Home care services vary greatly based on one's level and types of need. A worker may perform household tasks such as cleaning and shopping, or drive a client to doctors' appointments. It can also be assistance with daily tasks such as dressing, eating, and toileting. In-home services may be for a few days or for many years.

While home care may include health-related tasks such as medication reminders and preparing low-sodium meals, it does not include professional nursing or medical services.

Once you’ve decided what services you need, the next step is to choose whom you want to provide those services. This can be a scary time, because you may feel vulnerable to the strangers coming to help you. “Will I be safe?” or “Will they take advantage of me?” may be questions you ask yourself.

If you are working with a case management entity, they be able to assist you in locating quality people to come into your home. But whether you are hiring your own helpers or working with a case manager, there are some questions you can ask and steps you can take to make sure you know what to expect and are satisfied with the quality of people scheduled to help you.

When hiring helpers at home, ask or do the following before they enter your home:

• Ask the agency for references (people who know about the agency and the kind and quality of work it does), and check them out. Ask questions like:
  • Does the agency have extra insurance on its employees to cover theft and/or breakage?
  • Is your Area Agency on Aging familiar with this agency?
  • Is it a member of the Better Business Bureau or the Chamber of Commerce? If so, has anyone lodged a complaint about the agency or one of its employees?
  • If you are not satisfied with the answers to any of these questions, look for another agency.
• Ask for references on each employee and check them out. This is especially important if you are hiring someone who is not from a known agency.
• Interview the worker. If possible have a family member or friend with you the first time you meet the worker or during any interviews you have. Remember, you will likely feel more comfortable if someone you trust is there as you get to know your new helper. There are many books and articles with questions on how to interview. For more help, call your Area Agency on Aging or your case management entity.
• Ask about the training and supervision of the people you are hiring. Some questions may be:
  • Is the worker trained to do the kind of work you need done? By whom?
  • What kind of supervision do they receive (should it be under a nurse or social worker)?
  • What task is each worker allowed by law to perform? You should not ask workers to jeopardize their jobs by asking them to do things that they are not allowed or trained to do.
• Ask how payment arrangements are made (if possible, never pay in cash):
  • Will you be billed after the services are provided or do you pay before you get them?
  • What if you are not satisfied or the worker doesn’t show up? Do you get a credit? How do you get another worker?
  • What kind of receipt is provided for services? When you have hired someone to shop for you, insist that they provide you with receipts for purchases they’ve made for you.
  • Will you have to sign or initial a time sheet? Will you get to keep a copy of the time sheet? Never sign an incomplete time sheet.
  • Do not give a worker access to your checking account, credit cards or Social Security number.
• For the first few times, ask for identification before letting the person into your home. Read their card, badge, etc., and make sure this is who you are expecting. If not, contact the agency before opening your door.
• Ask for and expect regular contact with the helper’s supervisor. Make sure you can reach the supervisor whenever there is a problem or concern about the worker.
• Remove temptation. Once you have hired someone to help you, take a look around your home.
  • Do you have valuable jewelry that will be noticed by the worker? If so, put it in a safe deposit box or other secure location.
  • Do you have a lot of cash on hand? It is never safe to have money tucked away in a drawer. Put it in the bank.
  • Do you have your blank checks and bank statements sitting on a desk in plain view? Again, put them away. Purchasing a small locking file cabinet for such items can remove a lot of temptation for others.
  • Do you have valuable or fragile family heirlooms? Now may be the time to give those items to whomever you have selected to receive them after you are gone. You can still have the pleasure of seeing these items when you visit their home without the worry of accidental breakage.
• Remember that you are the customer and have the right to expect courteous, respectful help from people who are on time and work hard. This is true regardless of the funding source used to pay for the services. As helpers, they have the right to expect prompt payment for service (usually to their agency) and be treated with respect. If you do your homework, you will likely find terrific people who will help make the changes in your life easier to handle... and you may also make some wonderful new friends.

Home health care can include skilled nursing, occupational, respiratory, speech and physical therapy or home health aide. It can include assistance with dressing, bathing, toileting and self-administered medications. Home health care covers the use of assistive devices such as walkers, hospital beds, wheelchairs and oxygen. Home health care is usually medically oriented and is different from the homemaker and personal care services mentioned in the next section. People who provide home health care can be registered and licensed practical nurses, therapists or homemaker/home health aides. They usually work through a home health agency, hospital or public health department.

Kansas home health agencies must be licensed and surveyed annually. You may be able to verify their reputation through your local health department, Area Agency on Aging, or Kansas Department of Health and Environment. Ask the agency if they are accredited by additional professional organizations and request a copy of the accreditation report. All home health agencies are required to follow the Client Bill of Rights and a copy should be given to each client. If you have any care related problems, call 800-842-0078.

Medicare or Medicaid may pay for home health visits if all of the following conditions are met. You:

1. Must be homebound;
2. Need intermittent skilled nursing care, physical therapy, or speech therapy;
3. Must be under the care of a doctor who determines you need home health care and sets up a home health care plan;
4. Must use a home health agency certified to provide Medicare services;
5. Meet the age and resource eligibility guidelines when using Medicaid. You do not have to pay a deductible or coinsurance when you receive home health care covered by Medicare, with the exception of a 20% co-payment on durable medical equipment (like a wheelchair). Private insurance, Medicare supplement or long term care insurance may also cover some home health care expenses. Many home health agencies also offer services on a private pay basis. There may be other sources of funding assistance available as well. Call your local Area Agency on Aging for programs and eligibility information.

