Home Care After a Stroke in Massachusetts: What It Costs

Medicare will send a physical, occupational or speech therapist to the house a few times a week while somebody is homebound and a doctor has ordered it. It will not send anybody for the rest of the week. Our home health aide care is $45 an hour, from one to eight hours a day, with no minimum contract and no assessment fee, and that is what fills the gap between therapy visits.

Four hours each morning is $180 a day. One overnight is $540 for a 12 hour night.

What does an aide actually do after a stroke?

The hands on work that the therapy plan assumes somebody is doing between visits.

• Transfers and walking, which is where the falls happen. Bed to chair, chair to toilet, and the first few steps after sitting.
• Bathing and dressing, both of which take two or three times longer with one weak side, and both of which happen on a wet floor.
• Meals, including preparing food to whatever texture the speech therapist specified and sitting with the person while they eat it.
• Practicing what the therapist assigned, because an exercise done three times a week with a therapist and never in between does not rebuild anything.
• Being there, which after a stroke is not a small thing. Fatigue and low mood are part of recovery and both get worse alone in a quiet house.

What goes wrong in the first few weeks?

• A fall getting to the bathroom. Almost always at night, almost always alone, almost always the trip somebody decided they could manage by themselves.
• Choking or coughing on food and drink. If the hospital sent you home with instructions about thickened liquids or soft textures, those instructions are not a suggestion. Somebody has to follow them at every meal, not just the ones the family is around for.
• Therapy quietly stopping. Medicare home health is time limited. When it ends, the exercises end too unless somebody is there to keep them going.
• The spouse collapsing. The husband or wife who said they would manage is seventy eight and has not slept properly in a month. This is the most common reason families call us, and it is usually three weeks later than it should have been.

Can an aide give the medications?

No, and after a stroke that distinction matters. Our aides are trained, background checked and insured but they are not nurses and they cannot administer medication. They can be present while a client takes their own, help if something goes wrong, and call for help. Blood thinners and blood pressure medication after a stroke are not things to be casual about, so if somebody cannot reliably manage their own pills, you need nursing, which is a separate service priced separately. Say so when you call and we will tell you honestly which one you need.

Is it worth paying for help if the person might recover?

That is the right question and it argues for paying early rather than later. The months right after a stroke are when function comes back fastest, and the difference between somebody who practices daily and somebody who sits in a chair between therapy visits shows up in what they can do a year later.

It also argues for buying fewer hours for longer rather than around the clock for a month. Families who start at maximum coverage tend to run out of money and stop entirely, which is the worst possible shape for a recovery.

Should we start with the overnight or the morning?

Morning, in most cases. Bathing, dressing, breakfast and the first transfers of the day are the highest risk and the hardest work, and getting those done well sets up the whole day. Add the overnight if the nighttime bathroom trip is the thing keeping the family awake.

You can change the schedule as function returns. There is no minimum contract, so the plan is allowed to shrink when somebody gets stronger.

What about getting to the therapy appointments?

When home health ends, outpatient therapy usually begins, and that means two or three trips a week to a clinic. Ask your town's Council on Aging first, since many run free or low cost medical rides. If the person uses a wheelchair, or the house has steps they cannot manage yet, we also do that part.

Is there anything that pays for this?

Four things to check before writing checks indefinitely. A long term care policy may pay, though most reimburse you after an elimination period you fund yourself, which we cover on making a long term care policy actually pay. Veterans and surviving spouses should ask about Aid and Attendance. Your local Aging Services Access Point runs an income based state home care program. And if the person is on MassHealth Standard or CommonHealth and needs physical help with at least two daily activities, PCA hours cost the family nothing, though you do the hiring.

Medicare does not pay for an aide on an ongoing basis. The therapist it sends is skilled care and time limited. The day to day help is not a Medicare benefit and never has been.

How fast can you start?

Usually within a day or two, including a discharge day, because there is no assessment visit to schedule first and nothing to sign. Call 781-957-8076 and tell us the discharge date, what side is affected, whether transfers take one person or two, and whether there are steps at the house.

Care Remedy serves eastern and central Massachusetts from offices in Woburn, Brockton and Springfield.

This is general information about care at home and not medical advice. Follow the discharge and therapy instructions from the treating clinicians, and ask them about swallowing, activity limits and medication.