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Understanding the Basics of Home Care

By: Clare Absher RN, BSN

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There are distinct variations among home care agencies regarding types of ownership, services provided, caregiver skills, payment options, and management. Understanding these differences will better prepare you to choose the best home care agency to fit your needs.

Understanding Ownership

Most home care agencies are for profit and ownership ranges from small family-run businesses to large corporations that are often regional chains. They may be independently owned and operated or may be affiliated with hospitals, physician groups, and long-term care facilities. Sometimes agencies are not for profit and may be sponsored by religious organizations, fraternal groups or community-based agencies. They are governed by volunteer boards of trustees and any surplus income that is generated is turned back into the agency. Not-for-profit agencies in most areas are limited in number and benefit on account of their tax-exempt status. Ownership should not be a primary focus, but may play some role in your decision with regards to company size, affiliations and profit versus not for profit status. If interested in learning more about non-profit home care agencies refer to American Association of Homes and Services for the Aging.

Considering Your Needs

The types of services and caregivers providing them, and subsequent payment options are essentially determined by whether skilled or unskilled care is needed. Home Care is basically divided into two primary types of agencies: medical home health agencies that provide skilled care and non-medical home care agencies that provide unskilled care.

The medical home health care agency provides skilled services when ordered by a physician such as skilled nursing, physical and occupational therapy, speech therapy and social work. These agencies are licensed by the state and accept 3rd party reimbursement from Medicare, Medicaid, and other private health insurances. Research state reports on Medicare / Medicaid certified Home Health Care Agencies on Home Health Compare.

The non-medical home care agency provides what is termed un-skilled supportive custodial care that is supplied by home health aides, certified nursing assistants (CNAs) and also non-certified nurse aides, homemakers, and companions. Non-medical home care agencies may or may not be licensed as requirements vary from state to state but are universally private pay with exception of coverage from some long-term care insurance policies. However it is very important to point out that often unskilled personal care services such as bathing, dressing and meal preparation are what is needed most and therefore must be paid for out of pocket. Strict guidelines dictating skilled care requirements and/or when skilled care needs are discontinued are further justification for hiring a non-medical home care agency. Explore other possible supplementary funding to assist with private pay costs through local social service programs, disease specific organizations, or national charity foundations. Religious based agencies along with other non-for profit ownership agencies may have additional private funding to help cover costs.

Evaluating Management

Emphasis instead should be placed on learning more about who manages or runs the day to day operations of an agency. It's often advantageous when nurses or other health professionals manage home care agencies due to their relevant experience. In most states there is no law about who can start up an agency or manage one but a certain background in this field is usually beneficial. Managers with health-related experience in communities are competent in referring families to local valuable resources. Many competent agencies regardless of manager's background will schedule a health professional to make an initial free home assessment visit to set up a plan of care. Think of it as an estimate that one would expect from any business such as auto or home repair shop where actual services and costs are detailed. A qualified agency representative should also take on the role of arranging necessary home equipment, modifications and other supplies. Take advantage of a first visit by interviewing the professional representative to help size up the agency's qualifications. Be sure that if not satisfied with first impressions to continue shopping around. On the other-hand, if you are fortunate to have a good "gut feeling", then chances are a positive outcome for care will likely follow.

Choosing the Right Home Care Agency

Lastly, seek out any valid personal referrals and recognitions by local and national organizations to further identify which agencies are most reputable in the community. In addition to Medicare /Medicaid certification mentioned above, the "Joint commission" (JCAHO) is a nationally recognized accrediting organization that evaluates agencies who volunteer for review. Referrals may also come from discharge planners at hospitals, social workers at long-term care facilities, and staff members at physician's offices. Find out what if any affiliation that the referring source has with the agency to validate its credibility and if able to supply personal recommendations. Accreditations, knowledgeable referrals and personal recommendations from creditable sources are invaluable resources to help determine the best home care agency.