Frequently Asked Questions

When deciding amongst home health agencies, what factors should I consider?

In addition to your research and interaction with members of TheHomeCareDirectory.com community, we encourage you to speak with your doctor, hospital discharge planner, or social worker, as well as with friends and colleagues about their home health care experiences.

My doctor/hospital discharge planner/social worker has already recommended a home health agency, why should I use TheHomeCareDirectory.com?

When making a decision as important as choosing the right home health agency you should take numerous factors into consideration, including the recommendations and opinions of medical professionals. Use TheHomeCareDirectory.com as an informed second opinion, a resource to help you dig down into all of the available information on local home health agencies. With the amount of health care information available today it is impossible for even the most diligent health professional to stay current on everything there is to know. That's where TheHomeCareDirectory.com comes in.

What is a home health agency?

A home health agency (HHA) is an organization that provides homecare services, including skilled nursing care and home care aide services as well as occupational therapy, physical therapy, speech therapy, and medical social services. If you use a home health agency, the agency will hire and supervise the workers that come into your home. The agency assumes full liability for all care. The workers are employees of the agency, and the agency is responsible for all employee taxes and benefits.

What is a "needs assessment"?

If homecare is deemed appropriate by a physician, your home health agency will conduct a "needs assessment", a detailed evaluation of your situation that confirms the need for services ordered and identifies any other beneficial services. The assessment is usually made by a registered nurse either in the hospital or at home. The agency then tailors a homecare plan to your needs and reviews it with you. Before finalizing the plan, the agency advises your doctor of its assessment and presents the plan for your doctor's approval. The plan outlines key details, including treatment goals, the specific services and level of care that will be provided, and any medical equipment and supplies that may be needed.

What is a Medicare-certified home health agency?

A Medicare-certified home health agency has met federal requirements for patient care management, called Conditions of Participation, set forth in federal regulations. These agencies can therefore provide home health services that are eligible for reimbursement by Medicare.

Will Medicare pay for my home health care needs?

Currently, more than 2.4 million elderly and disabled people with Medicare receive care from more than 8,000 Medicare-certified home health agencies throughout the United States. Home health is covered under the Part A Medicare benefit. Medicare will help pay for your home care if: 1. You are homebound; 2. You need skilled nursing or skilled therapy services on an intermittent basis (less than seven days a week), or skilled therapy on a part-time basis (less than eight hours a day); 3. Your doctor certifies your need for care; and 4. You receive care from a Medicare-certified Home Health Agency

What is Home Care?

In its truest meaning, home care refers to any type of care (medical or non-medical) that is provided to the patient in their home. In recent years, however, there has been a slight shift in using the terminology to emphasize non-medical care such as companionship/homemaking services or personal care services.

How does home care differ from home health care?

While home care can be used to describe both medical and non-medical care, typically home care refers to non-medical care such as companionship/homemaking services or personal care services, while home health care refers to the provision of skilled nursing care and other care such as speech, physical or occupational therapy.

Why should I choose home care?

Home care is delivered in the home and keeps families together. When we are not feeling well, most of us ask to be home. We enjoy the comfort of our residences and the joy of being with our loved ones. When our loved ones are ill, we try to get them home as soon as possible. Home care is particularly important in times of illness when families desire to be near one another for support. Home care is a comforting alternative to premature admission to a long-term care facility. Since most people would prefer to stay in their own homes as long as possible, home care can provide a level of service that is customizable to the client’s needs. Homecare is safe and promotes healing. Many risks, such as infection, are eliminated or minimized when care is provided in the home. There is scientific evidence that many patients heal faster at home. Home care allows for the maximum amount of freedom for the individual and promotes continuity. Patients at home can remain active in their customary daily routines while receiving one-on-one care and attention. The patient’s care is monitored by their own physician. Home care is less expensive than other forms of care and is the preferred form of care. If skilled care is not needed around the clock, home care can allow you to create a customized care plan that meets your needs and your budget. National studies have shown that 95 percent of those age 75 and older prefer to stay in their current residence for as long as possible.

What Senior Living Options Are Available?

