When you are shopping for a home care agency, you are seeking a company that will assist you in providing for the health and safety of you or your loved one.

What to Look For When Choosing a Home Health Care Agency

What is Home Health Care?

Home health care services are initiated when someone is no longer able to care for him or herself due to failing health or recent changes to their health.

Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel.

Home care and home health care services may include:

Professional Nursing Care Services

  • In-Home Assessment
  • Medication and Pain Management
  • Diabetic Care
  • Oxygen Therapy
  • Ostomy Care
  • Orthopedic Care
  • Rehabilitative Care
  • Emergency Management

Personal Care Services

  • Bathing and Dressing
  • Feeding
  • Mobility, Transferring and Positioning
  • Toileting and Incontinence Care

In-Home Companionship and Care Services

  • Respite or Relief for Family
  • Grocery Shopping and Meal Preparation
  • Medication Reminders
  • Light Housekeeping, Laundry and Linen Washing
  • Errand Services and Incidental Transportation
  • Recreational Activities and Crafts
  • Grooming and Dressing Guidance
  • Mail Assistance and Organization
  • Conversation and Companionship
  • 24-Hour or Live-In Care

Who Provides Home Health Care?

Home health care services can be provided by a variety of trained individuals. Providers may be for-profit, non-profit, or hospital based.

Home care agencies provide homemaker services, which include household and personal care duties. These agencies may or may not be licensed, depending on the state they operate in.

Home health care agencies provide care services through teams of doctors, nurses, therapists, social workers, homemakers, and others. These agencies are regulated by state and federal laws and often are Medicare- and Medicaid-certified. This means they can get paid by these programs for providing home health services.

Examples of home care and home health care providers include:

  • Companions—Provide comfort and companionship to individuals who, for medical and/or safety reasons may not be left at home alone. They may also assist with household tasks.
  • Family Caregivers—Provide emotional, physical, and spiritual comfort to loved ones.
  • Home Health Aides—Assist patients with activities of daily living such as getting in and out of bed, walking, bathing, toileting, and dressing.
  • Homemakers/Chore Workers—Perform light household duties such as laundry, meal preparation, general housekeeping, and shopping.
  • Medical Social Workers—Evaulate the social and emotional factors affecting ill and disabled individuals; provide counseling; assist patients and their family members identify available community resources; serve as case managers; and coordinate a variety of services.
  • Occupational Therapists—Help individuals who have physical, developmental, social, or emotional problems. They also instruct patients on using rehabilitation techniques and equipment to improve function in basic household tasks such as eating, bathing, and dressing.
  • Physical Therapists—Work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage and other techniques; help to alleviate pain and restore injured muscles with specialized equipment; teach patients and caregivers special techniques for walking and transfer. Walkers, wheelchairs, and other medical equipment may be provided.
  • Registered Nurses/Licensed Practical Nurses—Provide skilled nursing services, such as injections and intravenous therapy, wound care, education on disease treatment and prevention, and patient assessments. RN's may also provide case management services.
  • Respiratory Therapists—Provide oxygen therapy to those in need.
  • Physicians—Work with home care providers to determine services that are needed by patients, which specialists are most suitable to provide these services, and the frequency of services to be provided. They also prescribe and oversee patient plans of care.
  • Speech Language Pathologists—Work to develop and restore the speech of individuals with communication disorders, usually as a result of surgery or stroke. They also retrain patients in breathing, swallowing, and muscles control.
  • Volunteers—Assist with a variety of patient needs. Depending on their level of training and experience, volunteers may provide companionship, emotional support, counseling and helping with personal care, paperwork, and transportation. Volunteers may provide respite care for family caregivers.

How is Home Health Care Paid For?

Home care and home health care services can be paid for by:

  • Patient and family (out of pocket),
  • Public third-party payers such as Medicare, Medicaid, and the Veterans Administration, or
  • Private third-party payers such as health insurance companies and managed care plans.

Often, these services are paid by some third party. Third party payors have specific eligibility and coverage requirements, and it is important that caregivers be aware of these requirements so that payment to care providers can be efficiently made without any interruptions in needed services.


Private Pay or Self-Pay

If third-party coverage is not available or does not cover all the care that you need, you and your family can hire providers and pay for services out of pocket.


Public Third-Party Payers

Medicare—80% of all home health visits are paid by Medicare. The Medicare program covers the elderly (those 65 and over) and individuals who have been disabled for two or more years.

