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How do I choose a home care provider?
The questions below will help you choose the home care provider that is appropriate for your medical needs and family situation. Regardless of whether the care you seek is skilled or home support care, it is important that you know the answers to the following questions.

What should I consider when hiring privately or through an agency?

AGENCY:
*Is the agency performing criminal background checks?
*How long and what geographical areas are covered in the background check they perform?
*What are the experience levels and specialties of aides available?
*Will the agency be responsible for finding a replacement caregiver if my regular aide is sick or on vacation?
*What hours can I speak to someone from the agency?
*Is the agency licensed and bonded?

PRIVATELY:
*Should the family perform a background check?
*What is the aid’s previous experience?
*Who will replace my caregiver if they are sick or on vacation?
*Does the caregiver have any type of licenses or certifications?
*Do I have to do reference checking?
*Who will be my advocate if I have a problem with my
caregiver?

Points to consider when choosing a home care provider:

— How can I cancel the service I requested?

— How much is the cancellation charge?

— Who do I call if my caregiver is unable to work?

— What is their phone number?

— What are the fees?

— What exactly is covered by those fees?

— Will the agency respond to requests for “short notice” services?

— Is there an extra charge for these services?

— Is there a minimum or a maximum number of hours of home care service per day?

— Is there a minimum or a maximum number of days of home care service per week?

— Is there someone available to assist me 24 hours a day, 7 days a week?

— How long will it take someone to return my call after business hours?

— How do I make changes to the initial caregiver schedule?

— Do the aides provide transportation if needed?

— What type of screening does the agency perform?

— How long will I wait for service after placing my request?

— Will the same caregiver assist me every day or will it be somebody different?

— Will someone from the agency call to see if I am satisfied with the services provided to me?

— How often will they call and check-in with me?

— Will I be responsible for providing meals for the caregiver?

— Will my live-in caregiver require a private bedroom?

— Will my caregiver clean my house and do my laundry?

— Do I need to sign a contract with the agency?

— How long is the contract good for?

— What does it entail?

— Do I need to have a qualified, elder law attorney review this contract before signing it?

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Home care includes a wide variety of services—from skilled intravenous therapy to snow shoveling—all provided to individuals in their homes or in an assisted, nursing, or hospital facility. Home care often supplements the care individuals receive in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.
Whether performed in the comfort of their own homes or in a facility, home care helps seniors to maintain their independence. Additionally, home care prevents the full responsibility of caregiving from falling on friends and family. These services are intended to promote, maintain, or restore health and help individuals to manage the responsibilities of daily life. Aides and nursing professionals can be engaged privately or through an agency.

What types of Home Care are available?
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section.
Home Support Care – is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not yet require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments. Training and certifications will vary from provider to provider.
Skilled Nursing Care – is care that is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

How much will Home Care services cost, and who will pay for them?
Home Support Care – is traditionally a “private-pay” service, which means that it is an out-of-pocket expense for the customer. Prices range from $10-$20 per hour. However, most long-term care insurance policies will cover home support care. You should carefully review your long term care insurance policy with your insurance agent to be sure that the type and amount of coverage you will need will be covered. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.
Skilled Nursing Care – will be paid for by Medicare, a government program that covers some of the medical needs of seniors over the age of 65, as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Be sure to fully understand what Medicare and your health insurance policy will cover before making arrangements for skilled nursing care. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.
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We hear all the time about the “graying” of America, as Baby Boomers get set to retire. And these Baby Boomers, for the most part, plan to stay put in their own homes. In fact, a recent AARP survey examining the opinions of Americans over the age of 45 on current and future housing situations found that the majority plans to stay in their current residence for as long as possible.

Combine this information with the Center for Disease Control’s findings that falls are the leading cause of injury deaths among people 65 years and older and 60% of these fatal falls happen at home, and it is no wonder that there is a growing trend among homebuilders and remodelers to create “universal design” living spaces.

