Evaluating In-Home Care Services – A Check List

The first step to choosing appropriate home care services is to understand the types of home care providers and services available to you. There are basically two types of home care services.

In-Home Care
“Skilled” Home Care Services

The first type of provider is for what they call in the industry “skilled” needs. This type of agency is usually a Medicare certified agency and requires and order from a physician for specific needs. The services provided are intermittent and for a specific length of time, less than 28 hours per week and not usually longer than 21 days.

The care is provided by professional and licensed nurses, and therapists. The aides provided by the “skilled” home care agency must be certified. This means they have some medical training to perform the duties required of the position.

To qualify for the services of a “skilled” nursing agency, you must be home bound and have needs such as wound care, physical, occupational or speech therapy. By Medicare definition, “homebound” means you are not able to leave the house for any purpose other than to see you health care provider or attend religious services. In most instances, insurance will cover ‘skilled” home care services, if you qualify for the benefits under your policy. It is important to check with your insurance carrier about any co pays for visits that you receive.

“Skilled” home care services may supply an aide to come in and assist with bathing and dressing. This is generally covered by the cost of the home care services only if it is part of the care needed and available from the home care agency. Many managed care insurance companies will not pay for those services and therefore the home care agency is not able to offer this service as an option.

When considering a “skilled” home care agency some things to investigate and ask:

  • Visit OurParents web site and check out the providers in your area This will not only give you names of certified agencies in your area, but you should be able to obtain some quality information about the home care services in your area.
  • Is the home care agency surveyed and accredited by a governing agency such as The Joint Commission’s Home Care Accreditation Program? Many insurance companies require this accreditation for payment. This accreditation means an agency has met certain requirements with regards to staffing, training and supervision.
  • Ask to see the home care agency’s survey report for health and safety.
  • Ask to see the outcome studies regarding your loved one’s condition.
  • Most states require agencies to be licensed and reviewed regularly. These reviews may be available upon request and can be valuable for assessing the quality of care provided by an agency. Contact your Office on Aging or your state health department for a copy of the agency’s state survey.
  • Ask the agency to provide references. References from doctors, hospital discharge planners, social workers and former customers of the agency.
  • What are the credentials of the providers? Are they licensed and bonded?
  • Does the agency provide resources, such as a social worker, to assist in obtaining   financial assistance, if needed?

“Custodial” home care services

The second type of home care services is what is known in the industry as “custodial” care. This level of service provides companionship, personal care such as bathing, dressing and light housekeeping.

“Custodial” home care services are usually paid by long term care insurance, private pay and in some instances through a Medicaid waiver program. Contact your local agency on aging to learn more if these services are available in your area.

“Custodial” home care services can be expensive, but you will find that it is much more cost effective than other institutional alternatives.

When considering “custodial” home care services some things to investigate and ask:

  • How long has the agency been in business?
  • Does the agency provide a written plan that details services to be provided by each caregiver?
  • Do they provide documents about financial arrangements before service begins? It is important so that there’s no misunderstanding about the service and cost to be provided.
  • Are the providers of care, insured and bonded?
  • Is there a criminal background check preformed prior to employment with agency?
  • Does the company provide worker’s compensation for employees? This is important so that you are not responsible for any injuries that occur on the job.
  • What procedures does the agency have for emergencies? Are caregivers available twenty four hours a day? Is there a supervisor on call and available to speak to on off hours and weekends?
  • Is there a policy regarding replacing a sick employee? Or an employee that has an emergency?
  • Does the agency have a policy in place on addressing and resolving problems? Who is the agencies main contact regarding any requests, questions or complaints?
  • Is there a requirement that a primary family caregiver be available as a condition of qualifying for services?  If so, what are the requirements of the family members?
  • Ask the agency to provide references. References from doctors, hospital discharge planners, social workers and former customers of the agency.
  • Is it possible to interview several potential aides and make a selection after those interviews?
  • Who will be working in the home? Will there be regular staff providing continuity of care? What will be their specific duties?
  • Is there a professional staff member, such as a registered nurse, that provides a plan of care to identify the needs of the client? How often does this supervisor review the plan of care?
  • Will the family and the client be involved in planning for care or making changes to the care plan?

Choosing home care services can feel overwhelming and stressful. For many aging seniors, the option to remain in their home is worth the time and energy it takes to investigate home care services. To be able to remain independent and safe, in the comfort of the familiar surroundings is the goal of many aging seniors. To feel in control of their life and choices is invaluable. Home care services make that option possible.


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