This long-term program may also be called home support, home care, continuing care, or community care. To qualify, you must be assessed by a nurse, social worker, physiotherapist, or occupational therapist. Most in-home support programs use homemakers with special training or resident care aides or certified nurse aides to assist elders with personal care such as bathing, dressing, and grooming.
Home care is usually free if you do not have much income; otherwise, payment is on a sliding scale depending on income. The assessors from the long-term care program in the continuing care division of the health unit look at your last income tax return to determine how much you will be asked to pay. If you have adequate income, you will have to pay well for the services you receive. Many private agencies that are not contracted to the regional health board charge less to clients for homemaker services than government-supported agencies. In the United States, home care may be covered under Medicare Part B or another private insurance plan, but certain conditions apply.
In-home care provides care appropriate to your needs as decided by the case manager. You are assigned a worker for a specified number of hours a day or week. Because of health care cutbacks, this service is often rationed in many communities, and is typically designed to enhance and complement the support you receive from family and friends. You can often purchase more hours of service from the agency that supplies your worker.
The regional health boards usually contract with an agency to have them provide home care. The agency may be either for profit or nonprofit, and there is no guarantee that you will get the same person each time. Although these agencies bid for government contracts at the regional health board level, no specific standards of care exist. So the quality of staff may vary from poor to superior.
Residential care services
Residential care services range from private luxury retirement homes to skilled nursing facilities or chronic/extended care nursing homes. In the United States, all nursing homes are private and the government does not subsidize care, so you will pay as you go. Medicare can cover some certified skilled nursing facilities, and Medicaid will pay for these same facilities if a client qualifies. Some nonprofit and religious homes, as well as Medicare and Medicaid homes, are available. You should check with your local health authority or senior services for more information.
In most Canadian provinces, residential care services operate under the auspices of the continuing care division of your local health authority. They are usually government supported and accessible to all elders who pay only the accommodation cost of $23 to $36 per day. The health care component is free because health care in Canada is free. Depending on the province in which you live, the number of hours of care is usually restricted to approximately 1.5 hours of nursing care in a 24-hour period per client. The care is supervised by a registered nurse, but most personal care activities are performed by resident care aides.
See Chapters 4 and 5 for more detailed information on the kinds of homes available.
Shared supportive living services
Also known as family care homes, these are single-family residences that care for up to two long-term care clients. These residences provide a protective, supportive, family life environment within a family home and are an alternative to admission to a nursing home facility. The Canadian government through the health department pays the family for the care of these clients. See Chapter 4 for more information on this kind of care.
In the US, adult family homes are the equivalent of Canadian family care homes. Adult family homes are privately owned, licensed, and regulated by the State. Medicaid or private pay will pay for the care.
Adult day-care programs
Adult day-care programs give respite to family caregivers. These programs usually operate from Monday to Friday and supply a hot noon meal, recreational activities, and social interaction for elders with physical or mental impairments. A few day-care programs can accommodate an elder overnight if the family is in crisis.
Special support services
Your regional health board may also supply meals, senior centers, adult day-care programs, and palliative and respite care.
Meal programs such as Meals on Wheels, Congregate Meals, or Wheels to Meals are run by volunteers but usually have a paid staff overseer. In the Meals on Wheels or Wheels to Meals programs, the hot and nutritious meals are provided for people who cannot do their own cooking. The client can purchase frozen meals for weekends. The food is usually prepared in a facility or government-inspected catering establishment where meals are wrapped, and volunteers deliver them to homes. The cost of meals is on a sliding scale depending on the client’s income. Congregate Meals is a program where clients gather to eat in a common place. The food is prepared off-site, and is brought and served by volunteers.
Many senior centers have preventive and supportive health programs for elders, such as friendly visiting, free transportation, help with shopping, and help with legal questions, bill paying, or other financial matters.
Palliative care provides support for people who are dying. Usually, the elder will get an increase in the number of hours of care in the home so he or she may die at home. Respite care is provided to the family to relieve them of their responsibilities for a while so that they can continue with some of their day-to-day activities. Family members can book their elder into an intermediate care facility if they are going on holiday. Respite can also take place in the home, and workers will be provided on a 24-hour basis to take care of the client at home while the family has a break. The continuing care division of the health department usually pays respite care.
In the US, it depends on what medical insurance or Medicaid to which the person qualifies. Often respite care is private pay.
An Encounter with the Quick-Response Program
One morning, at age 82, Mrs. Martino was going to feed her fish in the half-barrel when she slipped on the icy patio. She managed to crawl to the phone and call 911. The ambulance arrived and took her to the nearest hospital emergency that had a quick-response program.
To reduce the use of expensive acute-care hospital beds, some hmos and regional health boards have introduced programs that supply home care to clients on a short-term basis. A social worker usually arranges through a contracted agency to provide homemakers on a short-term basis of one to five days. Depending on an individual’s situation and whether or not the health board has previously assessed him or her, the service may be free or based on the person’s income.
Mrs. Martino was assessed by a physician, who determined that the only care she needed was bed rest while the vertebrae she broke during her fall healed. The emergency ward social worker called her son and told him that his mother could be discharged home, and she would receive home care for 16 hours a day for three days.
Unfortunately, it took longer than three days for her broken vertebrae to heal, so Mrs. Martino and her son needed to look beyond the quick-response program for help. If she had had no family, and if no interim rehabilitative places existed in her community, the hospital would have admitted her for a few weeks until she was sufficiently mobile to look after herself with some home care. Keeping her in the acute care hospital would have been a waste of those resources, however, because she really had no need for 24-hour care from registered nurses.
Luckily, Mrs. Martino had
