Common questions about our services

a. Home Health agencies provide skilled nursing and therapy to meet specific medical needs. It is medical care provided in your home, under the direction of your doctor. Licensed medical professionals help you manage chronic health conditions, like heart failure or diabetes. They can help you recover after surgery or a hospital stay. Care is “intermittent” instead of 24 hours a day.

b. Hospice agencies help those with a life-limiting illness. They treat symptoms of the disease, like pain or nausea, rather than treating the disease itself. Hospice nurses and doctors are skilled in the latest techniques to help relieve pain and improve your comfort. Social workers, chaplains, and volunteers also provide tremendous help and resources for patients and family members.

c. Preferred Pathways offers Medicaid ADvantage services, which is in-home care that care that allows people with specific needs to stay in their homes instead of moving to a long-term care facility. Our specially-trained employees help with daily activities so you can remain independent, such as personal hygiene, grooming, light housework, meal preparation, running errands, etc.

You must be “homebound,” which means it is difficult or risky for the patient to leave home. Some examples:

• Do you need a wheelchair, crutches, or help from someone else to leave home?
• Are you recovering from a surgery that makes it difficult to get in and out of a car?
• Are you unsteady when walking, or have a history of falls?
• Are you at risk of infection if you are around the public, possibly leading to more serious illness?
• Are you short of breath and need to limit walking?

You must have a skilled medical need. A few examples:

• Managing chronic conditions. This could include heart disease, high blood pressure, diabetes, asthma, COPD, kidney failure, cancer, blood disorders, muscular disorders, etc.
• Recovering after a hospital stay. You may need help checking your medications, adjusting your diet, learning more about a new diagnosis, or regaining your strength.
• Care after surgery. You may need skilled care to check incisions, change dressings, check your home for safety hazards, or safely exercise to regain mobility.

The agency must be Medicare-certified. The agency must follow very specific Medicare requirements. This ensures you receive high-quality care safely and with respect. All A Path Of Care locations are Medicare-certified.

You must have a face-to-face visit with your doctor that addresses your primary need for home health. Medicare requires that this is done 90 days before or 30 days after the start of home health services. This helps the doctor order the right home health services to meet your needs.

Home health is a covered benefit if you have original Medicare (Part A). This means you will have no out-of-pocket expense for these services with original Medicare. Medicare Advantage Plans (Part C) have different types of coverage. Some will cover home health, but there may be a copayment involved. We would be happy to check on coverage for you when we do our phone assessment.

There are so many different insurance plans, it’s hard to list them all here. However, some of the bigger plans include Medicare, Medicaid, certain Blue Cross Blue Shield plans, HealthChoice, and United. We’d be happy to check on your specific coverage for you when we do an assessment.

Home health is different from a housekeeping service, but we may still be able to help. Is there a medical condition that may be causing her lack of energy? For example, if she has heart failure we can show her how to conserve energy in her daily activities. We’ll check her medications and teach her to manage symptoms. This may help her continue to live safely and independently.

It varies based on your condition and how many services you need. The care plan is customized to you. For example, a nurse may come two to three times a week if you are just getting out of the hospital, and then reduce the visits over time. A physical therapist may come once or twice a week and then adjust as you begin to heal. Home health aides make visits depending on specific needs. We will adjust our visits based on your specific needs and the doctor’s orders.

If you would like to have someone monitor your vital signs each day, ask about our Remote Patient Monitoring services. Each day you can check your blood pressure, weight, or oxygen levels on special equipment in your home. A nurse monitors them from a central location, and contacts you and/or your doctor if there is a concern. This is not 24-hour emergency monitoring, but a way to watch trends over time. By catching problems early, you can often avoid an emergency room visit or hospital stay.

Every situation is different, but most people use the service for two to four months. Some stay on longer for complex medical conditions. Others just need a few visits to help safely recover from joint replacement surgery. Our goal is to give you the skills you need to live safely and independently at home.

Hospice care is a holistic approach to care that is provided to patients with life-limiting illnesses. It is focused on prioritizing the person and not the disease.

Hospice focuses on improving quality of life by providing pain control and symptom management. It includes medical care and the patient’s psycho-social, emotional, and spiritual needs.

The best time to call for hospice is when you or a loved one are diagnosed with a life-limiting illness. Early hospice care means that the patient can receive the best benefit possible.

Hospice services are covered by Medicare, Medicaid, the VA, and some private insurance carriers. Most patients that elect hospice services incur no out-of-pocket expenses.

Hospice care is provided in your own home. This can mean your house, assisted living community or long-term care facility. We work with you and your family to bring in medical equipment, medications and other resources for care at home.

Yes, you have the option to keep your doctor as part of your care team.

If your health improves you may be discharged and resume normal medical care. You are always eligible to re-elect hospice care in the future if needed.

The most important thing you can do is be there for them. Let them know you love and care for them, and that you still want to be a part of their lives. Be a good listener. Encourage your loved one to talk about what's on their mind. Educate yourself about your loved one’s illness. This will help you anticipate their needs.

Anyone can call a hospice agency to request hospice care for either themselves or for someone else. Some examples would be: family member, friend, clergy member, doctor, nurse, or social worker. After the initial inquiry, a hospice nurse will visit the patient and conduct an assessment to determine if the patient meets eligibility requirements.

When a patient begins hospice care the focus becomes improving quality of life, controlling pain, and managing symptoms of a disease or illness. Other curative treatments are not covered under the hospice benefit. However, treatments and services that provide pain control and symptom management are available.

These are services provided through the Medicaid ADvantage program and are different from other home health services. The program provides care to Medicaid-eligible Members who can live safely and independently at home instead of moving to a long-term care facility.

Case Managers work with you and your family to create a Member-centered plan of care. We also connect you with community resources to help meet your needs. This can include things like grab bars, eyeglasses, or wheelchair ramps to improve your safety.

Personal Care Assistants can help with housekeeping, laundry, errands, meal preparation or home-delivered meals, and more. We provide the extra help you need to stay in your own home.

There is no out-of-pocket cost to you if you qualify for the Medicaid ADvantage program. Medicaid pays for the services if you:

• Need a nursing home level of care
• Are age 65 or older, OR
• Are age 19 or older with a physical disability, OR
• Are age 19 to 65 with a developmental disability, and without certain medical problems that affect the brain
• Are eligible for Medicaid

The ADvantage program is specific to Medicaid, so other insurance coverage would not apply.

Your case manager will work with you and/or your family to develop a Member-centered plan to meet your needs. The visits will be based on that plan. Personal Care Assistants generally work with you from 2 – 16 hours a week. They can come daily if needed. Case Managers meet with you at least monthly to ensure you are receiving the services you need.

The services can last as long as you need them. There is no cut-off period if you qualify for the program. Many of our Members have used our services for years. The goal is to allow you to live safely and independently at home for as long as possible.

No. We do not usually provide a skilled level of care that requires a doctor’s order. However, if you have a specific medical need, we can bring in skilled nursing or home health to provide medical care under a doctor’s order.

You would apply through the Oklahoma Department of Human Services. Our agency can help you with this.

• The financial income limit is $2,349 per month for ADvantage program eligibility in 2020. The asset limit is $2,000 but certain assets are considered exempt. For example, your home and furniture are exempt up to a certain limit.
• There are also financial allowances made for your spouse. The spouse is entitled to have enough funds with which to live. As of 2020, up to $3,216 per month of an applicant’s income can be transferred to the spouse. This means it is not included in eligibility income.
• These requirements are subject to change, so please contact our office or the Oklahoma Department of Human Services for current information.