While Medicare has the most restrictive requirements for payment of home health services, it is frequently the only resource the elderly have for needed care.

Medicare Home Health Benefit is a federal program that has two parts—Part A and Part B. All home health services can be covered under either Part A or Part B while other forms of health care are only covered under one of the parts. Hospitals and short-term nursing home care are covered only under Part A, while doctor's visits, durable medical equipment, ambulance and outpatient services are covered under Part B.

If a patient is a Medicare beneficiary (who is enrolled in Part A, Part B, or both), Medicare will help cover home health care if the patient meets the following four (4) conditions:

  • A doctor must decide that the patient needs skilled care in the home and prescribe or order home care, and
  • Must need at least one of the following services: part-time intermittent skilled nursing care or physical therapy, speech-language services, and
  • Must be homebound, and
  • Must receive services from a home health agency that is "certified" (or approved) by Medicare.

If you meet all four of the conditions above, Medicare will help cover:

  • Skilled nursing. This is care that can only be delivered safely by a registered nurse, or a licensed practical nurse under the supervision of a registered nurse. It is care like injections and complex wound care.
  • Home health aide services. These services include help with personal care such as bathing, using the toilet or dressing. Medicare does not cover them unless you are also getting skilled care such as nursing or other therapy.
  • Therapy. This includes physical therapy, speech-language services and occupational therapy. Your doctor must say you need these types of care.
  • Medical social services. This is counseling to help with social and emotional concerns related to your illness.
  • Certain medical supplies. This includes things like wound dressings and ostomy supplies.
  • Certain durable medical equipment. This includes wheelchairs, hospital beds, oxygen and walkers (not all home health agencies provide equipment—and, if they do, you will be responsible for paying 20% of the cost of these items).

Medicare does not pay for:

  • 24-hour per day care in the home.
  • Prescription drugs (with a few exceptions—consult your physician).
  • Meals delivered to the home.
  • Homemaker services like cleaning, laundry and shopping.

Not all home care agencies are certified to provide care to people with Medicare. Those that are certified have met federal requirements for patient care. This allows them to provide home health services to patients covered by Medicare and Medicaid. Due to legal requirements, the agencies must report to Medicare, and their services are watched and controlled.

For more information about Medicare enrollment, or the Medicare Home Health Benefit, call 1.800.MEDICARE. Also, see the Centers for Medicare and Medicaid's document Medicare and Home Health Care.


Medicaid—Medicaid is a program administered by states that is designed to provide necessary health care to low income citizens. Eligibility is based on financial information, which is periodically reviewed. The reimbursement criteria differs from state-to-state and each state has its own process and criteria for participation. In all states, Medicaid pays for basic home health care:

Eligibility is based on financial information, which is periodically reviewed. The reimbursement criteria differs from state-to-state and each state has its own process and criteria for participation.

In all states, Medicaid pays for basic home health care:

  • Part-time skilled nursing,
  • Home health aide services, and
  • Medical supplies and equipment.

Medicaid may pay for homemaker, personal care and other services not paid for by Medicare.

For information about how to apply for Medicaid, contact your state Medicaid agency.

In Florida, contact the Florida Department of Children and Families (DCF), 1.866.76ACCES (1.866.762.2237).


Veterans Administration—Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care coverage by the Veterans Administration (VA). A physician must authorize these services, and the individual must be in need of intermittent nursing, physical therapy, speech therapy or occupational therapy services. The services must be provided through the VA's network of hospital-based home health providers.

For more information, contact the Social Services department of your closest Social Services department.

For Broward County, Florida residents, contact the Miami VA Healthcare System, 1.888.276.1785.


Older Americans Act (OAA)—Enacted by Congress in 1965, the OAA provides federal funds for state and local social service programs that enable frail and disabled older individuals to remain independent in their communities.

This funding covers home care aides, personal care, household chores, escort, meal delivery, and shopping services for those age 60 and older with the greatest social and financial need.

These services are often provided through your local Area Agency on Aging. To find your local Area Agency on Aging, you can contact the National Association of Agencies on Aging, 202.872.0888.

In Broward County, the Aging and Disability Resource Center is your local Area Agency on Aging. You may contact the Aging and Disability Resource Center by calling "Broward County's Elder Helpline" at 954.745.9779.