There are now many options available when it comes to elder care and senior care. Options available for elder care or senior care include: Home Care In its truest meaning, home care refers to any type of care (medical or non-medical) that is provided to the patient in their home. In recent years, however, there has been a slight shift in using the terminology to emphasize non-medical care such as companionship/homemaking services or personal care services. Home health care typically refers to the provision of skilled nursing care and speech, physical or occupational therapy in the home environment. Living Facilities When a senior moves away from their home to receive care, there are several options available today. Independent living facilities, assisted living facilities and skilled nursing facilities offer living solutions for seniors who need or prefer to move from their current living environment. Multi-unit senior housing developments that may provide supportive services such as meals, housekeeping, social activities, and group transportation are considered independent living facilities. Also known as congregate housing, supportive housing and retirement communities, independent living facilities typically provide meals in a central dining area at a set time. The term may also be used to describe housing with few or no services, such as a senior apartment. Many seniors may make use of home care options while living in these facilities. Assisted living facilities are a housing option for older adults who need some assistance with the activities of daily living, but do not require the kind of 24-hour nursing and medical care provided by a skilled nursing facility. Two-thirds of assisted living facility residents pay out-of-pocket for their expenses. In 2006, the national average base rate for assisted living facilities was $2,968 per month. Many facilities charge a base rate for facilities and offer services on an a-la-carte basis. (The MetLife Market Survey of Assisted Living Costs, Oct. 2006.) Skilled nursing facilities are an out-of-the-home care option for elderly persons who require continuous skilled nursing care. Often referred to as a nursing home, skilled nursing facilities can provide extensive care services such as intravenous feedings, blood pressure monitoring, medication administration, injections and care for patients on ventilators. In 2006, the national average cost of a private room in a nursing home was $206 per day – approximately $75,190 per year. (The MetLife Market Survey of Nursing Home or Home Care Costs, Sept. 2006.)

What are ADLs and IADLs?

Activities of Daily Living or ADLs include the basic tasks essential for day-to-day functioning, such as bathing, dressing, grooming, eating, mobility and toileting. Many seniors who require help with such activities are largely independent, but may require help with one or two ADLs. In some cases, intermittent help from a family member or friend may be all that is needed. However, in many cases, particularly when family or friends are unavailable and the importance of scheduling these activities is critical, informal care arrangements may not be adequate. IADLs are the Instrumental Activities of Daily Living are considered those activities which are less basic than the traditional Activities of Daily Living (ADLs). IADLs need to be performed, but scheduling may not be as critical. IADLs include such activities as shopping, paying bills, cleaning, doing the laundry and meal preparation. Many seniors require assistance with IADLs rather than with ADLs. Some seniors merely want someone to escort them when they are shopping and help them avoid any situations that might cause them to fall. Other seniors may welcome assistance with their bill paying and medical appointments.

What Should I Ask When Considering a Home Care Agency?

There are a number of questions you might ask when considering a home care service. Accreditation: Is the agency accredited by a nationally recognized accrediting body, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? The JCAHO (online at www.qualitycheck.org or www.jcaho.org) is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs that volunteer for their review. Accreditation is an important measure in selecting quality health care services. Certification: Is this home care program Medicare-certified? Medicare-certified programs have met federal minimum requirements for patient care and management. Because of legal requirements, services provided by these agencies are closely supervised and controlled. Medicare certifies only agencies with skilled nursing care. To find a Medicare-approved home health agency, you can visit "Home Health Compare."on the Web at www.medicare.gov. This helpful tool is listed under the title "Compare Home Health Agencies in Your Area" on their home page. It provides names, addresses, and phone numbers of nearby agencies. Licensure: Most states require licensing of home health agencies. If it is required in your state, is the provider licensed? Consumer information: Does the agency have written statements that list services (including cancer care services), eligibility requirements, costs and payment procedures, staff job descriptions, and malpractice and liability insurance? Ask that they send you any brochures or other information they can share about their services. References: How many years has the agency been serving your community? Can the agency give you references from cancer care professionals, such as an oncologist, oncology nurse, cancer center, or an oncology social worker, who have used this agency? Ask for names and phone numbers. A good agency will provide these on request. Talk to these people about their experiences. You may also wish to check with your local Better Business Bureau, your local Consumer Bureau, or the State Attorney General's office. They can tell you if complaints have been lodged against the agency. Admissions: How flexible is this agency in applying its policies to each patient or working out differences? If the agency imposes up-front conditions that do not feel comfortable, that may be a sign that it is not a good fit for you. Is the agency willing to help you clarify whether you or your family member qualifies for Medicare-covered home care, or whether you even want it? This can be useful in finding out how willing they are to work with you. Plan of care: Does the agency create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family, or is it based solely on what you asked for? Is the plan of care written out and copies given to all involved? Check to see if it lists specific duties, work hours/days, and the name and phone number of the supervisor in charge. Is the plan of care updated as your needs change? Ask if you can review a sample plan of care. Preliminary evaluation: Does a nurse or social worker conduct an evaluation before you are admitted to find out which services will be needed? Is it done in your home rather than over the telephone? Does it highlight what you can do for yourself? Does it include talking with oncology professionals, your family doctor, and other professionals who are already providing you with health and social services? Are other members of your family consulted? Personnel: If you are dealing with an agency, are references on file for home care staff? Ask how many references the agency requires (2 or more should be required for each staff member who gives in-home care). Does the agency train, supervise, and monitor its caregivers? Ask how often the agency sends a supervisor to the patient's home to review the care being given to the patient. Ask whether the caregivers are licensed and bonded. Whom can you call with questions or complaints? What is the procedure for resolving problems? Family caregiver: Does the agency require a family primary caregiver as a condition of admission? How much is expected of the family caregiver? Can the home care agency offer help to coordinate and supplement the family's efforts by filling in around job schedules, travel plans, or other responsibilities? If you live alone, what other options can the agency suggest? Confidentiality: Can the agency ensure patient confidentiality? What safeguards are in place? Costs: How does the agency handle payment and billing? Get all financial arrangements such as costs, payment procedures, and billing in writing. Read the agreement carefully before signing. Be sure to keep a copy. What resources does the agency provide to help you find financial assistance if it is needed? Are standard payment plan options available? Equipment: If equipment such as a respirator, oxygen machine, or dialysis machine is used, does the agency teach you or a responsible family member how to use and care for the equipment at home? Who is available if equipment problems arise during non-business hours? Quality of care: Does the agency have a 24-hour telephone number you can call when you have questions or complaints? How does the agency respond to your very first call? Does the telephone staff seem caring, patient, and competent from the first contact, even if they need to return your call? Do they speak in simple language, or do they use a lot of jargon? What is the procedure for receiving and resolving complaints? How an agency responds to that first call for help may give you a good idea of the kind of care to expect. Emergency: Does the agency have an emergency plan in place in case of a power failure or natural disaster? Ask to see a copy of the plan. In case of an emergency, you need to know if the agency can still deliver its services to the home. Services: How quickly can the agency start services? What are its service boundaries -- do they serve your area? Does the agency offer specialized services by rehabilitation therapists, dietitians, family counselors, or art therapists when these could improve your comfort? Does the agency offer to lend used medical equipment or other items that might also enhance your quality of life? Inpatient care: What are the agency's policies regarding inpatient care if you should need it? Where is such care provided? What are the requirements for an inpatient admission and how long can you stay? What happens if you no longer need inpatient care but cannot return home? Can you tour the inpatient unit or residential facility? Which hospitals contract with the agency for inpatient care? What kind of follow-up does the agency provide for inpatients? Do nursing homes contract with the agency? Does the agency provide as much nursing, social work, and aide care for each patient in the nursing home as it does in the home setting? Patient's rights and responsibilities: Does the agency explain these? Ask to see a copy of the agency's patient's rights and responsibilities information.

What is hospice?

Hospice represents a compassionate approach to end-of-life care. Although death is a natural part of life, the thought of dying still terrifies many people. You may imagine pain and loneliness, spending your final days in a cold, sterile environment far from family, friends and all you know and love. However, hospice care can transform your passage into a peaceful, healing transition. According to The American Cancer Society, the word hospice is "rooted in the centuries-old idea of offering a place of shelter and rest, or 'hospitality' to weary and sick travelers on a long journey. Dame Cicely Saunders at St. Christopher's Hospice in London first applied the term 'hospice' to specialized care for dying patients in 1967." Hospice has been available in the United States since the mid-1970s. The National Hospice and Palliative Care Organization (NHPCO) estimates that there were 3,300 operational U.S. hospice programs as of 2003. Hospice is more a concept of care than a specific place. It is an option for people whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) rather than ongoing curative measures, enabling you to live your end days to the fullest, with purpose, dignity, grace and support. Hospice care focuses on all aspects of your life and well-being: physical, social, emotional, and spiritual. What's more, there is no age restriction; anyone in the last stages of life is eligible for hospice services. While some hospitals, nursing homes and other health care facilities provide hospice care onsite, hospice most often takes place in the comfort of your own home, allowing you to remain in familiar surroundings as you prepare for a meaningful life conclusion. Because many people in the final stages of an illness will need assistance in researching hospice resources, the following information is presented with the understanding that it is inclusive of the hospice care recipient, spouses, partners, family members, and close friends.

What services are provided for hospice care?

Hospice services are interdisciplinary, and will be structured according to your needs, which may change over time. The Hospice Association of America (HAA) suggests a hospice team may include any combination of the following services: Nursing Care. Registered nurses monitor your symptoms and medication, and help educate both you and your family about what's happening. The nurse is also the link between you, your family, and the physician. Social Services. A social worker counsels and advises you and family members, and acts as your community advocate, making sure you have access to the resources you need. Physician Services. Your doctor approves the plan of care and works with the hospice team. In a full hospice program, a hospice medical director is available to the attending physician, patient, and hospice care team as a consultant and resource. Spiritual Support and Counseling. Clergy and other spiritual counselors are available to visit you and provide spiritual support at home. Spiritual care is a personal process, and may include helping you explore what death means to you, resolving "unfinished business," saying goodbye to loved ones, and performing a specific religious ceremony or ritual. Home Health Aides and Homemaker Services. Home health aides provide personal care such as bathing, shaving, and nail care. Homemakers may be available for light housekeeping and meal preparation. Trained Volunteer Support. Caring volunteers have long been the backbone of hospice. They're available to listen, offer you and your family compassionate support, and assist with everyday tasks such as shopping, babysitting, and carpooling. Physical, Occupational, and Speech Therapies. These hospice specialists can help you develop new ways to perform tasks that may have become difficult due to illness, such as walking, dressing, or feeding yourself. Respite Care.Respite care gives your family a break from the intensity of caregiving. Your brief inpatient stay in a hospice facility provides a "breather" for caregivers. Refer to Helpguide's Respite Care for additional information. Inpatient Care . By the same token, even if you are being cared for at home, there may be times when you'll need to be admitted to a hospital, extended-care facility, or a hospice inpatient facility. Sometimes medical intervention will be recommended to ease the dying process (for example, an IV drip with pain medication), requiring round-the-clock nursing care. Thus, a facility may be a better choice. Your hospice team will arrange for inpatient care, and remain involved in your treatment and with your family. Bereavement Support . Bereavement is the time of mourning we all experience following a loss. The hospice care team will work with surviving family members to help them through the grieving process. Support may include a trained volunteer or counselor visiting your family at specific periods during the first year, as well as phone calls, letters and support groups. The hospice will refer survivors to medical or other professional care if necessary.

Who is eligible for hospice care?

If your doctor has certified your prognosis as not longer than six months, you are eligible for hospice. This applies to anyone of any age. Of course, if your health improves and you no longer need hospice care, that's a blessing! You will remain eligible to reapply for hospice care if it again becomes necessary. You are permitted to go on and off hospice care as needed—or if you change your mind and decide to return to curative treatment. You may also enter the hospital for certain types of treatment, as long as the intervention is not related to your hospice diagnosis, and if the treatment involves improving your quality of life. While the majority of hospice referrals are cancer related, hospice is by no means exclusively for cancer patients. People with ALS, kidney disease and Alzheimer's disease, for example, can also benefit greatly from hospice care. Alzheimer's disease, in particular, is often overlooked for hospice referral because of its slow progression. People with Alzheimer's are usually referred to hospice when they are in the final stages of the illness, which can be very helpful to family members even if the person can no longer communicate. You can receive hospice care in a nursing home if the nursing home agrees to allow the hospice staff to provide the primary care. Hospice pays for all of the medications and equipment needed in the nursing home. If you're in a Board and Care facility, the B&C must obtain a waiver from licensing to have someone from hospice at the facility. (Refer to next section for licensing information.)

Can I afford hospice services?

You may be surprised to learn that hospice care generally costs less than inpatient care in a hospital, nursing home or other facility. This is because with home hospice, you pay only for the specific care that you need. In addition, volunteers may be able to provide many services at little or no cost, such as telephone support, friendly visits, meal preparation and running errands. Medicare, Medicaid, and most private insurance plans cover hospice services. Medicare regulations require that your hospice care be provided at home, with only short stays in an inpatient facility. According to the HAA, in order to qualify for the Medicare hospice benefit: Your physician must re-certify you at the beginning of each benefit period (two periods of 90 days each, one of 30 days, and an indefinite fourth period). You must sign an elective statement indicating that you understand the nature of your illness or condition, and of hospice care. By signing the statement, you surrender your right to other Medicare benefits related to your illness. (A family member may sign the election statement for you if you are unable to do so.) While patients usually pay out-of-pocket for any services not covered by insurance (known as a co-payment), hospice services are generally provided without charge if you have limited or nonexistent financial resources. If you are unable to pay, most hospices will provide for you using funds raised from community donations and charitable foundations.

How do I know whether homecare is right for my particular situation?

Homecare can be a viable option for persons who are disabled, chronically ill or recovering from an illness. Homecare may also be a viable option for seniors living independently who have medical &/or social needs that neither they nor family members can effectively meet.

What is TheHomeCareDirectory.com

TheHomeCareDirectory.com is the Internet's leading source of information on local home care and hospice home care agencies and services.

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