Probably the oldest and most familiar provider of home care services is known as the home health agency. The home health agency is licensed and usually Medicare certified and accepts other 3rd party billing of health insurances. Medicare certification means that the agency has met specific federal guidelines and criteria regarding patient care.
The main and distinctive purpose of this type of agency is to provide skilled care for treatment or rehabilitation services to homebound patients. Home care professionals must strictly adhere to a physician approved plan of care that is deemed medically necessary and updated every 60 days in order for Medicare benefits to continue.
Home health agency services include skilled nursing, physical and occupational therapy, social work, and home health aide while under professional supervision. Home health care agencies focus more on the skilled medical aspects of care and the home health care aide serves only as a supplement to this care. Regardless of reimbursement eligibility, Medicare will only pay for skilled care in the home for a limited period of time to treat an illness or injury. The HHAs can provide a pre-authorized amount of personal care while under professional supervision however must discontinue care when skilled care needs are no longer justified.
Individuals often may still have ongoing personal care needs even though skilled services are no longer required. As a result of this common need, some home health agencies offer a private pay, non-certified component within their agency for nursing assistants to continue providing personal and custodial care. Hiring a non-medical home care agency directly or a privately hiring a caregiver is another option when continued care through a home health agency is not feasible.
A non-medical home care agency is generally an agency that provides home care services which are not considered to be skilled care. These agencies provide what is termed non-skilled supportive custodial care that is supplied by home health aides, certified nursing assistants (CNAs) and also non-certified nurse aides, homemakers, and companions.
These greatly needed services range from housekeeping and companion care to assistance with personal care such as bathing, dressing, toileting, and eating. Non-skilled care is not reimbursable under Medicare and therefore is paid for privately, or in some cases by private long-term care insurance. A physician's order is not required as the need for care is not deemed medically necessary and patient homebound status not required. A professionally authorized and monitored care plan is unnecessary.
These private pay agencies are usually still licensed under authority of each state but licensure requirements and regulations vary widely from state to state unlike federally regulated Medicare certified home health agencies. Most agencies employ their workers, do background checks and manage payroll and taxes. Most of these agencies professionally supervise and monitor their staff with regards to patient care. Non-Medical home care agencies play an undeniably big role filling gaps in home care services not covered under skilled care. Non-skilled home care services such as personal care assistance or other cooking and cleaning help is often what may be needed most and by many in order to remain in their homes.
A private duty registry or employee staffing agency simply acts primarily as an employment service for a variety of skilled and non-skilled health care workers including nurses, nurse assistants (CNAs) and rehab therapists. Many states do not require these types of agencies to be licensed or conform to specific regulatory requirements.
The management of staff is the key difference between these private duty registries and both the home care and home health care agencies previously addressed. Generally home care and home health care agencies actually employ their workers that are sent into client's homes while registries do not. The registry matches an independent health care contractor with the patient needs, refers them to the client, and then collects a finder's fee. Consequently, the caregiver in the client's home does not work for the registry but instead the client acts as the employer. He or she becomes the supervisor, usually pays the worker directly, and is responsible for all payroll taxes including social security withholdings.
Registries and staffing agencies can be reimbursed for their services sometimes through long-term care insurance, Medicaid and private pay. These agencies refer various types of employees providing skilled care from licensed nurses to personal care and companion assistance from nursing assistants.
Requesting an employee referral through this type of service is similar to hiring an individual privately on your own. Managing your own employee offers more independence but at same time additional responsibility without the advantage of employee background screening and licensure verification that many registries undertake.
Private hire or independent caregivers include various types of nurses, therapists, nursing aides, homemakers, and companions. They are privately employed and managed by those who require their services. All responsibility for recruiting, hiring and supervising falls upon the client or family. Clients pay the caregiver directly; manage payroll taxes, and social security withholdings.
Agency rates are usually higher then private hire employees due to recruitment and management overhead costs incurred. Less dependence on agency staffing with the possibility of saving money may or may not be offset by the time-consuming responsibility of managing a private caregiver.