Annie Brumbaugh has become a bit of an expert on recuperating at home. Over the last two years, the 65-year-old wardrobe consultant has had two serious operations on her foot, plus a bone graft, each of which left her homebound for weeks at a time. “This is not easy,” said Ms. Brumbaugh, who lives alone in Manhattan. “Most people have no idea what they are in for.”
Even straightforward procedures, like C-sections and hip replacements, can involve longer-than- expected recuperations. Preparing for these requires more than stocking up on novels, DVDs and plenty of frozen entrees (though such supplies certainly are useful). After a hospitalization, you will need help doing things that you’re unable to do for yourself — even with performing basic tasks like cleaning and dressing. You may need a nurse to change the bandage on a wound or to administer intravenous drugs. You may need equipment, too: a walker, a bath seat or a commode to ensure you don’t injure yourself during recovery.
Equipment and support services will help speed up your recovery, but they also can put a dent in your savings. That’s because most insurers pay for home health care by skilled professionals only during the first, acute part of your recovery. Insurers do not pay for care provided by home care aides, often needed for both short and long recuperations.
The gap often comes as a shock to patients and their families. “There’s a big misconception about what home health care is and what services are covered by insurance,” said Heather McKenzie, senior director of clinical education and quality initiatives for the Visiting Nurse Associations of America. “Most people think all home services will be covered on a long-term basis.”
Every recovery is different, of course, but the more you know and the better prepared you are, the easier it will be to make cost-effective decisions. Whether you are entering the hospital for a planned surgery or just want to be better prepared for an emergency, a few strategies can help guide your way.
PLAN AHEAD Many patients wind up in the hospital as a result of an emergency. For them, lining up home care is likely to be a haphazard process. But a surprising number know in advance that they will be convalescing, yet fail to consider the need for help once they return home.
If you plan to go to the hospital for, say, elective surgery, have a frank talk with your doctor about how long your recovery may be and what you will and will not be able to do. Then call your insurer, whether it’s Medicare or a private carrier, and ask about your policy’s home care benefits.
The insurer can give you a general sense of the services you are entitled to. Be sure to check out your long-term care policy, if you have one; it should cover temporary home care. If you’re covered by Medicare, you can find information on covered home health care services on its Web site.
Elderly patients in assisted living may need skilled aides, as well. While the staff can most likely help with showers and dressing, they probably cannot perform medical tasks, like emptying surgical drains. Don’t leave it up to the hospital to figure out what the facility can provide.
“Hospitals often make false assumptions about what assisted living facilities can and cannot do,” said Maribeth Bersani, senior vice president of public policy at the Assisted Living Federation of America. Check with the assisted living facility directly.
APPROACH HOSPITAL STAFF Let’s imagine you land in the hospital as a result of a sudden emergency. The moment you are able, begin talking to the discharge manager or the social worker about what comes after the hospitalization. Better yet, designate a family member to speak on your behalf, someone who can get the ball rolling even if you’re not up to it.
Whoever does the talking should detail the situation at home for the hospital discharge manager or social worker, including who lives with you and how much help can be provided.
“Health professionals frequently assume there is more support at home than there is,” Ms. McKenzie said. It’s important to make clear that there may not be full-time support. The hospital will have to authorize skilled nursing care for your insurer to pay; discharge planners may consider someone living alone to be more qualified for services than someone living with a spouse.
If you feel you are being hustled out the door too quickly, or that more time is needed to make arrangements, say so. If the discharge planner balks, ask to speak to the supervisor or the hospital’s patient advocate.
“Discharge managers are under the gun to get people out when an individual’s insurance company indicates denial of further coverage and may overlook aspects of your case,” said Vanessa R. Bishop, founder of Elder Care Consultants Inc. in Reston, Va.
Ask, too, if the hospital can order equipment, like a walker or commode, so it is there when you arrive home.
DETERMINE YOUR NEEDS There are two basic levels of home care: skilled and unskilled. Most insurers will pay only for skilled care, but even then you must be homebound and require only temporary care. The hospital should have arranged for short-term nursing care, if needed, before you were discharged. But typically a nurse will also come to your home and evaluate your continuing needs.
Private insurers almost never pay for unskilled help, like a home health aide. If you decide you need more help than your insurer will authorize, first consider whether you need a nurse (who may charge $50 or so an hour) or whether a home health aide will suffice (more like $10 to $38, depending on where you live).
If you do want a skilled nurse, you must get a prescription from your doctor ordering the services, even if insurance is paying.
How do you find a home health aide? It’s usually less expensive to find someone on your own than to go through an agency, so start by asking friends and family for referrals. If you do opt to use an agency, call a few and ask for price quotes. Ask, too, whether they do background checks on their workers. (They should, of course.)
A good place to start is the local visiting nurse agency. These agencies are nonprofit and privately operated, so each one offers slightly different services, but some can provide the services of both nurses and home health aides. For tips on selecting health care agencies, go to the V.N.A.A. Web site at vnaa.org.
HIRE A MANAGER If you don’t have the time or stamina to figure out an ideal home health care plan for yourself or a loved one, turn to a health care advocate or, in the case of elderly patients, a geriatric care manager.
These consultants charge an hourly fee of $90 to $160, which is not reimbursed by insurers. But a one-hour consultation could potentially save you hours of precious time.
A nurse advocate or geriatric care manager can explain how insurance and Medicare work and the services you may be entitled to, and they can speak to doctors on your behalf. If you’re interested in hiring a geriatric care manager, contact the National Association of Professional Geriatric Care Managers. If you want to find an advocate, you’ll have to ask around for referrals, as there is no central resource.
Planning for Home Care After the Hospital Stay – NYTimes.com.
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