Home Care

What is Home Care?
Advantages of Home Care
Selecting a Provider
Paying for Home Care
Home Care Patients Rights

What is Home Care?

Home care is a health care service provided in an individual consumer’s home by licensed health care professionals. Licensed personnel may help the individual with daily tasks, such as bathing, eating, cleaning their home, and preparing meals. For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance.

Home care encompasses a wide array of health care services provided by certified nurse assistants, nurses, and therapists within the client’s residence. Depending on the level of care required by the client, a person may need care in their home a couple of times a week, once a day, or throughout the day everyday. Home care is utilized to recover from an injury or post-hospitalization, immediately following the birth of a child, or support within a retirement home or assisted living facility. Many consumers of home care utilize services in order to stay independent in their home while living with a chronic or terminal illness or the gradual decline of daily capacity that comes with aging. Each home care client receives an individual care plan that meets their needs to live independently with health care support in their home.

Assessing Home Care Needs

Before seeking a home care agency, consumers should determine what kind of care is needed and what are the goals for care:

Do you need skilled nursing care by a registered nurse?
Do you need assistance with personal care for activities of daily living, such as bathing, toileting, or dressing?
Are there any cognitive or behavioral health issues that need to be addressed?
Does your home need to be made safer and more accessible?

Advantages of Home Care

Last year, over 20,000 Rhode Islanders utilized home care agencies for over 1,000,000 home care visits. This is because:

Home care is the most cost-effective health care delivery offered as there are no room and board costs compared to nursing homes, rehabilitation centers, and other institutional care settings.
Home care promotes healing, as studies have shown that patients recover faster in the comfort of their home.
Home care offers individualized services that are tailored to the client’s health care needs and finances.
Home care reinforces and supplements care from the client’s family and friends.

Home care agencies have staff with expertise in assessing client needs and developing care plans, usually at no cost to the client. The professional staff at a home care agency can help clients navigate through the web of health care resources and effectively communicate your needs and goals to physicians, hospital staff, and nursing home staff. Home care agency staff can also assist clients and their family with any emotional barriers and concerns about accepting home care services.

Advantages of Working with a Home Care Agency

After deciding that home care is the right option, consumers weigh their options of hiring a home care agency or contract directly with a home health aide or nurse. However, consumers should be aware of the following benefits of working with a home care agency versus the risks of a direct hire:

Employer Obligations: By hiring a home health aide or nurse directly, the individual consumer and their family takes on the responsibilities as their employer. This includes paying for the employee’s payroll taxes, workers compensation, unemployment insurance, and liability. If the employee gets hurt during their time providing care or commuting to or from the individual’s home, it is the consumer that is legally and financially liable. Working with a home care agency alleviates the client of these responsibilities.

Peace of Mind: Unless the consumer does a criminal background check at their own expense, the consumer does not really know who is providing care in their home. Home care agencies are required to conduct thorough criminal background checks that provide more comprehensive data than available to the public prior to any home care agency employee stepping foot into a client’s home.

Security and Contingency: If a consumer’s direct hire harms or steals from the consumer, it is still the consumer that is liable. However, home care agencies are required to maintain various insurances to protect their clients and are required by law to promptly investigate all complaints of abuse or theft. Furthermore, home care agencies can provide a replacement without disruption of service if the home care agency employee gets sick, injured, or changes jobs.

Ongoing Training and Supervision: If the consumer has a direct hire, the consumer is responsible for continuous training and supervision. In contrast, home care agencies have the experience, knowledge, training, resources, and licensure to ensure that their employees are thoroughly trained in all services performed, including safe infection control, falls prevention, emergency preparation, and personal care tasks.

How long of a time period and how frequently do you expect that you need care?

Selecting a Provider

How Do I Select the Right Home Care Provider?

Once you acquire the names of several providers, you will want to learn more about their services and reputations. Following is a checklist of questions to ask providers and other individuals who may know about the provider’s track record. Their insight will help you determine which provider is best for you or your loved one.
How long has this provider been serving the community?
Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish patients with a detailed “Patient Bill of Rights” that outlines the rights and responsibilities of the providers, patients, and caregivers alike. An annual report and other educational materials also can provide helpful information about the provider.
How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
Does this provider include the patient and his or her family members in developing the plan of care? Are they involved in making care plan changes?
Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan, and do the caregivers update it as changes occur? Does this provider take time to educate family members on the care being administered to the patient?
Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? If so, how often do these individuals make visits? Who can the patient and his or her family members call with questions or complaints? How does the agency follow up on and resolve problems?
What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
What procedures does this provider have in place to handle emergencies? Are its caregivers available 24 hours a day, seven days a week?
How does this provider ensure patient confidentiality?
In addition, ask the home care provider to supply you with a list of references, such as doctors, discharge planners, patients or their family members, and community leaders who are familiar with the provider’s quality of service.
Contact each reference and ask:

Do you frequently refer clients to this provider?
Do you have a contractual relationship with this provider? If so, do you require the provider to meet special standards for quality care?
What sort of feedback have you gotten from patients receiving care from this provider, either on an informal basis or through a formal satisfaction survey?
Do you know of any clients this provider has treated whose cases are similar to mine or my loved one’s? If so, can you put me in touch with these individuals?

Paying for Home Care

Many government programs and private insurance will pay for home care services under specific circumstances:

Medicare (federal) and Medicaid (state): Covers home care services when the clients a) cannot leave their home without physical assistance; b) is currently under a physician’s care; and c) requires skilled nursing or therapy services.

Commercial Health Insurance: Covers home care services when the client is recovering from surgery, injury, or a specific illness, but generally not for chronic conditions or aging. Typically, home health care is covered with co-pays and deductibles.

Long-Term Care Insurance: Covers home care services as an alternative to nursing homes and other institutional care. The home care benefits are generally capped at a certain amount per day, week, or month.

Home care agencies work with new clients and their families everyday to understand what coverage they have and any limitations. Otherwise, the simplest way to pay for home care is to privately pay directly as you would for any other service. This affordable option maximizes you control for your care.

Home Care Patient Rights

Home care patients have the right to:

be fully informed of all his or her rights and responsibilities by the home care agency;
choose care providers;
appropriate and professional care in accordance with physician orders;
receive a timely response from the agency to his or her request for service;
be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed;
receive reasonable continuity of care;
receive information necessary to give informed consent prior to the start of any treatment or procedure;
be advised of any change in the plan of care, before the change is made;
refuse treatment within the confines of the law and to be informed of the consequences of his or her action;
be informed of his or her rights under state law to formulate advanced directives;
have health care providers comply with advance directives in accordance with state law requirements;
be informed within reasonable time of anticipated termination of service or plans for transfer to another agency;
be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements;
be referred elsewhere, if denied service solely on his or her inability to pay;
voice grievances and suggest changes in service or staff without fear of restraint or discrimination;
a fair hearing for any individual to whom any service has been denied, reduced, or terminated, or who is otherwise aggrieved by agency action. The fair hearing procedure shall be set forth by each agency as appropriate to the unique patient situation (i.e., funding source, level of care, diagnosis);
be informed of what to do in the event of an emergency; and
be advised of the telephone number and hours of operation of the state’s home health hot line, which receives questions and complaints about Medicare-certified and state-licensed home care agencies.
NAHC’s affiliate, the Hospice Association of America, has developed the following model bill of rights for all individuals receiving hospice care. It also is based on the patient rights currently enforced by law.