Home Care Basics

 

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types of agencies 


 

 

 

There are different types of home care agencies that provide services to patients. Home care agencies and programs differ in the services they provide and the New York State agency that oversees their operation. There are approximately 900 home care agencies in New York State, employing over 250,000 workers. In addition to professional nurses, therapists, and assistants, home care agencies hire and train workers as home health aides and personal care aides, and offer these paraprofessionals additional opportunities for career growth. New York State also licenses or certifies a variety of home care programs.

The New York State Department of Health (DOH) sets standards for and regulates all home care agencies that provide health or medically related services to people in their homes. DOH and the Federal Centers Medicare & Medicaid Services (CMS) jointly regulate agencies participating in the Medicare program. DOH regulations and standards require that home care providers meet the same standards relating to agency establishment, paraprofessional training, quality of care and consumer protection standards including service delivery and personnel requirements.

Types of licensed or certified home care agencies

Licensed Home Care Services Agencies (LHCSAs)

LHCSAs offer home care services that can include all levels of nursing care, various therapies as well as home health aides and personal care aides to clients who pay privately, have private insurance coverage or are covered through a variety of government payers. Some LHCSAs offer a full range of services from skilled to paraprofessional care, while other choose to focus on the delivery of one service or population, such as high-tech pediatrics, disabled patients or senior care.

Many LHCSAs also deliver services under contract with local departments of social services or other service-authorizing agents. In particular, services through the Medicaid Personal Care and Private Duty Nursing Programs are delivered in this way. Licensed agencies also sub-contract with other home care providers to deliver services to beneficiaries throughout New York State.

Certified Home Health Agencies (CHHAs)

CHHAs provide care and support services to individuals who, for the most part, have home health care needs for a limited duration. CHHAs offer nursing and home health aide services, and provide or arrange for other professional services, including physical and occupational therapy, speech pathology, medical social work and nutrition services. They are generally reimbursed through Medicare and/or Medicaid.

Long Term Home Health Care Programs (LTHHCPs)

Also known as "Nursing Homes Without Walls", LTHHCPs are CHHAs operating under a specific Federal Medicaid waiver. They offer health care and support services to the disabled and chronically ill who are medically eligible for admission to a nursing home, but who choose to be maintained at home. These programs provide a full range of professional and aide level health care services to those in need over a long period of time, at a budgeted amount of 75% of the cost of nursing home care.

Hospice and palliative care agencies

Hospice and palliative care agencies provide home and inpatient care and counseling for the terminally ill and their families. The goal is to prevent and relieve patient suffering rather than treating disease. These agencies provide dying persons and their families with physical, psychological, social and spiritual support and care.


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Choosing an Agency

It's your choice

Health care situations are as different and individual as each person. When faced with making a health care decision for yourself or your loved one, it is important to remember that you have choices. Even if a medical professional or hospital personnel recommend institutional care, you can and should explore all your options. The decision about care is ultimately yours.

Is a home care agency the right choice?

There are many times to consider home care, which can be the right choice for a wide range of health care services.

  • Patients of any age being discharged from the hospital who need short-term care to recover.
  • Disabled children or adults can choose to receive care at home.
  • Chronically ill children or adults can benefit from sophisticated medical treatment in their homes.
  • Older adults, disabled or chronically ill people who need both skilled care or personal care assistance to help with daily activities such as bathing, dressing, cooking and shopping.

Choosing hospice and palliative care

If someone has been diagnosed with a terminal illness, contact your local Hospice or home care agency that provides palliative care. The goal of Hospice and palliative care agencies is to ease suffering and to ensure that the person lives out his/her life as comfortably as possible. These agencies also provide essential support for families of the terminally ill.

Where do I begin in selecting an agency?

It can seem intimidating to begin searching for an agency, but knowing how to begin can make the process much easier. Here are some simple steps to follow when searching for an agency.

  • Gather all the information you can about the person in need of care including existing care, previous care, and any pertinent information about the existing situation.
  • Contact one or more home care agencies near where the person lives or where you want to care to be given.
    • HCP has many member agencies that are highly qualified and can provide a wide range of services. You can use HCP's Find a Provider search function on our Web site to help you find an agency in the area where care is needed.
  • Discuss the situation with each of the agencies so that you understand what your options are. Each agency should help you determine what type of care or treatment the person needs based on the situation, your family circumstances, and they will provide a nursing assessment, if appropriate.
    • They should also be able to tell you about any government services or programs that fit your situation.
    • They should be able to refer you to any appropriate program or service that you may need.
  • Based on your conversation, you should be able to determine which agency best meets your needs. Contact them to make the appropriate arrangements for care.

Some questions to ask an agency

Although each health care situation is different and it is important to discuss your particular circumstances with each agency, there are questions you can ask each of the agencies.

  • How long has the agency been in operation?
  • Is the agency licensed, certified, or another type of agency?
    • What counties does it serve?
    • What types of services does the agency provide?
    • Is the agency accredited? Professional accrediting means that an agency has met established standards set by the NYS Department of Health.
    • Will the agency provide you with written brochures or materials describing its services, fees, policies and procedures?
    • Are services available on the weekends and at night?
    • What is the role of the family in the care?
    • How does the agency handle emergency situations?
    • Will the agency do an in-person assessment of the patient, and if so, when?

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payment options

Who pays for home care?

Home care services are paid for through a variety of sources. The Federal Medicare program will pay for medically-necessary home care services, generally for a limited duration and most typically following a hospital stay. The same is true for most private health insurance plans. New York's Medicaid home care programs provide a wide range of services to those who qualify. Long-term care insurance is an increasingly important option for many people as it pays for home care services as well as nursing home services on a long-term basis. And thousands of New York State residents purchase home care services privately.

Government

Medicare
Most Americans over age 65 are eligible for the Federal Medicare program and some under age 65 are eligible because of disability. To qualify for home care services, a person with Medicare must be homebound, under a physician’s care and must need medically necessary skilled nursing or therapy services. Medicare pays for home health benefit services based on a 60-day episode of care.

Medicaid
Medicaid is a joint Federal-State medical assistance program for low-income individuals that is administered by the states. Each state has its own set of eligibility requirements. In New York, the New York State Department of Health (DOH) regulates the home care service programs that are available to certain Medicaid-eligible people under the State's Medicaid program.

The New York State Office for the Aging (NYSOFA) regulates home care programs that are provided through county offices for the aging, including the Expanded In-Home Services for the Elderly Program for elderly people who do not qualify for Medicaid.

Private Insurance

A variety of different types of insurance is available to cover home care needs.

Health Insurance

Commercial health insurance policies normally include a home health benefit covering services for acute needs. Most plans will also cover comprehensive hospice services. Many people with Medicare coverage purchase private “Medigap” policies to cover services that Medicare does not which may include home care services. Some Medigap policies offer benefits that pay for personal care services when the policyholder is receiving Medicare-covered skilled home health services.

Long-Term Care Insurance


Long-term care insurance is becoming an increasingly popular way for individuals to prepare for the eventual need for long-term care services. Originally thought of to cover lengthy stays in nursing homes, private long-term care policies have expanded their coverage of personal care and other home services. Home care benefits vary among plans and there may be limitations and exclusions.

Workers' Compensation

Someone with medically necessary home care needs as a result of an injury on the job can receive coverage through workers' compensation.

Self-pay


Individuals who are not covered for home care services by any of the third-party options may pay directly for services, negotiating fees with the home care agency.

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