The Illinois HomeCare and Hospice Council understand that entering the world of home care and hospice frequently occurs during an emotionally draining time. Medical providers and staff discuss terms and services that are likely confusing. Below are terms frequently used in discussion home care and hospice.
Adult Day Care
Adult day care includes programs, services, and facilities designed to assist physically or mentally impaired adults remain in their communities. These are persons who might otherwise require institutional or long-term care and rehabilitation. There are two general purposes for adult day-care. The first is to provide an alternative to placement in a residential institution. The second is to create a respite for care-givers, often the children of the persons for whom the care is being provided.
Assisted living is a long-term care option that combines housing, support services and health care, as needed. Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management or assistance, bathing, dressing and transportation. Some residents may have memory disorders including Alzheimer's, or they may need help with mobility, incontinence or other challenges. Residents are assessed upon move in, or any time there is a change in condition. The assessment is used to develop an Individualized Service Plan.
Community Care Provider
Established in 1979 by Public Act 81-202, the Illinois Department on Aging’s Community Care Program helps senior citizens, who might otherwise need nursing home care, to remain in their own homes by providing in-home and community-based services.
The Program and its providers are aimed at assisting seniors to maintain their independence and providing cost effective alternatives to nursing home placement.
The Community Care Program provides services to any person who applies for the program and meets all current eligibility requirements. The Community Care Program is one of the 1915(c) waivers for home and community-based services under the Medicaid Program.
Companion care is primarily emotional support and companionship for seniors who are generally healthy and who want to remain independent at home. However, it can also include a range of non-medical services that help make a senior's life more manageable.
These services can include light housekeeping, assistance with activities of daily living (ADLs), medication reminders and more.
Though companion care focuses on those seniors in their homes, it can be provided to those in assisted living facilities and nursing homes. Companion care also falls under the titles personal care assistants and homemaker services.
Clergy provide pastoral support to hospice patients, their families and friends dealing with the loss of a loved one for up to 13 months following death.
Dietitians provide counseling services to individuals who need professional dietary assessment and guidance to properly manage an illness or disability and maintain healthy nutrition.
Durable Medical Equipment (or Home Medical Equipment) and Supply Dealers
Durable medical equipment and supply dealers provide home care patients with products ranging from respirators, wheelchairs, and walkers, to catheter and wound care supplies. These dealers employ staff who deliver and, when necessary, install these products as well as instruct patients on their proper in-home use. Durable medical equipment and supply dealers usually do not provide physical care for patients, but there are a few exceptions. Some dealers offer pharmacy and infusion services, where a nurse administers medication and nutritional formulas to patients and teaches them the proper techniques for self-administration. Some companies also provide respiratory therapy services to help individuals use breathing equipment. Durable medical equipment and supply dealers that bill the Medicare program are required to meet federal minimum standards. Some states, like Illinois, require these organizations be licensed. Each dealer is liable for its personnel and the services provided to patients.
Home Health Agencies
The term home health agency often indicates that a home care provider is Medicare certified. A Medicare-certified agency has met federal minimum requirements for patient care and management and therefore can provide Medicare and Medicaid home health services. Individuals requiring skilled home care services usually receive their care from a home health agency. Due to regulatory requirements, services provided by these agencies are highly supervised and controlled. Some agencies deliver a variety of home care services through physicians, nurses, therapists, social workers, homemakers and health care aides, durable medical equipment and supply dealers, and volunteers. Other home health agencies limit their services to nursing and one or two other specialties. For cases in which an individual requires care from more than one specialist, home health agencies coordinate a caregiving team to administer services that are comprehensive and efficient. Personnel are assigned according to the needs of each patient. Home health agencies recruit and supervise their personnel; as a result, they assume liability for all care.
Home Health Aides
Home health aides assist patients with ADLs such as getting in and out of bed, walking, bathing, toileting, and dressing. They may also do light housekeeping and simple meal preparation. Some aides have received special training and are qualified to provide more complex services under the supervision of a nursing professional.
Home Infusion Therapy Companies
Home infusion therapy companies specialize in the delivery of drugs, equipment, and professional services for individuals receiving intravenous or nutritional therapies through specially placed tubes. Nurses also are hired to teach self-administration in patients' homes. Some home infusion therapy companies are home health agencies, which are certified by Medicare and licensed in Illinois. Each company assumes responsibility for personnel and the services rendered.
