of community services that can benefit older adults. One person may need only a little help with shopping to be able to live at home. Another person may need a mix of services, such as help with housekeeping, transportation and preparing meals. Others may seek social contacts through senior centers or volunteer activities, such as the foster grandparent or senior companion program.

Caregivers of older people who are chronically ill or disabled also benefit from home- and community-based services. For example, adult day care and respite care enable caregivers to work or take time off from caregiving responsibilities, knowing their loved ones are getting the care they need.

What Types of Services Will You Need?

One of the best ways to anticipate the types of services you will need is to educate yourself about the concerns that may affect older adults.

Work with your physician to develop your understanding of the issues with which you might be dealing. Don't hesitate to ask what types of care you might need "down the road" given your physical condition. You aren"t asking the doctor to predict the future, but you are asking for guidance as you begin to research your options.

Sampling of Skills

A general overview of your physical condition and skills is often a good place to start planning. As you look over this list of skills, are there areas where you are not sure if you can manage the task? Are you worried about your ability to "keep up" with these tasks?

If you have decided that home- and community-based services are the best option for yourself or a family member, here is a checklist of things to remember. If you believe any of these could be a problem for you, let us help you access the appropriate service so that you can relieve your worries and still live independently in your community.

Decide what activities you need help with. Consider if you might now or in the future need help in any of the following areas:

Managing Medications

• Taking the correct dosage at the correct time
  
• Keeping track of the types of medication you currently take
  

• Driving a car
  
• Traveling by bus or taxi

• Home health
  
• Rehabilitative therapy
  
• Other medical care -- These services can be provided in the home or in a community setting.
  

• Shopping for food
  
• Preparation of nutritious and well-balanced meals -- Some services can deliver meals to your home, and congregate (group dining) meal programs are also an option.

• Shopping for clothing
• Doing laundry correctly and as often as needed
  
• Dressing oneself

• Bathing
• Personal care
• Using the toilet

• Sleeping through the night

• Light housekeeping
  
• Heavy housekeeping
  
• Yard work

• Managing accounts/investments
  
• Writing checks/paying bills
  
• Managing legal matters
  

• Using stairs and outdoor steps

• Able to be alone
  
• Able to make phone calls
  
• Not being lonely or isolated

Services Available

A wide variety of resources are available to you to help fill gaps in skills and functioning. We provide many of these services. If you need a service we do not provide, we can help you locate and access the service through other providers. Some of the services you might find helpful include:

• Assistance with shopping
  
• Case management
  
• Chore services
  
• Friendly visiting
  
• Home health aides
  
• Home health care services
  
• Home repairs and maintenance
  
• Homemaker services
  
• Housing (including a wide variety of housing with services)
  
• Legal assistance
  
• Meals programs
  
• Medical alert products
  
• Medicare/Medicaid assistance
  
• Rehabilitation and therapy
  
• Senior citizen centers
  
• Snow removal and lawn maintenance
  
• Telephone reassurance
  
• Transportation
  
• Veterans' services
  
• Visiting nurses
  
• Wellness training
  

A description of some of these services will help you identify which ones might be helpful. Later in this handbook, we will discuss the easiest ways to access them.

Community-Based Services

Case Management

Case management services include responsibility for locating, managing, coordinating and monitoring all proposed services and informal community supports needed by an older adult or disabled person. Case management activities include:

• Client placement
  
• Reevaluation of level of care
  
• Reassessment of your need for community services
  
• Review of providers and services
  
• Locating, managing and coordinating community services
  
• Monitoring and maintaining documentation of program requirements
  
• Client records and quality of care
  
• Review of your progress
  
• Review of social and medical necessity of community services
  
• Determination of cost-effectiveness of community services
  
• Contracting for services
  
• Providing information and referral, advocacy, crisis intervention, protective and guardianship services and assistance to help you locate safe and appropriate housing.
  

If you are otherwise able to manage at home, some of the most successful assistive services are related to chores in and around the house. Chore and homemaker services cover minor household repairs, yard work, housekeeping, shopping, meal preparation, assistance with self-administered medications and personal care.

Many older adults readily accept help with lawn mowing and maintenance, snow removal, basic home repairs, cleaning, and the putting up and taking down of storm windows.

You might have difficulty with heavy, or even light, housekeeping. It is possible to hire someone to come in on almost any schedule (once monthly, or weekly, or more often) to dust, vacuum, wash floors, clean the bathrooms and kitchen, and do laundry.

It is relatively easy to hire someone to provide these services. A good resource might be the want ads, or neighborhood teenagers (contact the high school to see if they have a volunteer program), or even a professional lawn or maintenance firm. Additionally, many communities have programs where volunteers assist with these tasks as part of an organized event sponsored by churches or other charitable organizations. Please let us know if you would like us to provide you other access resources or if we can  help you find assistance.

Companionship

Many people can benefit from the company of a companion or "friendly visitor" program. Older adults often become isolated as their children take on the responsibility of raising their own children. Also, as you advance in years, it sometimes becomes more difficult for you to leave the house to socialize.

Companions or friendly visitors are not able to provide health/personal care but they can provide company, reminiscing, reading to you, playing cards, and sharing meals. Sometimes you might enjoy going with a companion to a movie, concert, or other event.

