Alice’s 100-year old mother, Lillian was hospitalized for a fractured hip when she fell out of her bed. After two weeks in the hospital and three weeks in rehab, she returned to her home where she is receiving 24- hour live-in care through Medicaid.
Before she went into the hospital, Lillian was showing signs of dementia and needed assistance with many daily activities. Although she could get by with a walker, she was unsteady on her feet and needed assistance standing and ambulating. She required help with dressing, bathing and eating as well. Medicaid determined that she needed a live-in aide to support her during the day, with occasional assistance at night.
Since her return from the hospital Lillian’s condition has deteriorated. She is now unable to walk and relies on a wheelchair. She can no longer get to the toilet without assistance and is much more confused. The family feels she requires more than an aide that sleeps over; she needs an aide who will be available for her around the clock.
Many families are unaware that there are two types of live-in care; one offering more intense care than the other. Here are the differences.
Live-In Home Care
A Medicaid live-in home attendant is hired to stay in a client’s home around the clock but is assumed to have time to sleep. The client’s needs are defined as predictable and can be scheduled during the day with only occasional disruptions at night. The aide helps the client with basic activities such as dressing, bathing, and eating during the day, but has time for herself at night.
Before a client can receive a live-in aide, the family is required to provide the attendant with sleeping accommodations and must understanding that (s)he is entitled to sleep at least eight hours a night. There are times when a client might need assistance at night, but New York State regulations require the aide get at least five hours of uninterrupted sleep nightly.
A live-in aide can only work in a home for up to four consecutive days per week then must be replaced by a second aide for the remaining three days. Live-in aides are paid on a daily rather than an hourly rate because they are considered to be off duty while they sleep.
Around the Clock Home Care
Around the clock home care, also called split shift care requires that a client needs uninterrupted service both day and night. The attendant must be alert and available at all times. This kind of care demands at least two home attendants in a 24-hour time period. The day can be divided into two 12-hour shifts or three 8-hour shifts. Aides are paid an hourly rate and are on duty at all times. They are not expected to sleep.
Reasons why a client might need split shift care might be because (s)he must be repositioned in their bed every couple of hours, need to be toileted several times a night or must be monitored for wandering. In Lillian’s case she could no longer get to the bathroom unassisted and was in danger of getting bedsores.
Before she could be approved for split shift service, Alice needed to get a written statement from Lillian’s attending doctor, and needed to have Lillian re-evaluated by her home care agency nurse. In this case, the agency determined that Lillian needed that additional care.
As our frail aging population continues to grow, more families are requiring live-in home care or around the clock care. Unfortunately this demand is cutting into the Medicaid budget and home care agencies are reluctant to approve more hours.
This puts the onus on families. Family members must become knowledgeable of the types of home care that are available and must learn how to request these needs. Only by being a savvy caregiver can a family protect an aging loved one and get her/him the care that is required.