Home Services Agencies
Home care agencies employ homemakers or chore workers and companions who support individual's activities of daily living, such as housekeeping, personal laundry, meal preparation, dressing, housekeeping and companionship. Personnel are assigned according to the needs and wishes of each client. Illinois required these agencies to be licensed effective September 2008 and meet minimum standards established by the Illinois Department of Public Health (IDPH). Most homemaker and home care agencies recruit, train, and supervise their personnel and thus are responsible for the care rendered.
Home Services Workers
Home services workers (sometimes referred to as homemakers , chore workers or companions) assists with activities of daily living, such as housekeeping, cleaning, personal laundry, meal preparation, dressing, bathing, shopping and companionship. Home services are focused on providing assistance that is non-medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence.
Hospice care involves a core interdisciplinary team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for the terminally ill and support for patients' families. Hospice care also includes the provision of related medications, medical supplies, and equipment. It is based primarily in the home, enabling families to remain together. Trained hospice professionals are available 24 hours a day to assist the family in caring for the patient, ensure that the patient's wishes are honored, and keep the patient comfortable and free from pain. Although most hospice services are provided in the home, they may be provided in a facility (hospital, skilled nursing facility (SNF), or inpatient hospice facility). Most hospices are Medicare certified and are licensed according to state requirements.
Independent Paid Caregivers
Independent paid caregivers are nurses, therapists, aides, homemakers, chore workers, and companions who are privately employed by individuals who need such services. Aides, homemakers, chore workers, and companions are required to meet government standards if they receive reimbursement through state funded programs. In this arrangement, the responsibility for recruiting, hiring, and supervising the paid caregiver rests with the client. Finding back-up care in the event that the provider fails to report to work or fulfill job requirements is the client's responsibility. Clients also pay the caregiver directly and must comply with all applicable state and federal labor, health, and safety requirements.
Programs organized for the purpose of providing medical and social services for mothers and children. Medical services include prenatal and postnatal services, family planning care, and pediatric care in infancy.
Meals on Wheels
Meals delivered to elderly people or homebound people who are unable either to prepare meals or have meals otherwise provided.
Medical Social Worker
Medical social work or Med.SW is a sub-discipline of social work, also known as Hospital social work and Healthcare Social Work. Medical social workers typically work in a hospital, outpatient clinic, community health agency, skilled nursing facility, long-term care facility or hospice. Social workers in this field have a graduate (post graduate) degree or a bachelor's degree with graduate/post graduate diploma in healthcare specialization, and work with patients and their families who face certain psychosocial barriers. Medical social workers assess the psychosocial functioning, environmental and support needs of patients and families and intervene as necessary. Interventions may include connecting patients and families to necessary resources and supports in the community; providing psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand and strengthen their network of social supports. Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.)
Medical transport refers to taking elderly people or people with disabilities to medical appointments, daycare, etc.
Occupational Therapists (OTs)
Occupational therapists (OTs) help individuals who have physical, developmental, social, or emotional problems that prevent them from performing the general activities of daily living (ADLs). OTs instruct patients on using specialized rehabilitation techniques and equipment to improve their function in tasks such as eating, bathing, dressing, and basic household routines.
Pediatric care is the branch of medicine that deals with the care of infants and children and the treatment of their diseases.
Personal Emergency Response System
Personal Emergency Response System (PERS) is an electronic device that enables individuals at high risk of institutionalization to secure help in an emergency. Typical systems have a wireless pendant or transmitter that can be activated in an emergency. When the medical alarm is activated, the signal is transmitted to an alarm monitoring company's central station, other emergency agency or other programmed phone numbers. Medical personnel are then dispatched to the site where the alarm was activated. Elderly people and disabled people who live alone commonly use/require medical alarms.
A pharmacy is a place where drugs are compounded or dispensed.
Physical Therapists (PTs)
Physical therapists (PTs) work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage, and other methods. PTs often alleviate pain and restore injured muscles with specialized equipment. They also teach patients and caregivers special techniques for walking and transfer and exercise programs to improve and maintain function and strength.
