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:
- Keeping Elders at Home: https://www.evernote.com/shard/s509/sh/50c16a15-8ba2-4d88-bc02-7a14237f4afa/6ea341a347a2885af9c1c3a1f5972d0e
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