Q: Why home health care?
A: Home health care is a cost-effective option for receiving health care services. Returning to one’s home and family can quicken recovery and improve the quality of life for both patient and family or caregiver.

Q: Who pays for home health care?
A: Most health insurance companies, HMOs, PPOs and Workers Compensation cover home health care. In addition, Medicare and Medicaid pay for home care services. Some insurance providers do not cover all home health services. Our staff will verify health coverage for the patient.

Q: What criteria are required for Medicare to approve services?
A: The following criteria are used to meet Medicare requirements:
• The patient is a Medicare recipient.
• The patient must be homebound. This is defined by Medicare as “normal inability to leave the home and that leaving the home requires considerable and taxing effort.”
• The skilled care must be medically necessary as determined by the physician.

Q: What if I have a problem at night or on the weekend?
A: We have registered nurses on call 24 hours a day, 7 days a week.

Q: Do I need a physician’s order for home health care?
A: Yes, all health care provided in the home occurs under direct order and supervision of the patient’s physician.

Q: What types of services can be provided at home?
A: Many medical conditions that previously required hospitalization can safely be treated in the home. Home care services may include but are not limited to:

Skilled Nursing:
• Observation and assessment of condition
• Patient and family education of disease process
• Management and evaluation of patient care plan
• Medication education and management
• Dressing changes
• Home safety education
• Wound care
• Catheter care
• Injections
• IV therapy
• Ostomy care
• Pain management
• Diabetic care
• Nutritional support

Assistance with Daily Living:
• Bathing/dressing
• Transfer/ambulation
• Light meal preparation
• Light housekeeping
• Grocery shopping
• Medication reminder
• Laundry
• Companionship/Conversation
• Reading/writing
• Pet sitting/walking
• Escort to appointments
• Live-ins
• Respite
• Exercise therapy assistance

Q: How does Paloma Home Health Care, Inc. ensure quality care in the home?
A: Providing continuous quality care to patients is paramount to all we do. All patients are given a patient satisfaction survey that is incorporated into our ongoing evaluation process to continually increase our patient satisfaction. New programs and processes are developed through our quality improvement team to promote favorable outcomes.

Q: How do I find out more about home health care?
A: Please call our office to learn more about how you can benefit more about the service, at 972 346 2013

Q: What services can Paloma Home Health Care, Inc. offer?
A: Our services include but are not limited to:
• Supportive Care Education of Disease Process
• Individual and Family Counseling
• Management and Evaluation of Patient Care
• Observation and Assessment
• Home Safety and Emergency Education
• Medication Education
• Assistance with ADLs
• Nutrition Education
• Restorative Therapy (Physical, Occupational and Speech)

More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.

At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.

How Do I Make Sure That Home Health Care Is Quality Care?
As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.
In looking for a home health care agency, the following 20 questions can be used to help guide your search:

How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one. Is the agency an approved Medicare provider? Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations? Does the agency have a current license to practice (if required in the state where you live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary? Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver? How closely do supervisors oversee care to ensure quality? Will agency caregivers keep family members informed about the kind of care their loved one is getting? Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day? How does the agency ensure patient confidentiality? How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with questions or complaints? How does the agency handle billing? Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.

Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services).

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

Illnesses/injuries, and signs of an emergency medical situation Likes and dislikes Medications, and how and when they should be taken Need for dentures, eyeglasses, canes, walkers, etc. Possible behavior problems and how best to deal with them Problems getting around (in or out of a wheelchair, for example, or trouble walking) Special diets or nutritional needs Therapeutic exercises.

In addition, you should give the home health care provider more information about:

Clothing the senior may need (if/when it gets too hot or too cold) How you can be contacted (and who else should be contacted in an emergency) How to find and use medical supplies and medications When to lock up the apartment/house and where to find the keys Where to find food, cooking utensils, and serving items Where to find cleaning supplies Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure) Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).

A WORD OF CAUTION . . .
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

HOW CAN I PAY FOR HOME HEALTH CARE?
The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.

Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:

The patient must be homebound and under a doctor’s care; The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” The home health care agency providing the services must be certified by the Medicare program.

http://www.medicare.gov.

Physical therapy is required to help victims of accidents or patients suffering from devastating conditions – to help them regain mobility, acquire flexibility and achieve balance and co-ordination. Conditions treated through physical therapy and rehabilitation services include permanent disabilities caused by accidents, strokes, traumatic brain injuries, birth defects, development delays, muscle weakness, brain injuries, post operative problems, spinal cord injuries, musculoskeletal disorders and neuromuscular disorders.

