ZSFG AM Report Pearls 12/20/2017: Work, Work, Work, You Can Work From Home – Keeping Elders at Home

Thank you pre-Holiday ZSFG residents for presenting a great case of an elderly woman with fall with LOC coming in with facial bruising. In addition to talking about bradycardia, we had a great discussion about home supports for elderly patients.

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Keeping Elders at Home: Social Supports at Home

  • In-Home Supportive Services (IHSS) Program
    • Administered through the California Department of Social Services
    • Can help with domestic chores, laundry services, food shopping, other shopping/errands
    • Maximum of 283 hours/month (9 hrs per day) for severe disability
    • Maximum of 195 hours/month (5 hrs per day) for not severe disability
    • Note that is can be very difficulty to get up to this max number of hours
  • Home Health
    • RN, PT, OT, SW, SLP, home health aide (“Skilled Needs”)
    • Does not provide for “non-skilled” needs like custodial care
    • Somewhat variable in the amount they can see a patient
    • Requires a physician to complete a “face-to-face” evaluation and designate that a patient is essentially homebound
    • Covered by Medicare/Medicaid for some amount of time
  • Meals on Wheels
    • Can provide 2 meals per day delivered to a patient
  • Adult Day Health
    • Typically privately paid for by patient’s families
    • Typically provides 4-5 days/week of day time (think office hours) oversight
    • Can be highly variable in the activities and services available ranging from including transportation to/from facility, meals, physical therapy, occupational therapy, exercise
  • OnLok/PACE Programs
    • Medicare funded model for wrap-around care
    • When a patient enrolls, OnLok becomes the insurer and medical provider including the PCP
    • OnLok is the model program for PACE programs across the country (started in SF)
    • Revolves around a Day Program, where residents are picked up from their homes and brought to program
    • Drop-in for physicians and can bring multiple services into site (including Ophtho, Dental, Podiatry, etc.)
    • If you join OnLok, you cannot keep IHSS and this can be a barrier

 

Evernote:

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