What's new?
I’m in week four of the new gig, and I’m having a hard time remembering what my old job was like already. The biggest change has been that I now no longer work in a facility. I don’t have an office or a ‘home base;’ I live out of my car all day. I have perfected the art of eating lunch in my truck, and my daily step count during work has gone from between 3500-4000 steps to 2500 on a good day. I spend some time during the week at the company home office, but that’s not a requirement. My job is to connect with both our company’s facilities as well as other senior care facilities and encourage the use of our home health and home care services, which requires a lot of face-to-face visits to facilities and not much time at a desk.
I have learned so much now that I’ve moved into more of an external health care role, and I’m going to continue to help you become educated with me. Here are a few new tidbits I’ve picked up:
1. Home health and home care are different. Home health includes nursing, physical, speech, and occupational therapy, and is covered by insurance. Home care is paid for privately or through Medicaid (if the company is Medicaid licensed), and includes general homemaking and personal services.
2. This might be obvious to you, but I was surprised to learn just how much your insurance can dictate the care you receive. For example, there are certain insurances we are licensed to work with for our home health services and some we aren’t. I already know which insurance companies are the ‘black sheep’ that either pay minimal coverage or are very difficult to work with, and I feel bad for seniors who use those insurances because accessing services they need can be more difficult to arrange.
3. Our services are usually ordered by a social worker or discharge planner in a Skilled Nursing Facility (SNF), otherwise known as a Post-Acute Rehab Center. This is where a senior would go after a surgery or procedure in the hospital for additional therapy and monitoring until they’re deemed safe to return to where they were before. A common scenario is for a senior to have a fall or some other kind of traumatic incident, spend a few days in the hospital and then a few weeks in a SNF, and then maybe go home or to an Assisted Living Facility (ALF) or other senior living community. In the SNF they receive individualized therapy and the benefits of 24-hour nursing oversight to make sure they’re returning to their baseline, and our services are essentially a continuation of that care, but in their own home.
4. Despite having ‘home’ in the name, I’d guess that half of the time our services occur in a facility, which is often the senior’s current home. I’d previously pictured that home health only served seniors who lived alone in a big house and slept in a bedroom at the top of three flights of stairs but refused to move into a senior community. In a few cases that’s been accurate (including one senior who refused to give up sleeping in his bedroom at the top of a rickety spiral staircase despite falling down it three separate times), but often seniors who require extended stays at a SNF and then continued services through home health need the additional benefits of living at a facility. Therapy services are not standard at Independent Living Communities (ILs) or ALFs, so we often follow seniors back to their facility to ensure they’re still making progress toward returning to their baseline abilities. Essentially, we extend the care the facility can provide as they make the transition to living at home again.
5. Typically our clients receive three services from us: nursing care (wound treatment, complex medication management, oversight and case management), physical therapy (standing, sitting, bending in a safe manner), and occupational therapy (ensuring safety during Activities of Daily Living, or ADLs, such as getting dressed, maneuvering around the home, etc). I really didn’t know the difference between PT and OT before this job, or how important their combined services can be. We also provide speech therapy, but it is less common that this discipline is necessary. An example of someone who would receive nursing care, PT, OT, and ST would be a senior recovering from a stroke.
Most of my new coworkers in home health come from SNF backgrounds or other home health agencies, so my experience in an ALF has actually proved to be quite insightful. I am again enjoying learning by doing, which involves a lot of trail-and-error, asking forgiveness not permission, and talking my way around questions I have no idea how to answer. With those kinds of skills, I often feel as though I’m preparing myself for a life in politics. I have always wanted to set a record of being the oldest person to do such-and-such, so don’t be surprised if I’m running for mayor when I’m 97.
