What is Home Care?
"Home care" is a simple phrase that encompasses a wide range of health and social services. These services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.

Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends. Adults who are disabled or recuperating from acute illness are choosing home care whenever possible. Chronically ill infants and children are receiving sophisticated medical treatment in their loving and secure home environments. Adults and children diagnosed with terminal illness also are being cared for at home, receiving compassion and maintaining dignity. As hospital stays decrease, increasing numbers of patients need highly skilled services when they return home. Other patients are able to stay at home, avoiding hospital stays altogether, receiving safe and effective care in the comfort of their own homes.

Who pays for Home Care Services?
Home care services are reimbursed by self-pay, Medicare, Medicaid, Older American's Act, Veterans Administration, Social Services Block Grant Programs, commercial health insurance companies, long term care insurance, managed care organizations, Champus and worker's compensation.

When services are covered by Medicare and/or Medicaid, home care providers must bill their fees directly to the payor. Providers often will bill other third-party payors directly as well. Any services or products that are not covered are billed to the patient. The home care agency will notify each patient before rendering services if the services do not meet Medicare or Medicaid payment eligibility criteria.

The Medicare Home Health Benefit...
Medicare requires that the following conditions be met before they will reimburse for home health services:

• 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 that 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, who deliver direct hands-on care, 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 Health Care Personnel Registry to ensure aides have adequate training and to also allow the public and employers access to complaints about nurse aides.

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.