Universal design homes need to accommodate occupants with decreased health, vision, mobility, hearing, dexterity and income. There are a number of ways that new houses can be designed, or existing houses can be remodeled, to make life easier for people with such limitations, whether they be elderly or a teenager with a ski injury. And the bonus is that such modifications usually make the home more comfortable for everyone. The concept of universal design works for all.

Most issues related to universal design fit into one of three categories: convenience, safety/health, and economy. Designs for convenience include anything that makes life easier, such as automatic garage door openers, lighted switches, lever handles for doors and faucets, wheelchair ramps, home elevators and stair lifts, wider halls and doors, intercom systems, taller toilets, openings without raised thresholds (including shower stalls), among many others.

Safety considerations include adjusting water temperature to avoid scalding injuries, good lighting, installation of smoke detectors, placement of handrails and grab-bars, removal of slippery throw rugs and generally reducing clutter and obstacles.
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Before opening your home to any service provider, including in-home caregivers, you should take a few steps to make sure that you protect yourself and the caregiver. Taking these steps does not demonstrate a lack of trust in the provider, nor does it mean that they are not trustworthy. It is simply logical to make sure that you look after your assets. You should place any of the following items in a safety deposit box or other secure location:

• Small valuables

• Irreplaceable or sentimental items

• Small family heirlooms

Let family members know that you have removed these items from the house and that they are safe. By taking these simple steps, you can make sure that you, your family, and your caregiver do not have to face the problems that arise when precious items are misplaced.
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Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.

Coverage by other financing options will vary widely, but the follow services, programs, or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:
Ø Is the provider Medicare/Medicaid certified?
Ø If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).
Ø How many years has the provider been in business?
Ø Is the provider associated with a larger health care group or hospital?
Ø Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?
Ø Will the agency help you find the best homecare options for you?
Ø Does the provider have a written policy describing the patient’s rights?
Ø Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
Ø Will the provider give you written information describing how they commence and discontinue services to patients?
Ø What backup does the patient have if their caregiver cannot show up at the scheduled time?
Ø What are the internal complaint procedures?
Ø Will the provider give a list of citations they have received from state surveyors over the past year?
Ø Does the provider have a nursing supervisor on call and available 24 hours per day?
Ø How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
Ø What types of reimbursements will the agency accept?
Ø Will the provider give a list of references?

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Are you or a loved one struggling with health issues that are making it harder to remain at home? Are you looking for care to help you recover from surgery or an injury? Do you need help with household chores or activities of daily living? Is managing a long-term illness becoming more difficult? Home Health Care is a rapidly growing field in the senior care industry that may help families negotiate these challenges and remain in their own home.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place—receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.
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Paying for Medical Supplies and Equipment
Medicare helps pay the costs for durable medical equipment. According to Medicare, in order to be covered, “items must be reusable, such as walkers, wheelchairs, or hospital beds.” Durable medical equipment for home health services is paid for under both Medicare Part B and Part A. Medicare coverage varies, and some equipment must be rented, while other equipment must be purchased. Durable medical equipment regional carriers can provide more specific information on coverage by Medicare.

Coverage by private insurance for durable medical equipment will vary greatly depending on the company and the specific policy. Coverage for medical supplies by both Medicare and private insurance will depend on the products required, specific medical needs, and doctors’ recommendations.

Finding a Medical Supplies and Equipment Provider
Medical supplies and equipment providers can offer a single solution product or multiple products to meet a range of needs. Before purchasing from a medical supplies and equipment provider, individuals should be comfortable with the professionalism and reliability of the company. Request specific information about costs and product delivery time frames. Consumers should also be aware of any warranties that cover maintenance, repair, or replacement of durable goods.

Finding a reliable provider is an important decision. The products that these providers deliver can lead to important and positive changes in the lifestyles of individuals with increased health care needs, decreased mobility, or who simply want to maintain or increase their level of independence.
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