What is Home Health?

Home health care is the provision of health and social services to persons at home who are recovering from an illness or injury or to persons requiring assistance with their activities of daily living such as eating, dressing and bathing. Services are divided into two areas - skilled and non-skilled. Skilled services are nursing, social services and/or rehabilitation. Non-skilled services are homemaker activities, such as meal preparation, assistance with bathing or dressing or grocery shopping.

Home health care is appropriate for persons who do not need long term, 24 hour nursing supervision. Home health care is provided to a wide range of individuals from newborns with chronic conditions needing monitoring to older persons needing assistance due to diminishing physical capabilities or sudden illness.

Types of Home Health Agencies

Home health agencies may operate as for-profit or non-profit organizations. They may be operated by individuals, hospitals, local health agencies, such as a county nursing services, or large corporations. In addition to traditional services, agencies may provide medical equipment and supplies, drug infusion therapy or pharmaceuticals.

Certified Versus Non-Certified

Home care providers elect to become certified as a Medicare and/or Medicaid participant. To become certified, agencies must meet federal standards for patient care and management. Services provided by these agencies are highly supervised and controlled. Approximately 7,800 providers are Medicare certified. Home Health Report Cards� only provides ratings for Medicare certified home health agencies. Non-certified agencies provide homemaker services, private duty nurses, companions and health care aides, which are paid privately by the patient. Some states require these agencies to be licensed and meet minimum standards.

Non-Profit Versus For-Profit

Non-profit home health agencies usually operate under religious or other voluntary organizations. For-profit home health agencies are commercial establishments owned by corporations or individuals. Often private or public corporations own a chain of agencies in a geographic area. Home health corporations may also own pharmacies, rehabilitation agencies, nursing homes and the like.

Quality Measurements

When analyzing home health care quality, it is best to look at several quality measurements to make your decision. The following are some good sources of information to include in your evaluation.

Home Health Report Cards�

Ratings that compare home health agency performance are an important issue for health care consumers. Home Health Report Cards� provides up-to-date objective ratings for home health agencies across the U.S. using a blend of quality measurement data related to survey performance.

Licensing Surveys or Inspection Reports

Every certified home health agency is inspected by the state agency responsible for certification and licensing. The inspection is a survey of agency compliance with nearly 150 different regulations. Survey performance is a key measurement of how a home health agency meets certain health and safety requirements. A survey determines if a home health agency is in compliance with Medicare certification requirements. Please refer to Facts About Home Health Surveys to learn more about this performance indicator.

Accreditation

Home health agencies can voluntarily seek additional endorsements through accreditation. Accreditation means that a home health agency has quality assurance programs and meets health and safety standards. The following organizations accredit home health agencies:

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• Accreditation Commission for Home Care, Inc.
• National Committee for Quality Assurance
• Community Health Accreditation Program

Coordination of Care

Home health agencies must follow regulations for coordinating services. The patient must be informed, in advance, about the services that will be furnished and any changes to those services. Also, the doctor must be consulted and approve of the services (plan of care). The doctor must review the plan of care as often as the patient's condition dictates but not to exceed 62 days. Ask the agency how often the plan of care is reviewed and how the patient and his/her doctor are involved.

The evaluation for creating the plan of care, called an assessment, is done initially by a registered nurse (RN). A professional therapist, such as a physical therapist, must perform an evaluation for rehabilitation service plans. Professional therapists must provide supervision of the therapy or rehabilitation activities. Registered nurses must provide supervision of nursing services, especially those carried out by a licensed practical nurses or home health aides. How supervision is carried out is defined differently by state regulation and/or by type of nursing services. Ask the home health agency about its supervisors and how often these individuals make visits to the home. Are supervisors accessible for questions and concerns?

Payment Considerations

There are eight basic ways in which home health care costs may be financed.

1. Personal Resources
   If home care services fail to meet the criteria of third-party payors, then the patient or another party must pay for it.
   
   
2. Private Insurance
   Long-term care insurance is on the rise with more insurance companies offering insurance plans to cover home health care. Types of coverage depend on the insurance policy. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) covers services for dependents of active military personnel and military retirees and their dependents and survivors. Worker's Compensation also will cover an individual who requires medically necessary home services as a result of an injury on the job.
   
   
3. Medicaid
   Medicaid is funded by both state and federal sources and is health insurance for eligible low-income individuals. Each state has its own set of eligibility requirements; however, all states must at least provide home care services to individuals who receive federal income assistance such as Aid to Families with Dependent Children and Social Security. Coverage for these individuals must include part-time nursing, home health aide and medical supplies and equipment.
   
   
4. Medicare
   Medicare will pay for home health services if a doctor certifies that the individual receiving such services is homebound (i.e., confined to home except for infrequent or short absences or trips for medical care) and requires one or more of the following services: physical therapy, speech therapy, or skilled nursing. Medicare will only pay for services provided through a Medicare-certified home health agency.
   
   
5. Older Americans Act (OAA)/Social Service Block Grants
   The OAA was enacted in 1965 by Congress to provide federal funds to state and local social service programs for frail and disabled older individuals to enable them to remain independent in their areas. Home health aides, personal care, escort, meal delivery and shopping services are covered for individuals with the greatest social and financial need who are 60 years of age or older. Additional federal funds are provided to social service programs for state-identified service needs. Portions of these funds are often directed toward homemaker or personal care services. Individuals may inquire about these services through the local Area Agency of Aging.
   
   
6. Veterans Administration
   Veterans who are at least 50% disabled due to a service-related condition are eligible for home health services provided that their doctor authorizes the services. Services must be delivered through the VA network.
   
   
7. Community Organizations
   Some community organizations such as local chapters of the American Cancer Society, the Alzheimer's Association and the National Easter Seal Society also provide funding to help pay for home care services. Social workers, local offices on aging and the United Way are sources for information about such resources.
   
   
8. HMO or Managed Care
   HMOs and managed health care plans also cover home health care. A home health agency must be a designated provider of the plan before home health care will be covered. Also, because Part A Medicare benefits are assigned to the HMO or managed care plan, coverage of home health care must at least follow the requirements listed above for Medicare. The difference is that the HMO or managed care plan will determine if the individual meets the requirements and will determine when the individual does not continue to meet the requirements for home health care.

Gathering information

Fortunately, most areas have a variety of home health providers from which to choose. It is recommended that before you start your search, you determine what type of services will be required or needed at home.

Referrals

Home Health Report Cards� is a conclusive list of Medicare-certified agencies. Since some states license agencies apart from Medicare certification, you may obtain a list of state licensed agencies through your state's department of health, aging or social services. These offices can also direct you to the Medicare hot line for information about the quality of services provided by Medicare-certified home health agencies. You may also inquire about how to obtain a copy of the Medicare Survey Report.

Other sources for referrals or information about home health agencies are:

• Hospital discharge planners
• Doctors who serve seniors
• Geriatric case managers
• Clergy
• Area Agency on Aging

Questions to Ask When Choosing a Home Health Agency

• Is the agency Medicare certified?
• Is the agency a member of national or state associations?
• Has the agency received accreditation from an accrediting organization?
• How long has the agency been serving the community?
• Who assesses the patient's needs -- a nurse or therapist? How often is this done and how does the agency involve family or other caregivers?
• What are the agency's financial procedures for explaining costs and covered services?
• Does the agency qualify employees through references and criminal background checks?
• What procedures are in place for emergencies and after hours?
• Are supervisors assigned to oversee the quality of care? If so, how often do these individuals make visits to the home?
• Does the agency teach family members about the type of care being given?
• Who can you call for complaints or questions?

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