What is Home Care?
Home care is a broad term that describes a wide variety of health and health related services provided in the home setting. Home care is health care brought to your home to maintain or restore your health and well-being.
Home care services include: Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Work, In-home Aide Services, Medical Supplies and Equipment and other specialized services such as Infusion Therapy, Respiratory Therapy and Nutritional Services.
Why Home Care?
Care provided in the comfort and security of your home through a licensed agency gives you, your family and friends a sense of control and peace of mind. Home care provides a wide range of health care and social services to the patient and teaches families to help care for their family member.
How Do I Access Home Care Services?
Patients and/or family members may directly contact home care agencies in order to access services.
Many agencies are listed in the yellow pages of your telephone directory. Your physician may also make recommendations about home care and, if needed, will provide the necessary medical orders for home care services.
Who Provides Home Care?
Home care services are provided by a variety of organizations, including home health agencies, private duty nursing agencies, in-home aide agencies, councils-on-aging, county departments of social services, home medical equipment companies and home intravenous (IV) therapy agencies.
Licensed home care agencies may also provide companion and sitter services, in-home management, home modifications and volunteer services.
Who pays for Home Care Services?
Many home care services are reimbursed by Medicare, Medicaid, worker’s compensation, private or group health insurance, HMOs, Veteran and military benefits (VA/Champus), or through other special funds such as block grants. Also, private payment may be arranged with many home care agencies on an individual basis. When services are reimbursed by either public sources of funding or through insurance, it’s important to understand the eligibility criteria for reimbursement.
While the Medicare and Medicaid home health programs reimburse home care services for homebound patients, other Medicaid programs also cover in-home services. These include, Medicaid Personal Care Services (PCS), Medicaid Home Infusion Therapy (HIT), Medicaid Community Alternatives Programs (CAP), Medicaid Durable Medical Equipment (DME), and Medicaid Private Duty Nursing (PDN).
What is the Medicare Home Health Benefit?
Medicare home health services are included under the larger umbrella of home care and are available to Medicare recipients who meet certain eligibility criteria including:
The individual to whom the services are provided is an eligible Medicare beneficiary.
The services are provided by a Medicare certified home health agency.
A physician certifies (orders) the need for services and establishes a “plan of care”.
The beneficiary must meet Medicare’s definition of “homebound”.
The care must be provided in the patient’s place of residence.
The individual needs skilled nursing on an intermittent basis or physical therapy or speech therapy or has a continued need for occupational therapy once one of the other skilled disciplines has established a plan of care.
When the above conditions are met, physicians may also order home health aide services or medical social worker services.
Medicaid also has a home health program with similar qualifying criteria, but Medicaid does not cover medical social worker services.
Who Oversees Home Care?
Home care agencies must meet state and federal regulations that govern the delivery of home care services. In North Carolina, all home care agencies must be licensed under the oversight of the North Carolina Department of Health and Human Services, Division of Facility Services.
For agencies who provide Medicare and Medicaid home health services, the Federal Government requires a process called certification. The Division of Facility Services makes on-site survey visits to licensed and certified home care agencies to assess the quality of agency services, unless an agency has been granted deemed status by meeting a higher level of accreditation standards (which requires on-site surveys by the accrediting agency).
In addition, agencies conduct criminal background checks on employees. Licensed home care agency employees will either be professionally licensed, registered with the state on the nurse aide registry, or work under a health care professional to whom the employee must demonstrate ongoing competency.
The State maintains a registry to ensure aides have adequate training and to also allow the public and employers access to complaints about nurse aides. Nurse aides listed on North Carolina’s Nurse Aide Registry work under the supervision of professionally licensed nurses.
In addition to regulatory requirements, agencies may also be accredited which means they have demonstrated that they meet an additional set of standards. For more information about home care, contact your local home care agency, Department of Social Services, or aging agency.