Physicians visit patients in their homes to diagnose and treat illnesses just as they do in hospitals and private offices. They also work with home care providers to determine which services are needed by patients, which specialists are most suitable to render these services, and how often these services need to be provided. With this information, physicians prescribe and oversee patient plans of care. Under Medicare, physicians and home health agency personnel review these plans of care as often as required by the severity of patient medical conditions at least once every 62 days. The interdisciplinary team reviews the care plans for hospice patients and their families at least once a month, or as frequently as patient conditions and/or family circumstances require.
Private Duty Home Nursing
Home nursing agency means an agency that provides services directly, or acts as a placement agency, in order to provide skilled nursing services to persons in their personal residences. A home nursing agency provides services paid for by the hour. These services are provided by a licensed nurse. Illinois will require these agencies to be licensed effective September 2008 and meet minimum standards established by the Illinois Department of Public Health (IDPH).
Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia. Nurses in this area receive more training in psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and the administration of psychiatric medication.
Registries serve as employment agencies for home care nurses and aides by matching these providers with clients and collecting finder's fees. These organizations usually are not licensed or regulated by government. Registries will be required to screen and conduct criminal background-checks on the caregivers. In addition, although not legally required to, some registries offer procedures for patients to file complaints. Clients select and supervise the work of a registry-referred provider. They also pay the workers directly and must comply with all applicable state and federal labor, health, and safety laws and regulations, including payroll tax and social security withholding requirements.
Respiratory therapy is the treatment or management of acute and chronic breathing disorders, as through the use of respirators or medication in aerosol form.
Respite care is the provision of short-term accommodation in a facility outside the home in which a loved one may be placed. This provides temporary relief to those who are caring for family members, who might otherwise require permanent placement in a facility outside the home.
Skilled Nurses/Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)
Registered nurses (RNs) and licensed practical nurses (LPNs) provide skilled services that cannot be performed safely and effectively by nonprofessional personnel. Some of these services include injections and intravenous therapy, wound care, education on disease treatment and prevention, and patient assessments. RNs may also provide case management services. RNs have received two or more years of specialized education and are licensed to practice by the state. LPNs have one year of specialized training and are licensed to work under the supervision of registered nurses. The complexity of a patient's medical condition and required course of treatment determine whether care should be provided by an RN or can be provided by an LPN.
Social workers evaluate the social and emotional factors affecting ill and disabled individuals and provide limited counseling. They also help patients and their family members identify available community resources. Social workers often serve as case managers when patients' conditions are so complex that professionals need to assess medical and supportive needs and coordinate a variety of services.
Speech Language Pathologists
Speech language pathologists work to develop and restore the speech of individuals with communication disorders; usually these disorders are the result of traumas such as surgery or stroke. Speech therapists also help retrain patients in breathing, swallowing, and muscle control.
Staffing and Private-duty Agencies
Staffing and private-duty agencies generally are nursing agencies that provide individuals with nursing, homemaker and companion services. Effective September 1, 2008, Illinois requires these agencies to be licensed or meet regulatory requirements. Some staffing and private-duty agencies assign nurses to assess their clients' needs to ensure that personnel are properly assigned and provide ongoing supervision. These agencies recruit their own personnel. Again, responsibility for patient care rests with each agency.
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.
A temporary work agency, temp agency or temporary staffing firm finds and retains workers. Other companies, in need of short-term workers, contract with the temporary work agency to send temporary workers, or temps, on assignments to work at the other companies. Temporary employees are also used in work that has a cyclical nature, requiring frequent adjustments to staffing levels.
In some cases, ventilator care is focused on reducing or eliminating dependence on a ventilator for breathing. In others, the program is designed to provide optimum care for patients with complex ventilator requirements due to respiratory failure resulting from injury, neurological disorders or pulmonary disease. Home care nurses are often faced with providing specialty care to adult and pediatric patients with medically complex needs. The most complicated of these patients require the use of a ventilator in order to maintain adequate breathing to sustain their life. Patients with this level of need require a competent nurse with current knowledge of and experience with the latest medical technology and the ability to work with patients and their families who are experiencing the challenges associated with life with a ventilator.
Volunteers meet a variety of patient needs. The scope of a volunteer's services depends on his or her level of training and experience. Volunteer activities include, but are not limited to providing companionship, emotional support, and counseling and helping with personal care, paperwork, and transportation.