Home Care

Several options are available for those who want to bring care into the home. The following information offers a general overview of the types of agencies, care providers, and staff available to provide in-home care. Most of the terms used are general, but may vary based on state or region.

Home Health Care Agency

A home health care agency is typically a Medicare certified home care provider. According to the National Association of Home Care, there were almost 9,000 Medicare certified agencies in the United States in 2006. Medicare certified agencies provide the following skilled services:

• Nursing services*
• Certified nurse aide services*
• Physical therapy*
• Occupational therapy*
• Speech therapy*
• Medical social worker*

* skilled service which requires a physician’s order that will usually be obtained by the home care agency

Private Duty Home Care Agency

Many home care agencies—whether they provide Medicare services or not—may also be paid for privately, through a medical insurance benefit, or through long term care insurance benefits. The following services may be provided by a Private Duty Home Care Agency:

• Nursing services*
• Certified nurse aide services*
• Physical therapy*
• Occupational therapy*
• Speech therapy*
• Medical Social worker*
• Personal Care Provider
• Homemaker
• Companion
• 24 hour care
• Overnight care
• Transportation
• Medication set up*
• Medication reminders

* skilled service which requires a physician’s order that will usually be obtained by the home care agency

Companion Services

Many private agencies are designed to provide companion and homemaking services (also known as non-medical services). These agencies typically do not offer any medical assistance, medication management, or personal care assistance.

Independent or Private Care Provider

Many families opt to hire their own care provider or a team of care providers. If you choose this route, there are some issues that you should consider.

• They must be private contractors for tax purposes
• You must provide them with 1099 IRS forms each tax year
• You should check with your homeowners insurance carrier to make sure that any job-related injuries will be appropriately covered

How do I find a Home Care Agency?

• Ask a current or previous home care user for suggestions or a referral
• Look under Home Care or Senior Care in your local yellow pages
• Call your local senior center
• Call your local Area Agency on Aging (call 1-800-677-1116 to find your local AAA)
• Do an online search for “home care YOUR CITY”
• Do an online search for “home health care YOUR CITY”
• Go to www.nahc.org and look for the home care finder section

How do I find a private home care provider?

• Talk to friends and family to spread the word of your need
• Look in classified ads in your local newspaper
• Post an ad on local college job boards
• Post a classified ad in your local newspaper
• Ask friends and family for a referral

Are Home Care Agencies regulated?

Home Health Agencies are regulated by the Health and Human Services Division of each state. Regulations, certification, and licensure options vary by state. Contact your State health department to learn more about the requirements in your state.

Some states regulate all home care providers. Many only require certification or licensure of agencies providing skilled care or care being paid for by third-parties. It is very important that you research any agency you are considering to make sure they follow certain quality standards.

How do I choose the right home care option?

Finding a home care provider that best fits your situation will involve some research.

Here are some things you should determine before contacting an agency:

• What do I want the care provider to do?
• When do I want the care provider to be available?
• What kind of care provider will my care recipient best respond to?
• Will my homeowner's insurance cover a care provider working in my home?

You can download the Toghers Home Care Checklist to guide you in this process.

Who pays for Home Care?

Several sources of payment are potentially available for home care.

Medicare: Home Health benefits covered by Medicare are limited to services that are deemed medically necessary (also called skilled services) and must be ordered by a physician. Usually services are limited to a duration of approximately six weeks and are typically authorized after a fall, hospitalization, or new diagnosis of certain chronic illnesses. Medicare does not pay for unskilled care, 24 hour care, or companion care.

Medicaid: The same skilled services covered by Medicare can be covered by Medicaid for those who are low-income but do not qualify for Medicare. Many states also have a Home and Community Based Services (HCBS) waiver program that pays for unskilled home care that enables a person to remain in their home. These services are usually limited to personal care assistance and homemaking tasks. If your care recipient has already qualified for Medicaid, check with the case manager to see if your state offers any coverage for home care. Some states also have programs that will reimburse a family caregiver for the services that they would otherwise be paying for.

Veterans Administration: The VA offers coverage for in-home services based on need. Speak to your local VA representative to determine if your care recipient is eligible.

Private pay: Many people pay privately for home care services. Rates vary depending on location, needs, and services, and can range from $15 per hour to $30 hour for personal care, companion care, errands, and homemaking. Some agencies may offer a sliding scale fee program or have scholarship funds for low-income participants.

Long Term care insurance: Many long term care policies cover home care services. Check with your policy administrator to see if this is a covered benefit.

Health Care Insurance: Many insurers cover limited in-home care after surgery or hospitalization.

Workers Compensation Insurance: Workers compensation may cover in-home care if it is deemed necessary.

Using an Agency vs. Hiring a Private Care Provider

When deciding between using a home care agency or hiring a private care provider, you may want to consider the following:

Using an agency may be a better fit if:

• You need multiple shifts covered
• You do not have time to oversee the scheduling
• You need to have the assurance of a back-up system should a care provider be unavailable for a scheduled shift

Hiring a care provider may be a better fit if:

• You already know someone within your community who you know and trust
• You don’t need to have set days and times covered (your schedule is flexible)

Copyright © 2008 by Toghers

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