A physical therapist will use techniques such as strength training, stretching exercises, balance and coordination activities, hot packs and cold compresses, electrical stimulation, and ultrasound therapies to help the patient resume normal function. Physical therapy can be broadly classified into specialized areas such as orthopedic physical therapy, geriatric physical therapy, neurological physical therapy, cardiovascular and pulmonary rehabilitation physical therapy, sports medicine and pediatric physical therapy.

Orthopedic physical therapy deals with disorders and injuries of the musculoskeletal system and rehabilitation of patients after orthopedic surgery. Geriatric physical therapy covers issues that affect people as they grow older and neurological physical therapy is focused on neurological disorders. Cardiovascular and pulmonary rehabilitation physical therapy is ideal for patients with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery, while pediatric physical therapy assists in early detection of health problems in children.

Physical therapy and rehabilitation services often succeed in bringing out miraculous recoveries in cases where modern medicine alone may not. The physical therapy and rehabilitation service map can be created for each patient according to his individual needs. Thus through a combination of medication, exercises and rehabilitative training, physical therapy and rehabilitation services can help a patient to improve his daily function.

JUST AS MAINSTREAM MEDICINE has a fairly consistent approach to illness, so does al-ternative medicine. Most prevalent in alternative medicine are the six naturopathic principles. In one form or another, these principles are revisited again and again throughout Section Two of this text. The following principles are described by Dr. Catherine Downey and excerpted from her chapter on naturopathic medicine.

1. The Healing Power of Nature (Vis medicatix naturae)

The body has the inherent ability to establish, maintain and restore health. The healing process is ordered and intelligent: nature heals through the response of the life force. The physician’s role is to facilitate and augment this process, to act to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment. In short, give the body the appropriate tools and it will heal itself.

2. Treat the Whole Person (The multifactorial nature of health and disease)

Health and disease are conditions of the whole organism, involving a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, and social factors. The physician must treat the whole person by taking all of these factors into account. The harmonious functioning of all aspects of the individual is essential to recovery from and prevention of disease and requires a personalized and comprehensive approach to diagnosis and treatment.

3. First Do No Harm (Primum no nocere)

Illness is a purposeful process of the organism. The process of healing includes the generation of symptoms, which are, in fact, an expression of the life force attempting to heal itself. Therapeutic actions should be complementary to and synergistic with this healing process. The physician’s actions can support or antagonize the actions of the vis mediatrix naturae; therefore methods designed to suppress symptoms without removing underlying causes are considered harmful and are avoided or minimized. Therapeutic actions are applied in an ordered fashion congruent with the internal order of the organism.

4. Identify and Treat the Cause (Tolle causam)

Illness does not occur without cause. Underlying causes of disease must be discovered and removed or treated before a person can recover completely from illness. Symptoms are expressions of the body’s attempt to heal, but they are not the cause of disease; therefore naturopathic medicine addresses itself promptly to the underlying causes of disease, rather than symptoms. Causes may occur on many levels, including physical, mental-emotional, and spiritual. The physician must evaluate fundamental underlying causes on all levels, directing treatment at root cause rather than at symptomatic expression.

5. Prevention (Prevention is the best “cure”)

The ultimate goal of naturopathic medicine is prevention. This is accomplished through education and promotion of lifestyle habits that create good health. The physician assesses risk factors and hereditary susceptibility to disease and makes appropriate interventions to avoid further harm and risk to the patient. The emphasis is on building health rather than on fighting disease. Because it is difficult to be healthy in an unhealthy world, it is the responsibility of both the physician and patient to create a healthier environment in which to live.

6. The Physician as Teacher (Docere)

Beyond an accurate diagnosis and appropriate prescription, the physician must work to create a health-sensitive, interpersonal relationship with the patient. A cooperative doctor-patient relationship has inherent therapeutic value. The physician’s major role is to educate and encourage the patient to take responsibility for health. The physician is a catalyst for healthful change, empowering and motivating the patient to assume responsibility. It is the patient, not the doctor, who ultimately creates or accomplishes healing. The physician must strive to inspire hope as well as understanding. Physicans must also make a commitment to their personal and spiritual development in order to be good teachers.