Another variety of "friendly visitor" is the telephone reassurance program. Each day, the caller will phone you to check on you, remind you to take your medication, and provide some conversation and company.

Medical Alert Products

Medical alert products can offer peace of mind for older adults who live alone, and for their families, by providing a way for the older adults to communicate if they need help.

Emergency Transmitters: Emergency transmitters (for example, Lifeline transmitters) enable an older adult to call for help in an emergency simply by pushing a button on a transmitter worn around the neck. When you need emergency assistance, you simply press the help button. The signal goes to a central operator, who telephones you. If there's no answer, then a predetermined friend or relative is called and asked to go to your home to check on you.

Medical transmitter programs are available anywhere with telephone communications. You can work through a hospital or home health agency to ensure you are using a dependable firm.

Medical Alert Bracelets: These bracelets or necklaces are embossed with vital health information and/or a telephone number where emergency personnel can call a central resource to receive vital patient information.

Meals Programs

Meals Delivered to the Home: Through programs like Meals on Wheels, nourishing meals can be delivered to your home by volunteers. To find out about programs offered, let us help you or ask the area agency on aging, or senior centers, clubs and organizations.

Meals Provided in the Community: Many schools, hospitals, churches, and senior centers provide meals in their facility to older adults on a regular basis.

Senior Centers

The senior center is an excellent social contact for well elderly who can get to the center on their own (although sometimes transportation arrangements are available).

Senior centers provide opportunities for socialization and recreational activities for older adults. Today, many senior centers offer a wide variety of programs including social, exercise, and health-screening programs. You can go to one of these centers for a class, a film, a game of cards, and a hot, nutritious meal.

Additionally, the local senior center is an important access point for other programs. The staff at the senior center pass along information about programs and benefits for older people. These centers also may offer legal, financial and counseling services, and often provide transportation.

Transportation Services
Some groups offer volunteer drivers to bring older adults to their functions -- church services, club meetings, or senior centers.

Assistance with Medical and Personal Care

Home Health Agencies

The typical home health agency offers three general categories of care:

Homemaker-type services:  Homemaker-type services include taking care of household chores. This category of service also includes friendly visitors and telephone reassurance programs which provide companionship and someone to check on you. Homemakers and friendly visitors do not provide personal care or nursing services.

Home health aide services or personal care:Home health aides and personal care workers provide personal care services, including help with bathing, dressing, and other types of personal care. Some home health aides provide light housekeeping, and home health aides also may be able to apply prescribed ointments and change dressings. A home health worker provides many of the same services as a nurse's aide in the hospital or nursing home.

Skilled medical care: This level of home care includes visits from a registered nurse in addition to care from a home health aide. Skilled medical care also can  involve visits from physical and occupational therapists.

When contracting with a home health agency, make sure the agency is licensed by the State Department of Health and Family Services. Ask if the agency is Medicare certified. Are employees insured and bonded? The home health agency should carry adequate insurance, including malpractice insurance for nurses and other professional personnel. Home health aides should be supervised by a registered nurse to whom you have easy access. There should be structured case management by a registered nurse supervisor at least once a month.

There is a cost involved in home health care. The agency will be able to determine whether you are eligible for insurance coverage and for how long. Sometimes a physician can "order" a home health aide, homemaker, or skilled care. This often is valuable in obtaining insurance coverage.

Financial Assistance Available for Home- and Community-based Services

The financial assistance that is available depends on the type of service, the area in which you live and the type of insurance you have. Meals and transportation often are available through local senior programs for a suggested contribution.

Medicaid is the joint federal and state program that helps older people and those with disabilities pay for nursing home care and health care at home after they can no longer afford the expenses themselves. Medicaid pays for some community services, usually limited home health, hospice and personal care, depending on the state in which you live.

Medicare, the federal program that underwrites health insurance for persons 65 and older and some persons with disability, also covers limited home health and hospice care. Other federal assistance, such as the Older Americans Act and social services block grant funds, pays for some supportive services.

The long term care community options program (COP) screens persons who are at risk of entering a nursing home or state Center for the Developmentally Disabled to determine whether they can be served by non-institutional, community-based services. The program provides for both assessment of persons to determine if community-based services are appropriate and funding for eligible, low-income persons to obtain those services necessary to remain at home or in the community.

Considerations

If you have decided to utilize any of these home- and community- based services, do your homework prior to committing to the service. Educate yourself as to the service you will receive and what financial liability you will incur.

• Consider the fees for the services.
  
• Find out if your insurance company will cover the services.
  
• Consider if Medicaid can assist in paying for this service. Medicaid pays for some community services, usually limited home health, hospice and personal care, depending on the state in which you live.
  
• Also consider if Medicare can assist in paying for this service. (It also covers limited home health and hospice care.)
  
• Explore COP and other forms of federal or state assistance that may aid in paying for the service. The Older Americans Act and Social Services block grant funds may be able to offer some assistance.
  

Go to Introduction
Go to beginning of Home and Community Based Services
Go to Senior-Specific Residences
Go to How to Access Services
Go to Stay Organized
Go to Making the Transition
Go to The Not-for-Profit Choice
Go to a listing of the not-for-profit facilities and services that are members of WAHSA.