With people living longer and the baby boomers reaching the age where they will need assistance with care to stay in their homes, the need for home health care will increase. I receive many calls from clients or their families on how to find care, what type of care is needed, who is going to pay for this care, and how to go about choosing which agency to provide the care.
For the individual with Medicare benefits, home care through a Medicare-certified agency is an option for short-term care, provided the individual is home-bound. There are stringent rules and definitions of what constitutes home-bound status. According to Duska Robinson, RN BSN CHPN (Certified Hospice and Palliative Care Nurse) at Community Health and Counseling Services, for Medicare to cover home-care services, there has to be a skilled need services.
The need must be acute, defined as “recent changes in disease process.” The patient must have a physician who is qualified to certify for home health services, and the physician must have seen the patient within the last three months. If you feel you need skilled services under your Medicare benefit, you may call your physician or a Medicare-certified home health agency. Some agencies will make a free home visit to help determine whether your condition qualifies you for these services.
If your health care is covered by MaineCare ,and you need assistance with activities of daily living, first you would need to be assessed by Goold, a company contracted by the state to determine medical eligibility. A referral may be made to Goold by a physician’s office, hospitals, long-term care facilities, Medicare-certified home health-care agencies, or the client or client’s family member.
If the assessment determines that you qualify for services, it is sent to EIM (Elder Independence of Maine). This organization will assist in finding an agency that will meet your needs. Depending on the program you qualify under, you may be placed on a waiting list.
Another payer source is a long-term care insurance policy. These policies have specific language about what will qualify the individual for home-care services. Most companies require that the agency providing the services be licensed by the state. Some agencies are willing to check eligibility with your insurance company for you.
Home-care services may also be obtained and paid for privately. The challenge is how to choose the agency that will give you the best quality of care. Some good questions to ask:
• Is the agency licensed by the state? Licensed agencies follow regulations that define care and quality and are monitored by the state by the Division of Licensing and Certification for compliance. Some agencies are registered by the state.
• Are the agency’s employees bonded?
• Are the agency’s employees trained and certified? Some agencies hire employees with little to no experience, and certification may not be completed until several months after hire.
• How are employees screened before hiring?
• How and how often are employees supervised?
• Do you have an RN on-call after hours in case the staff or the client have a question or concern?
• How does the caregiver know how to meet your needs? Some agencies require a RN to set up your plan of care with you in the home before services start.
As Dorothy in the Wizard of OZ says, “There is no place like home.” I hope this helps you as you navigate and search for the care needed to keep you in that best place: home.
Kathy Frodahl is the president and CEO at New England Home Health Care.