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Frequently Asked Questions

Main Title

What are the Medicare Guidelines?

In order to qualify for home health services under Medicare, the patient must:

  • Be eligible for Medicare benefits
  • Be under the care of a physician who periodically reviews the plan of care
  • Require skilled nursing on an intermittent basis or physical therapy
  • Require services reasonable and necessary for treatment of the illness or injury
  • Be currently homebound

What is the definition of homebound?

The patient's condition must be such that leaving the home requires an extremely taxing effort. In most instances a "homebound" patient will only leave home for specific medical treatment. Absences are infrequent, are of relatively short duration and do not indicate that the patient has the capacity to obtain care outside rather than inside the home.

If patient's condition, due to an illness or injury, restricts the patient's ability to leave home except with the aid of supportive device (cane, wheelchair, walker, aid of another person), or if their condition is medically contraindicated by leaving, they are considered homebound. Any absence for religious services is deemed to be an absence of infrequent or short duration, and thus does not negate homebound status.

Does the patient have a choice in selecting a home health agency?

If your doctor decides you need home healthcare, you have the freedom to choose among a list of participating Medicare-certified home health agencies that serve your geographic area. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency.

Home Health Patient Rights

As a patient of a Medicare-approved home health agency, you have several rights that the home health agency must provide you a written copy of. They include the following:

  • The right to choose your home health agency.
  • The right to have your property treated with respect.
  • The right to have your family or guardian act for you if you are unable.
  • The right to complain to the agency or the State Survey Agency about your treatment or care if inadequate.
  • The right to be given a copy of your plan of care, so you can ask questions as needed.

What Questions to Ask when choosing a Home Health Care Agency?

  • How many years has the agency been serving your community?
  • Does the agency offer printed material describing its services and costs?Is the agency an approved Medicare provider?Is the agency accredited? This means that their quality of care has been surveyed and approved by an outside accrediting organization (such as CHAP, JCAHO or Medicare).
  • Is the agency licensed by your state (if required)?
  • Does the agency provide patients with a "Bill of Rights" that outlines the rights and responsibilities of the agency, patient, and caregiver alike?
  • Is there a written plan of care for the patient's treatment that the patient, physician and family participate in developing? Is this plan updated over the course of the treatment? Does the patient get a copy of the plan?
  • Is the patient's course of treatment documented, detailing the specific tasks to be carried out by each professional?
  • Are supervisors assigned to oversee care to ensure quality?
  • Does the agency staff educate the family members on the care being administered to the patient?
  • Are agency caregivers available 24 hours per day, 7 days a week?
  • Does the agency have a nursing supervisor on call and available 24 hours per day?
  • Does the agency ensure patient confidentiality? How?
  • How are agency employees hired and trained?
  • Does the agency require criminal record background checks and communicable disease screens for its employees?
  • What is the procedure for resolving issues that may arise between the patient/family and home health care staff?
  • Who can you call with questions or complaints?
  • What happens if a staff member fails to make a scheduled visit?
  • How does the agency handle billing? (i.e., will I be billed for services?)
  • Will the agency provide a list of references?

