What is Home Care? È

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. Services include: nursing, physical therapy, occupational therapy, speech therapy, medical social work, in-home aide services, medical equipment and supplies, infusion therapy, respiratory therapy and nutrition.

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 and social services to patients and teaches families to help care for their family member. Home care is personalized care that reduces the anxiety and stress associated with most forms of healthcare and allows a maximum amount of freedom for the individual. In most cases, home care also means significant savings in the cost of care when compared to a hospital setting or nursing home.

Millions of Americans rely on home care to stay out of a hospital, nursing home, rest home or other institution, and remain in the comfort of their own homes. There is no more important social value than keeping families together, particularly in time of illness. There is much scientific evidence that patients heal more quickly at home and there is very high consumer satisfaction associated with care delivered in the home.

Home care not only helps add years to life, but also life to years. Studies in the US and abroad show that those receiving home care have higher rates of satisfaction with life.

How Can I Access Home Care Services? È

Patients or family members may directly contact home care agencies 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.

Home care services may be 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 therapy agencies.

Who Pays for Home Care Services? È

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 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), Home Infusion Therapy (HIT), Community Alternatives Program (CAP), Durable Medical Equipment (DME), Private Duty Nursing (PDN) and Hospice.

Medicare requires that the following conditions be met before reimbursing for home health services:

• The individual to whom the services are provided is an eligible Medicare beneficiary
• A physician certifies 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 services are provided by a Medicare-certified home health agency
• 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. Medical social worker services may also be provided under Medicare, but are not covered under Medicaid.

How Do I Select A Home Care Provider? È

As in selecting any healthcare provider, patients and families should ask questions and make an informed selection, based on the specific needs of the patient. It is also critical that individuals take advantage of consumer protections that currently exist to promote high quality care.

State Licensure

All agencies that provide "hands on" care in the home must be licensed by the NC Division of Facility Services. Through licensure, the State ensures that agencies meet specific standards of care. All home care agencies must meet stringent requirements including those related to the administration of the agency, staff qualifications and supervision, patient care and patient records. Consumers should carefully consider working through licensed agencies rather than hiring individuals independently that would not be bound by many state and federal regulations governing the delivery of care as well as other safeguards. Under state mandate supported by the home care industry, all licensed home care agencies are required to perform a criminal history records investigation on all employees required to enter a patient's home. In addition, all agency employed nurse aides must maintain listing on the North Carolina Nurse Aide Registry to be eligible for employment.

Certification

Those agencies that provide Medicare and Medicaid home health services must also be certified by the Federal Government and meet their conditions of participation. The Division of Facility Services makes on-site survey visits to all licensed and certified home care agencies to assess the quality of their services.

Accreditation

Agencies accredited by nationally recognized accrediting bodies demonstrate they meet yet another set of quality standards during on-site surveys.

A Word on Patient Choice of Care Provider... È

According to the Health Insurance for the Aged and Disabled Act (title XVIII of the Social Security Act), known as "Medicare," a "patient is free to choose any qualified institution, agency, or person offering him/her services." In addition, since the N.C. Division of Medical Assistance does not "waive" freedom of choice, Medicaid recipients are also free to choose the service provider of their choice.