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Home Care & Hospice Services

Home Care & Hospice Services

As an alternative to moving from one’s home, many older Americans would prefer to have the care come to them. Home Care may be contracted to provide services in a person’s home, apartment and oftentimes in an independent living community setting.

The National Association for Home Care and Hospice has identified several types of services that home care providers offer. Among them are medical services provided by physicians, registered nurses (RN), licensed nurse practitioners (LPN), occupational and physical therapists (OT and PT) which are generally referred to as Home Health Services. These services typically include wound care, respiratory care, physical, occupational and speech therapy, intravenous or nutrition therapy, injections and monitoring serious illness as well as ongoing health status. Each Home Health Service agency requires a state license to operate and each clinician must have an active individual professional license to deliver hands-on services.


Non-medical services provided in the home include assistance with activities of daily living (ADLs) and chore services, These services are ideal for seniors that require assistance with personal care, grocery shopping, light housekeeping, cooking, etc. and desire to age in place. Non-medical support services may or may not be accompanied by licensed professionals who perform monitoring for an acute or chronic medical condition. In addition, home health aides may be contracted as companions to provide the human interaction and oversight support for peace of mind for the senior and their family. This includes respite care which can give relief to the family caregiver who needs a break to get out of the house for their own physical and mental well–being.The regulatory requirements to operate a home care company can vary from state to state. Some states require a license, some certification, some both and some none.

There are also several other specialty mobile services that may also be classified under Home Care. These services include mobile beauticians/barbers, dentistry, pharmacies, X-rays, foot care, and more.

Home Care costs are most often paid out-of-pocket, particularly for non-medical services. However, a senior interested in this option but unable to afford it should speak with a local advocate through Senior Information and Assistance about alternative methods of payment. Home Health Services may be covered by Medicare if the certain eligibility conditions are met. Check out Medicare.gov or benefitscheckup.org to learn more.

How Do I Select the Right Home Health Care Provider?

Consumers are often uncomfortable selecting a home care provider if they have not had experience with these types of service providers in the past. Having someone come into your home without secondary on-site supervision can be a concern to many consumers. Making an informed decision based on some good purchasing practices can provide the peace of mind needed to get the right in home care services needed for safe and effective care. A word of mouth referral from a trusted professional or friend who used home care services in the recent past and had a good experience is always beneficial.

When doing a search on providerdata.com for home health care (medical services), you can use the filter to find only those agencies that are Medicare Certified by selecting the filter option "US DHHS Home Health Care". Please note that some private insurance companies may only cover services provided by a Medicare Certified agency. To evaluate quality differences between home care providers in a given area, SNAP has integrated the Medicare.gov Quality Metrics* into an easy to read set of graphs to help consumers compare and contrast one provider from another.


* You will want to scroll down the individual home health agency listing to view the Quality Metrics for each Medicare Certified home health and hospice provider.

Home Care & Home Healthcare Provider Checklist

Use this guide when you speak to a home care or home healthcare provider representative. Asking the right questions upfront will help you make a more informed decision.

Agency Business Practices

  • How long has the agency been in business?
  • How many hours are in a minimum shift? What about a maximum shift? Can a shift be split?
  • Can the agency respond to your needs 24 hours a day?
  • Does the agency carry malpractice insurance?
  • Is the agency bonded? Are each of the caregivers bonded?
  • Does the agency give or receive payments for referrals?
  • Does the agency employ geriatric care managers to conduct assessments?
  • Does the agency complete fall risk assessments for each client? If so, how often?
  • How does the agency resolve problems or complaints?
  • Is staff provided with continuing education?
  • What educational opportunities are offered?

Documentation & Supervision

  • Does each client have a written care plan which documents the caregiver’s routine duties? How often is the care plan updated?
  • Will a supervisor visit the client’s home periodically to review the client’s care?
  • Is there an automated system in place to document caregiver arrival and departure times?
  • Do caregivers receive an orientation for each new client prior to working in the home?

Caregiver Information

  • Are the caregivers employees of the agency or are they contractors?
  • Are all caregivers licensed and certified? If not, what are the minimum qualifications for each caregiver?
  • Are all caregivers current on CPR and First Aid Training?
  • Do all caregivers have a current tuberculosis (TB) test?
  • Do caregivers have any special training such as Infection control, safe bending and lifting practices, managing incontinence, managing difficult behaviors, dealing with memory loss or confusion?

Personal Services (ADLs, special needs)

  • Which services are available?
    • Assistance with activities of daily living
    • Housekeeping
    • Daily chores
    • Transportation
    • Companionship
    • Medical care
    • Rehabilitation

Transportation

  • Is transportation available for specific appointments?
  • If yes, are there any limitations? Additional fees?

Healthcare

  • Does the agency offer healthcare services?
  • Is nurse delegation available to provide services at a lower cost?
  • Does the agency have licensed nurses such as RNs or LPNs on their staff?

Policies & Cost

  • When is payment due?
  • What is the cost of overtime if a caregiver stays late?
  • What are the billing, payment and credit policies?
  • Are there any additional costs for travel time or additional services?
  • When may a contract be terminated?
  • What is the policy for requesting another caregiver?

Buyer Beware…

If you decide not to contract with an agency but to secure home health care services directly from an individual professional or home health aide, it is important to understand that the regulatory requirements vary widely from state to state. You can contact your state department of licensing or Health and Human Services agency to inquire what the laws are in your respective state. Some states require caregivers to register and have successfully passed background screening to ensure there is no criminal history and that they are legally able to work in the U.S. For those states that don’t have such a requirement for home health aides or attendants, you may want to do your own background screening in advance of engaging their services. It is also advisable to do thorough reference checks on any individual you’re considering to hire to care for a vulnerable ill person. If you do decide to hire an individual, it would be prudent to expect to orient and train them in the home to get them familiar with the home setting and to ensure that the patient and caregiver feel comfortable with one another. It is also good practice to get the terms of your engagement in writing not just verbally.

How do I pay for Home Health Care?

There are significant cost variances from region to region within the U.S. for home health services. Depending on the type of health care provider, the likely duration the person will need to services and the amount of services each day, the amount of competition in a market, the costs can fluctuate considerably. If the consumer of home care services has an active long term care policy with home health benefits and qualifies for eligibility, then a portion if not all of the cost for home care may be covered by the insurance policy. It would be wise for the consumer or their advocate to check on the policy coverage in advance and to make certain that the home care agency being considered meets the requirements for the policy to make payments according to the benefit coverage, Home care services are typically paid directly by the patient and his or her family members, or through a variety of public and private sources. Many home care agencies will not accept assignment of benefits and will expect the patient to seek reimbursement from a private home care insurance policy rather than have the insurer pay the home care agency directly. The possible sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.

Where Can I Get More Information About Home Health Care?

There are several national organizations that can provide additional consumer information about home health care services. These include the following:

  • The National Association for Home Care, which can be reached at (202) 547-7424 or by visiting its website at http://www.nahc.org.

To find out more about home health care programs where you live, you will find your local your local aging information and assistance provider or Area Agency on Aging (AAA) by searching on www.providerdata.com.

 

Resource Downloads

Asking the right questions upfront will help you make a more informed decision about the right home care and hospice services for you.

Use this guide when you speak to a home care or home healthcare provider representative.

Home Care & Home Healthcare Provider Checklist