Why Choose a Licensed In-Home Care Agency When Hiring a Caregiver

Many families seeking to hire in-home staff turn to private individuals rather than working through an agency. While at first glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer. These risks can be eliminated or minimized by utilizing a State licensed Home Care Agency.
Tax Issues
As a private employer, the individual or family is required to pay Social Security, unemployment and payroll taxes. Many self-employed caregivers will represent themselves as independent contractors, ostensibly relieving the hiring individual of these tax obligations. However, the hiring party has the responsibility to be sure that the caregiver they hire truly meets the criteria of an independent contractor and is paying their own taxes. In many instances, the paid caregiver will not meet the legal criteria as an independent contractor. If the paid caregiver has not met his or her tax obligations, this responsibility falls to the employer. This can be a serious obligation because it may involve interest on back taxes, civil fines and the possibility of criminal penalties. These costs are often finally recovered in full during probate proceedings from the estate of the older person who hired the caregiver. Potential private employers should seek the advice of an attorney familiar with labor laws to assure appropriate hiring practices with respect to federal tax laws.
Workers' Compensation and Liability Issues
As the employer, the individual or family paying for the independent Home Care Aide would be held liable for any work-related injury that occurs on the job. This can include the cost of all medical expenses and any disability payments that might become applicable. The home-care industry is noted for work-related injuries. This can be a huge risk to the employer, especially if the care giving tasks include lifting, transferring or bathing. There are also risks related to communicable diseases if the aide does not abide by universal precautions that are required by all licensed agency personnel. Liability insurance and Labor and Industries payments are a major cost for a licensed Home Care Agency. Along with ongoing costs for licensing, employee recruitment, training and supervision, they account for much of the difference between agency rates and those of an uninsured independent Home Care Aide or Personal Assistant. Furthermore, the employer retains any liability that arises out of an injury to the person being cared for or any other person on the premises. If the Home Care Aide or Personal Assistant causes an accident in which other family members suffered any harm or losses, the employer would bear the full responsibility for all costs and compensation.
Abuse and Exploitation
Unfortunately, there is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual. While most individuals who become Home Care Aides and Personal Assistants do so out of a desire to help others, there are always those who see this type of work as an opportunity to take advantage of someone. This becomes especially easy when the aide and the recipient of care are isolated in a private home setting with little or no supervision. Families don't fail to provide supervision out of malicious neglect. Supervision is often difficult because of geographic distance, lack of expertise, or the close emotional bonds that often get established between the aide and the person receiving the care. Furthermore, families often do not have the time or the resources to do criminal background checks or to contact references. Sometimes families are so grateful for the care provided by an aide that they are also vulnerable to manipulation and exploitation. Sadly, most cognizant vulnerable adults blame themselves for being gullible or too trusting, and choose not to pursue prosecution for the crimes committed against them. Others, due to dementia, are unable to provide credible testimony. Those who prey on vulnerable adults know there is a low risk of prosecution.
Criminal home care workers, many of whom are younger relatives who "need a break" because of their "run of bad luck", are all too often guilty of physical neglect and abuse, emotional abuse, forced isolation and false imprisonment, financial exploitation, and even sexual abuse. Some move from community to community as they become known to authorities. In each town they introduce themselves to easily-spotted frail or vulnerable victims by offering to lend a hand in a supermarket parking lot, lend an ear at a church function, bring in the newspaper from the driveway, or in any of a number of ways that seem to mark them as a caring individual. Soon they are revealing their wealth of experience caring for people with exactly the same ailments as your vulnerable relative. Please be extremely cautious of the friendly stranger who enters your older or disabled relative's life and especially if they are not employed by a licensed Home Care Agency.
Before you know it, the perpetrator has moved in, and convinced the older person that they are the only ones who can or will take care of them. As evidence, nobody seems to call any more (the phone is off the hook and/or callers are screened). They'll offer to help pay the bills and do the shopping, but need to be added to the checking account in order to sign the checks at the store or utility company. Err on the side of caution in allowing the hiring of an independent caregiver.
Agency Supervision
A licensed home care agency has a responsibility to provide ongoing supervision and proper training for their employees. This includes helping the aides to understand the changing needs of clients, assuring the proper limits of care according to the practice acts of the various levels of staff, and mediating difficult relationship issues. Providing supervision is often as important for the aide as it is for the family. Home Care Aides and Personal Assistants work with very challenging situations in the isolation of the client's private home. There are often issues of different cultural and faith traditions, different expectations about personal schedules, eating preferences and expectations. An agency supervisor will help to clarify the roles of the home care aide, and the expectations of both worker and care recipient. For example, an older adult might expect an aide to help with dressing changes, insulin injections, or other skilled care that is legally the responsibility of a licensed nurse. The agency can support the aide in setting appropriate limits on the types of care that can be provided, and find solutions to those care issues that are beyond the scope of the Home Care Aide's practice. In situations in which there are personality issues because of cognitive changes or a history of challenging relationships, the agency supervisor is available to provide guidance and support to both staff and care recipient. This can be very delicate, especially if there is a lack of trust or behaviors that are strange to the home health aide. The supervisor can reinforce and expand the aide's awareness that this is part of the disease process and offer techniques and strategies for coping with problematic behaviors so that the aide and the client can have a successful relationship. Supportive supervision is the key to making a challenging situation work. If supervisory help doesn't remedy the relationship problem, the agency can find a more suitable replacement without an interruption in care. Sadly, the independent caregiver often does not utilize or have access to continuing education, training, and supervision, and has an incentive to cover up their deficits.
Be aware that Nurses' Registries do not take on care staff as employees. These caregivers typically affirm to the Registry that they will, as independent contractors, abide by all employment and related tax and worker's compensation requirements, and are qualified to work as care providers. As independent contractors, they are not allowed to be supervised by the Nurses' Registry or made to work at times they do not choose.