4 Things You Should Know About Home Care

An overview of medical vs. non-medical, ownership types, management laws, and how to compare quality.

By Clare Absher RN, BSN  

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

1. There are two types of home care agencies.

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.

The non-medical home care agency provides what is termed unskilled 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. It is important to note that 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 when skilled care is 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.

2. There is a broad range of ownership types.

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.

3. There is no law about who can manage an agency.

Emphasis 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 a 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. If you are not satisfied with first impressions, be sure 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.

4. There are multiple ways to compare home care agencies.

Agencies that provide skilled in-home care services are Medicare/Medicaid certified meaning that they undergo annual state inspections to evaluate performance. This report card is accessible to consumers via Home Health Compare and should be carefully reviewed when it exists. On the other hand, non-medical home care agencies do not have this same certification, thus you will need to rely upon other referral sources. Actively seek out recommendations from healthcare professionals, social workers, and other family caregivers in your community. In addition to word of mouth referrals, compare agencies by researching their awards, recognitions, and accreditations. The "Joint commission" (JCAHO) is a nationally recognized accrediting organization that evaluates both medical and non-medical agencies. Voluntarily undergoing evaluation by JCAHO demonstrates an agency's commitment to quality care. Use online resources such as our home care directory to find local agencies and compare them. Networking with others in your community along with conducting your own research will help you select a quality home care agency.

Clare Absher RN BSN

About the Author

Clare Absher is a Registered Nurse with 44 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.

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