Continuing care, home health care… understanding these terms can ensure better care for those who prefer aging in their own home. Consider this situation…
One morning, Mary wakes up and, as she’s getting out of bed, slips on the throw rug and falls. In her late 80s, the retiree suffers a badly broken hip which requires surgery.
After surgery at the hospital, then a short stay at a rehabilitation facility, she wants to recover where she is most comfortable—at home.
Once home, Mary will need help caring for the surgical site, along with rehabilitative therapy and caregiver assistance with bathing, dressing and maneuvering around her residence.
This common story—or any of the other hundreds of scenarios older adults face—has very different potential scenarios for care.
Health Care on the Fly
In one scenario, while Mary is undergoing surgery, her husband Bob and their children are scrambling to find in-network providers who can help once she’s released from the hospital. They feel overwhelmed trying to handle everything at once, instead of just being able to worry about Mary and her surgery.
In this case, home health care benefits will be provided through Medicare and any supplemental insurance Mary might have. In Mary’s case, skilled nursing and physical therapy will be needed, along with someone to help with activities of daily living. Since caregiver costs are not covered by Medicare, any assistance Mary needs for bathing, dressing and other daily tasks that cannot be provided by family or friends must be paid for out-of-pocket. Plus, since Medicare coverage stops once Mary is considered stable, Mary’s family is expecting to spend several thousand dollars for care.
The sudden situation has forced her family to be reactive, quickly jumping into action to help Mary. Though stressful, Mary’s family manages to coordinate the providers and insurance benefits.
All things considered, home health care can often be considered a reactive measure.
Well-laid Plans for Continuing Care at Home
In another scenario, when she was in good health, Mary purchased a Sun Health at Home membership, joining Arizona’s first continuing care at home program long before her fall. Members live in their own home and receive wellness, in-home care and long-term care services, all coordinated with the help of a wellness coordinator. Therefore, when Mary’s needs changed because of her broken hip, instant support was available with a single phone call. All care coordination was handled.
“Continuing care at home” programs provide a spectrum of health and wellbeing services to those who prefer to age in place, including in-home caregiver services, skilled care, assisted living and memory care.
Members may choose from different plans depending on their needs. Some providers (like Sun Health at Home) are Life Care plans that guarantee coverage for the life of the member, regardless of their financial circumstances. While seamless care is available to all members, costs of that care depend on the plan a member has purchased.
Since it is offered as an adjunct service by a Continuing Care Retirement Community (CCRC), some allow members to exchange their plan for living at the CCRC, should their spouse pass away or their ability to live independently diminish. (Learn more about your CCRC options here.)
In this case, Bob calls the wellness coordinator, who then handles all necessary arrangements during the entire recovery process. Since the wellness coordinator is coordinating care from various providers, Bob is free to concentrate on Mary.
Even better, services not covered by health insurance are now covered by the Continuing Care at Home plan—including caregiving—leaving Bob and Mary with no out-of-pocket costs. In addition to her home health nurse and physical therapy, Mary was able to obtain all of the caregiving services she needed, without concern for insurance coverage, even if her recovery took longer than anticipated.
Down the road, if Mary needed further rehabilitation at a facility, or her health care needs become more serious or long-term, her transition to those facilities would be just as smooth.
If transportation was required for outpatient physical therapy, that would be covered, too.
Many feel the proactive approach of a continuing care at home plan, with its seamless transitions and ready providers, offers reassuring peace-of-mind. It provides a full spectrum of in-home care services from all angles, all from within the comfort of their home.
For more information about Sun Health’s continuing care at home program and how it helps you be proactive in planning your future, click here to join an upcoming, no-obligation Discovery Seminar.
