In-Home Counseling for Patients, Families and Caregivers
About the Article: HCCInsights sat down with Cherish Reinwald, Executive Director, In-Home Counseling, to learn more about her organization, and how her network can support home-based primary care providers and practices in the Chicago area, Illinois, and across the country.
HCCInsights: Would you provide some background on In-Home Counseling, including types of services provided, who your patients are and the geographic areas you cover?
Reinwald: In-Home Counseling provides short- and long-term psychotherapy and counseling in the home, and over the phone, and via telehealth. We specialize in treating the geriatric population and those who have barriers or limitations to leaving their homes, though we also can see clients as young as 11 years old.
Patients are typically referred to us through medical or mental health professionals for concerns such as anxiety, adjusting to new living arrangements, aging issues, new or worsening medical issues, isolation, grief and loss, caregiver stress, phobias, mental illness, and the emotional impact of physical conditions.
In-Home Counseling was started in 2008 for a single client by a social worker. She then offered in-home visits to older adults because she saw a need. Soon, through word-of-mouth, she began being asked to see patients by medical and mental health professionals across the Chicagoland area. At that point, she hired more social workers to assist, many of whom still work for In-Home Counseling.
We started accepting insurance in 2009 and then began receiving referrals from more medical professionals across Chicagoland and Rockford, Lake County, McHenry County, DuPage County, and Will County. We now have more than 100 counselors across Chicagoland and have expanded into nine states, including Michigan, Wisconsin, Arkansas, Colorado, Texas, Tennessee, Florida, Indiana, and California.
HCCInsights: Besides home-based primary care providers, who else refers clients to In-Home Counseling?
Reinwald: Most of our referrals come directly from medical or mental health professionals. We receive referrals from home health agencies, specialty doctor groups, dialysis clinics, hospice organizations, caregiver companies, oncology and other specialty practices, hospitals, and insurance companies, among others. At times we are also called into assisted living facilities where we may have a counselor see multiple patients. Plus, clients and caregivers themselves can also reach out directly to us.
HCCInsights: Are the counseling services provided by In-Home Counseling covered by insurance?
Reinwald: Yes, we accept Medicare, Medicaid, most Medicare and Medicaid commercial replacement plans, and most commercial insurances across all states. Of course, insurance plans vary, but if an elderly patient, for example, has Medicare and does not have any supplemental insurance, or does not have Medicaid, it would be 20% for the co-insurance amount. If they do have Medicaid or a supplemental insurance, there is typically no cost per visit.
HCCInsights: Do the counselors work directly for In-Home Counseling?
Reinwald: All the counselors in our network work for In-Home Counseling. We do the interviewing, background checks, and all credentialing. The counselors also receive ongoing education, training, and support from our clinical and management team.
HCCInsights: What are the main types of situations your counselors get involved in?
Reinwald: We provide psychotherapy (i.e., talk therapy) in the home, or by phone or telehealth, for those who are feeling depressed, anxious, stressed, having family issues or other adjustment issues, and more. The issues may be limiting an individual’s ability to live a full happy life. In addition to providing mental health counseling, counselors also connect patients to additional resources such as other medical professionals, Meals on Wheels, and so on.
HCCInsights: How would a home-based primary care provider assess whether in-home counseling is appropriate for their patient and refer a patient to you?
Reinwald: The provider can call In-Home Counseling’s intake team at 888-903-5604 for help with determining whether in-home counseling would be appropriate or to make their referral over the phone. Often, the provider has already done a depression screen and knows the client has some significant depression or other mental health issues – or the provider has observed the client is tearful, isolated, anxious, or having compliance issues with their medical treatment.
The provider can also initiate a referral by faxing 224-788-5112. We also have referral forms we can email to the provider and can accept referrals online at www.InHomeCounselingServices.com (click on the “Referrals” tab).
Once we have the referral information, In-Home Counseling verifies the insurance eligibility and then we identify a counselor who would be the best fit for that client. We reach out to the counselor who in turn contacts the client to schedule an appointment at a time that works well for both. Scheduling is flexible and worked out between the counselor and client. If we run into any scheduling difficulties or can’t reach the client, we reach back to the referring provider to let them know.