Usually, individuals receiving home health care services pay for these services themselves. Some health insurance and long term care insurance plans cover home health care, and short-term services may be covered by Medicaid or Medicare.

Hospice is a service that provides care and support to individuals and families coping with terminal illness. There are many independent providers of Hospice services. A physician’s orders are required to receive Hospice care. Each patient is cared for by a team. Nursing and other medical and home-health personnel, social workers, chaplains and volunteers provide a range of services including pain relief, symptom management and supportive services for the patient and caregiver. Hospice agencies are certified and surveyed by the Kansas Department of Health and Environment.

Services are provided whether the patient lives in a private home or a nursing home, under a doctor’s direction and in cooperation with a designated caregiver. Arrangement for inpatient care is made when needed. Hospice staff assists the caregiver in caring for the individual. Members of the care team will visit on a regular basis or at the request of the caregiver. Staff can be reached 24 hours a day, seven days a week.

Hospice care may be covered by Medicare and Medicaid if the patient has Part A Medicare, a physician’s orders and a diagnosis of terminal illness. Check with other insurance options to see if hospice coverage is provided.

Hospice agencies are located across Kansas. To learn what is available in your area, contact your physician or reference the ADRC Regional Map of Locations for regional phone numbers.

Home-delivered meals are available in many Kansas communities to individuals who have been determined to meet established eligibility criteria. Meals are nutritious and tasty and are delivered by volunteers. Frozen or “shelf-stable” meals requiring minimal preparation may be available in some areas. Some providers deliver two meals daily, but most deliver only one. Special diets may be available to those who need them. In some areas of the state, (e.g., remote, rural areas) a multi-day supply of meals may be delivered.

A donation is suggested for meals, but is not a condition for receiving a meal. Spouses, regardless of age, can also receive a meal on a contribution basis if it is in the senior’s best interest.

For more information reference the ADRC Regional Map for regional phone numbers.

Hospital beds, wheelchairs and walking aids, bathroom safety devices, and oxygen tanks and ventilators are just some of the helpful products and devices that are available for home use.

Many companies sell or rent durable medical equipment for home use. Some offer professional evaluation of the client and his or her home environment. They provide instructions on how to use and maintain the equipment, and may offer emergency service in case the equipment breaks or malfunctions.

Many types of home medical equipment are covered by Medicare and private insurance. Otherwise, individuals pay for these products themselves.

A broad range of reminder services, "smart devices," and other tools help individuals manage their health, take medications on time, and record health information. For instance, emergency response or medical alarm systems enable users to contact 24-hour emergency assistance at the push of a button. Depending on the type of product or service one chooses, potential benefits include: reducing the burden of remembering medication schedules, early detection of side effects or clinical deterioration, immediate and personalized answers to health questions, and emotional support.

Individuals usually pay for these services themselves. You may also wish to check whether your health insurance or long term care insurance plan covers monitoring and reminder products or services.

The Program of All-Inclusive Care for the Elderly (PACE) was developed by Medicare/Medicaid to meet the health care needs of individuals who wish to remain in the community.

The PACE program provides comprehensive health care services designed to meet the following goals:

• Enhance the quality of life and independence for older Kansans.
• Maximize dignity of, and respect for, older Kansans.
• Enable older Kansans to live in the community as long as possible.
• Preserve and support the older Kansans family unit.

A team of professional and paraprofessional staff assesses the participant’s needs, develops a plan of care with the individual and his/her caregiver, and delivers all services (including hospital and other acute care and when necessary, nursing facility services). The PACE provider coordinates and provides all needed preventive, primary, acute and long term care services, so that older Kansans who need nursing home level of care can continue living in the community. The PACE service package must include all Medicare and Medicaid covered services, such as but not limited to:

• Adult day center services
• Diagnostic tests and other acute care
• Durable medical equipment
• Hospital/emergency care
• Meals
• Medications
• Nursing care
• Nursing facility care
• Nutrition counseling
• Oral health
• Personal care
• Primary care physician
• Restorative/physical/occupational therapies
• Surgical care
• Social services
• Transportation

Please contact one of the PACE organizations and they will provide an initial overview of PACE. To be eligible to enroll in the program an individual must meet the following requirements:

1. Be 55 years of age or older;
2. Be assessed to meet the functional eligibility guidelines established by the State of Kansas;
3. Reside in the service area of the PACE organization; and
4. Meet any additional program specific eligibility conditions imposed under the PACE program agreement.

Currently, Kansas has two PACE centers:

316-858-1111
Via-Christi HOPE serving Sedgwick county

785-232-2044
Midland Care Connections serving Shawnee, Douglas, Jackson, Jefferson, Lyon, Marshall, Nemaha, Osage, Pottawatomie and Wabaunsee counties

316-284-2900
In the future, Bluestem Communities will be serving McPherson, Lincoln, Ottawa, Ellsworth, Saline, Dickinson, Rice, Marion, Reno and Harvey counties

Waiver programs are opportunities for states to test innovative ways to provide and pay for home and community-based services. States can implement new service programs that were not previously covered under Medicaid. The programs are monitored in order to measure whether they are effective in serving consumers and do not cost more than traditional Medicaid services.

An example of a waiver program is the use of Medicaid to pay for in-home care services. The purpose of this waiver program is to keep consumers out of long-term care institutions by providing the same care in the home at the same or less cost.

Waiver programs, by definition, are funded by Medicaid dollars. In some instances, eligibility is expanded to include those who would otherwise not be eligible for Medicaid.