Social Services Block Grant Programs—Each year, states receive federal social services block grants for state-identified service needs. Portions of the funding are directed in programs providing home care aides and homemaker services.

For more information, contact your state health department or ACF Social Services Block Grant Program.

In Florida, contact the Florida Department of Health, 850.245.4444.


Community Organizations—Some community organizations, along with state and local governments, provide funds for home health and personal care. Depending on a person's eligibility and financial need, these groups may pay for all or a portion of needed services.

Your local office on Aging, the United Way, and your American Cancer Society are excellent sources about what's offered in your area.


Private Third-Party Payers

Commercial Health Insurance Companies—Commercial health insurance policies typically include home care benefits for short-term needs, but benefits for long-term care vary from plan to plan. Requirements for coverage vary greatly. Check with you insurance company for further information and be sure to ask about your insurance coverage not only for home care but also for home hospice care.


Managed Care Organizations—Managed Care Organizations (MCOs) and other group health plans sometimes include coverage for home care services. Managed Care Organizations that have contracts with Medicare must provide the full range of Medicare-covered home health services available. Coverage may be limited to doctor-directed medical services and treatments, but your choice of agency is restricted. Be sure to ask about you plan's coverage.


How Do I Choose a Home Health Agency?

Remember: When you are shopping for a home care agency, you are seeking a company that will assist you in providing for the health and safety of you or your loved one.

Don't be shy about asking any questions that come to mind. Don't worry about taking too much of anyone's time with your questions. And don't hesitate to ask a question more then once if you don't remember the answer or if the first answer was incomplete or unsatisfactory.


License and Certification

Is the agency licensed by the state?

State License—All states require licensing of home health care organizations, except Idaho, South Dakota, and Vermont. To confirm that an agency has met state licensing requirements, contact your state health department.

In Florida, contact the Florida Department of Health, 850.245.4444.

If an agency is supposed to have a state license, but does not, then you should look for another agency.


Is the agency certified by Medicare/Medicaid and/or The Joint Commission?

Certified by Medicare/Medicaid—Medicare and Medicaid will only pay for home care provided by a certified home care agency. In order to obtain certification, all home health care agencies that are approved for Medicare/Medicaid payment must meet specific state and federal requirements for patient care and financial management. Non-certification could indicate a problem.

Certified by The Joint CommissionThe Joint Commission, formerly known as Joint Commission on Accreditation of Healthcare Organizations, is a not-for-profit organization that reviews quality of healthcare service. The Joint Commission provides voluntary accreditation for hospitals, nursing homes, home health care agencies, hospices, and other medical facilities. Accreditation may indicate a commitment to providing quality care.


Does the agency provide confirmation or proof of malpractice and liability insurance?


Ability to Provide Services

What services does the agency provide?


Does the agency service the area in which you live?


Can the agency provide all the services you need?


Will the agency provide a written description of services to be provided?

Ask the agency if they will develop a personalized care plan designed to meet your individual needs and requirements as determined by your doctor, your family caregivers, the home care agency and you? How often will this plan be revised and updated?


Are services available 24 hours, 7 days a week?


Would services begin immediately? If not, how long is the wait?


Can the agency make arrangements for the delivery and maintenance of all necessary medical equipment?


Can the agency provide training for use of any necessary medical equipment by family caregivers?


Quality of Services

How long has the agency been providing home health services?


Does the agency provide references?

The agency should provide, upon request, several professional references, including hospitals and social workers that have used their services. Obtain the specific names of individuals and their telephone numbers and call them.


Is the agency inspected by an outside organization?

When was the last inspection and are the inspection reports available?


Costs

What are the total costs of the services you require?


Is the agency certified to be paid by Medicare and Medicaid?


Does the agency bill Medicare or insurance companies directly?


Are you required to use the services for a minimum number of hours per day or per week?


Are there deposits, fees, or any extra costs besides those charged for each service?


How much of the cost will be covered by your insurance coverage and how much will you have to pay out-of-pocket?


If you have to pay part of the costs, will the agency provide a sliding scale based on income?


Does the agency provide payment plan options?


Are all cost and payment expectations in writing?


How often does the agency bill?


Agency Staff & Training

Does the agency require and verify employee references?


What are the employee qualifications and their specific job descriptions?


Do the employees receive special training related to caring for home health patients? Is the training ongoing?