HCCInsights: What role does the primary care provider play in the counseling process? Do they have an initial consultation with the counselor and then receive updates?
Reinwald: When a patient is referred for services, we ask the referring provider/source for information about the patient so that we can match the patient’s needs with a counselor. In terms of sending the provider updates, the patient will first need to agree with our doing so by signing a release form. Then we can send the provider treatment notes on a regular basis by email or fax, or the counselor and provider may speak by phone.
In-Home Counseling can also provide visit reports to physician groups that would like to partner with us. These reports include patient visit dates and case statuses and are sent on a semi-monthly or monthly basis, depending on the group’s preference.
HCCInsights: What process does a counselor follow with the patient for treatment?
Reinwald: Counselors begin an assessment at the first visit. This is where they learn about the client’s life and health history, complete a mental health screening, and evaluate the client’s emotional health to determine treatment direction and diagnosis. They also begin creating a treatment plan for the client to follow.
The client’s needs determine the duration and frequency of visits. Typically, most visits are 60 minutes, once per week, to start. The duration of treatment may be a couple of months or it can last longer if there are chronic mental health concerns. Our goal is to help improve the client’s mental health and maintain or improve their current level of functioning, depending on the case.
HCCInsights: How has the pandemic affected the way services are being delivered? Have clients adapted to these newer ways of conducting visits?
Reinwald: Services are currently being provided face-to-face with providers following all protective guidelines — they wear masks, use hand sanitizer, and switch appointments to telehealth if they or the client are not feeling well. Services are also provided via telehealth and phone, dependent upon patient and counselor preference. We began using telehealth in March 2020, which allowed us to seamlessly continue offering services to existing clients and offer support to new clients. Post-pandemic, we will still have telehealth visits with all insurances that continue to allow its use.
As the pandemic has unfolded, we have seen more clients feeling isolated and depressed. Some who were being seen in person were transitioned to telehealth, which was initially challenging, but then it went well, which has helped the situation.
HCCInsights: How has COVID affected your clients’ well-being in general?
Reinwald: With some who were clients prior to COVID, session and treatment plans have changed to different degrees. They may feel more isolated because family members are not coming around as much. Some patients are also feeling more grief and loss. The increased loss of freedom brought about by the pandemic is significantly affecting the older adult community. Fortunately, the counselor’s visit, whether through telehealth or in-person, can alleviate some of the loneliness and feelings of isolation.
With younger people, it is also difficult. We’re seeing feelings of isolation brought on by the increase in remote learning and more kids are also withdrawing from their families. In children, depression can look like someone being tearful, but generally it’s more like withdrawing, changes in eating habits and personal hygiene, and things like that.
HCCInsights: How do counselors work with significant others and family members, and non-family caregivers?
Reinwald: It really depends on the situation and circumstances. We can provide family counseling to benefit the identified patient, which can help the whole family better understand the patient’s needs and how to support them. We can also provide counseling for spouses and significant others. In addition, there are times when we identify that a family member or caregiver needs their own support and counseling. In these instances, we encourage them to become a client of In-Home Counseling as well. That is a separate arrangement due to privacy/HIPAA issues.
HCCInsights: Last question – what do you love about house calls, about providing in-home counseling services?
Reinwald: That’s easy. It gives our counselors a more transparent view of what’s really going on. They can see whether the house is tidy, if there’s food in the cupboard, maybe there are a lot of animals in the home or the atmosphere is chaotic, and so forth. The in-home counselor gets a more accurate view of the client’s life – one they wouldn’t get during an office visit.
Providing in-home services also allows counselors to observe family members, caregivers, and the surrounding support system. Plus, it helps counselors build rapport in a different way – they’re not clinicians in an office anymore, they’re individuals coming into someone’s home. They see the family photos on the wall and can make deeper connections.
All of this helps the counselor better assess and treat the patient, which hopefully improves their situation and that of family and other caregivers.
How to Contact In-Home Counseling: