Home Health Care

Home health care helps older adults live independently for  as long  as possible, even with an illness or injury. It covers a wide range of   services and can often delay the need for long-term nursing home care.

Home health care may include  occupational and physical  therapy, speech therapy, and skilled nursing. It may  involve helping  older adults with activities of daily living, such as bathing,   dressing, and eating. It can also include assistance with cooking,  cleaning,  other housekeeping, and monitoring one’s medication regimen.

It is important to understand the  difference between home  health care and home care services. Although home  health care may  include some home care services, it is medical in nature. Home  care  services include chores and housecleaning, whereas home health care   usually involves helping someone to recover from an illness or injury.  Home  health care professionals are often licensed practical nurses,  therapists, or  home health aides. Most of them work for home health  agencies, hospitals, or  public health departments licensed by the  state.

As with any important purchase, it is wise to talk with   friends, neighbors, and your local Area Agency on Aging (AAA) to learn  more  about the home health care agencies in your community. Consider  using the  following questions to guide your search. 

• How  long has the agency served this community?
• Does  the agency have a brochure describing services and costs? If so, take or  download it.
• Is  the agency an approved Medicare provider?
• Does  a national accrediting body, such as the Joint  Commission for the Accreditation  of Healthcare Organizations, certify  the quality of care?
• Does  the agency have a current license to practice (if required by the state)?
• Does  the agency offer a “Bill of Rights” that describes  the rights and  responsibilities of both the agency and the person  receiving care?
• Does  the agency prepare a care plan for the patient  (with input from the patient,  his or her doctor, and family members)?  Will the agency update the plan as  necessary?
• How  closely do supervisors oversee care to ensure quality?
• Are  agency staff members available around the clock, seven days a week, if  necessary?
• Does  the agency have a nursing supervisor available for on-call assistance at all  times?
• Whom  does the agency call if the home health care worker cannot come when scheduled?
• How  does the agency ensure patient confidentiality?
• How  are agency caregivers hired and trained?
• How  does the agency screen prospective employees?
• Will  the agency provide a list of references for its caregivers?
• What  is the procedure for resolving problems, if they occur? Whom can I call with  questions or complaints?
• Is  there a sliding fee schedule based on ability to pay, and is financial  assistance available to pay for services?

When purchasing home health care  directly from an individual  provider (instead of an agency), it is even more  important to conduct  thorough screening. This should include an interview with  the home  health caregiver. You should also request references. Prepare for the   interview by making a list of the older adult’s special needs. For  example, the  patient may require help getting into or out of a  wheelchair. If so, the  caregiver must be able to provide appropriate  assistance. 

Whether you arrange for home health  care through an agency  or hire an independent aide, it helps to spend time  preparing the  person who will provide care. Ideally, you will spend a day with the   caregiver, before the job formally begins, to discuss what is involved  in the  daily routine. At a minimum, inform the caregiver (verbally and  in writing) of the  following things that he or she should know.

• Health conditions, including illnesses and injuries
• Signs of an emergency medical situation
• General likes and dislikes
• Medication, including how and when each must be taken
• Need for dentures, eyeglasses, canes, walkers, hearing       aids, etc.
• Possible behavior problems and how best to handle them
• Mobility issues (trouble walking, getting into or out       of a wheelchair, etc.)
• Allergies, special diets, or other nutritional needs
• Therapeutic exercises with detailed instructions

Although most states require home health care agencies to  perform  criminal background checks on their workers and carefully  screen applicants,  actual regulations will vary depending on where you  live. Therefore, before  contacting a home health care agency, you may  want to call your local area  agency on aging or department of public  health to learn what laws apply in your  state.

The cost of home health care varies across and within   states. In addition, costs will fluctuate based on the type of health  care  professional required. Home care services can be paid directly by  patients and  their families or through a variety of public and private  sources. Sources for  home health care funding include Medicare,  Medicaid, the Older Americans Act,  the Veterans Administration, and  private insurance. To learn more about paying  for home care, visit https://longtermcare.acl.gov/costs-how-to-pay/.