Q: My mother lives alone. She refuses to consider assisted living and insists on remaining in her home. Are there services that can help my mother remain independent in her own home?
A: If I were older and alone, I'd be like your mother: I'd want to remain living in my home. We all want to hold on to our independence for as long as possible.
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Two services can help make this a reality for some people. They are home health care and private duty care.
Home health care is a temporary service that brings nurses and therapists into the home to provide treatment. It's intended for people who are recovering from illness, injury or surgery, with the goal of helping the person to get better and regain their independence. So it may not be appropriate in your mother's case.
I assume that your mother is covered by Medicare. If so, Medicare will pay for home health care services when her doctor certifies that they are necessary. This can include nursing care (changing bandages, giving shots, giving intravenous drugs, tube feedings and teaching about medical treatments your mother might require).
It also can include physical therapy to improve your mother's mobility and strength. Occupational therapy and speech therapy are often helpful in people who have had strokes and need help relearning certain skills.
Medical social services also are covered by Medicare. These include finding community agencies that might be able to help your mother, such as by bringing meals into her home. Medicare won't pay, even temporarily, for 24-hour-a-day care at home, or for meals delivered to the home. It also won't pay for services like help with bathing, dressing, using the bathroom, shopping, cleaning and laundry when your mother does not also need some type of medical services.
If your mother might be eligible for home health care services paid by Medicare, her doctor and social worker should obtain those services through a Medicare-certified home health agency.
Private duty care, on the other hand, provides the day-to-day help most people need to remain in their homes. Care is available for a few hours or up to 24 hours per day.
Private duty care workers usually fall into two categories: licensed or registered. Both offer homemaker services, such as housework, cooking, shopping, overseeing medication routines and transportation.
But a licensed worker will also be trained in body mechanics. As a result, he or she can provide hands-on physical care such as help bathing, eating, brushing teeth and using the bathroom.
Medicare does not pay for private duty care. But some long-term care insurance policies do.
When choosing a private duty service, look for a company that employs its workers rather than an independent contractor or a registry that simply matches workers with clients for a fee. That way, you'll know that the caregiver's company is monitoring his or her performance as well as the care your mother receives.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com.