A Home Healthcare Primer

National Family Caregivers Association

What is home care? Home care is a general term that represents a wide range of community-based services to support someone who is recuperating from an acute situation, such as a hip fracture, or needed by persons with ongoing chronic conditions, such as stroke or cerebral palsy. The skills and duties of home care personnel vary, but all have one thing in common-they make it possible for care recipients to remain at home in a safe environment and in some cases have more independence than they did before. In the process, they also provide family caregivers with a chance to replenish their depleted physical and emotional reserves.

Home care personnel include:

• Registered nurses (RNs) who provide skilled nursing care according to a doctor's medical plan of treatment, including assessment and monitoring of vital signs, complex wound care, administration of intravenous and other medications, and teaching family caregivers how to perform procedures including the use of certain equipment in the home.
• Therapists who work with patients to restore or maintain their motor and mobility function, speech and communication, and cognitive skills.
• Home care aides who provide personal services such as bathing, dressing, toileting, preparing light meals, and who in some cases may accompany or transport patients to the doctor.
• Companion/homemakers who help with homemaking chores such as shopping, meal preparation, and housekeeping, but who usually do not perform personal care duties for the recipient of services.

Getting Started with Home Care

If you are considering getting home care help to assist you with your caregiving responsibilities and/or to get some time for yourself, there are a number of things you need to consider, and also things you need to know.

The first step is to make sure you and your loved one are comfortable with the idea of someone else taking on some of the tasks that you've been doing by yourself. There are many care recipients who are totally opposed to the idea, and some negotiations will need to occur before any plan can be put in place. It is important for all concerned to understand what is prompting the need for home care and the personal issues that lie beneath refusal to consider it. Getting beyond objections isn't necessarily easy and you might need some guidance on how to go about it, perhaps from other family caregivers who have dealt with the issue or from professionals who counsel family caregivers.

Defining the tasks that need to be done by the home care worker will help you determine exactly what type of home care is most appropriate in your situation. Do you need a nurse to clean and bandage wounds and monitor equipment, a home care aide to help your loved one get showered and dressed, or would a companion/homemaker be more appropriate in your circumstance?

Once you know what type of assistance you need, and all parties agree that it is necessary or desirable, the inevitable questions about where to find home care services, how much they will cost, and whether any of the cost is covered by insurance or provided by government programs must be asked and answered. Some federally-funded programs, insurance companies, and health maintenance organizations (HMOs) do provide for some home healthcare services, but the coverage provided may not meet your needs. To determine whether or not you have any coverage at all, it is imperative that you review your insurance benefits.

If you're like the majority of family caregivers, you need the most help with personal care tasks-the very type of care that is not covered by private health insurance programs or Medicare. So unless your loved one had the foresight and the funds to purchase long-term care insurance prior to becoming ill, your access to home care will be limited by what you can afford. You may be able to get some help from state programs that take into account your ability to pay and the age or extent of disability of your care recipient, but the sad reality is that more often than not the costs of home care services will have to come out of your own pocket.

Choosing the Right In-Home Care

How do you find the right home care solution for your family, the one that provides the services you need at a price you can afford? There are several ways of tapping into the home care network. Here is a look at some of the most common ones and what you need to think about when considering them:

Home Care Agencies are companies in the business of meeting home care needs. Not all home care agencies provide the same variety and level of service, however, so make sure the agency you are considering can provide all the services you need. The issue isn't bigger or smaller but rather which one meets your criteria.

If your care recipient is approved for skilled care that Medicare will pay for, it's vital that the agency be Medicare certified. This ensures that the agency has met minimum federal requirements. If your loved one only requires personal care or companion/homemaker care, Medicare certification need not be a factor in your decision. Some companies may have separate departments that provide Medicare-covered services as well as private pay/private duty services.

Some agencies are accredited in addition to being certified. Well-known accrediting organizations are the Community Health Accreditation Program, the Joint Commission on Accreditation of Healthcare Organizations, and the Home Care Aide Services Accreditation of the National Association for Home Care. This type of credential tells you that the agency conforms to national industry standards, and there is always comfort in knowing you are dealing with an organization that has proven its worth to its peers.

What do home care services cost through an agency? Some agencies charge flat fees ranging from $100 to $120 per visit. Others have a minimum two- or four-hour fee. The actual hourly rate will vary depending on the services you require and the part of the country you live in, but don't be surprised to find rates ranging anywhere from $13 to $35 per hour.

Questions to Ask Any Agency With Whom You Are Thinking of Working: