How should I choose a home health care agency?
There are differences in how home health agencies operate and one may meet your needs better than another. When selecting a home health care agency, there are several factors to consider:
- Ask your doctor, hospital discharge planner or social worker what their experience has been with a particular agency.
- Ask friends about their home health care experiences.
- Ask at your local senior or community center what agencies they recommend.
- Consider how long an agency has been in existence and their history.
- Call the agency directly and ask questions from a representative in the intake department.
- Review the quality measures found on the Medicare.gov website, however, keep in mind this is only one factor to consider when making your choice.
Can I choose the home health care agency that I want to receive care from?
If your doctor decides you need home health care, you have the freedom to choose among a list of participating Medicare-certified home health agencies that serve your geographic area to give you the care and services you need.
Your choice should be honored by your doctor, hospital discharge planner or other referring agency. Although you have a say in which agency you use, your choices may be limited by agency availability, or by your insurance coverage. Managed care plans may require that you receive home health services from agencies they contract with. The discharge plan should also identify any of the home health agencies in which the hospital has a financial interest.
Who is eligible for home health care?
VNA of Care New England provides home health care services to adult patients; those who are 18 years of age or older. Those under 18 may also receive home health care services and there are agencies in Rhode Island who specialize in this population.
Are there certain criteria to receive home health care?
If you have Medicare, you can use your home health benefits and receive services from a Medicare-certified home health agency if you meet all the following conditions:
- You must be under the care of a doctor.
- Your plan of care includes a list of the services that you need and may include personal care services.
- The Plan of Care is designed to identify what services you will receive to reach and maintain your best physical, mental and social well being.
You must need, and your doctor must certify, that you need one or more of the following
- Intermittent skilled nursing care.
- Physical therapy.
- Speech-language pathology services.
- Occupational therapy.
You must be homebound and your doctor must certify that you are homebound. This means:
- Leaving your home is not recommended because of your condition.
- Your condition keeps you from leaving home without help, such as a wheelchair or walker, special transportation or getting help from another person.
- Leaving home takes a considerable and taxing effort.
A person may leave home for the following reasons:
- Medical treatment.
- Short, infrequent, absences for non-medical reasons, such as attending religious services.
- Attend adult-day care, however, home health care services are provided in your home.
Who is not eligible for home health care?
If you need more than part-time or “intermittent” skilled nursing care, you are not eligible for the Medicare home health benefit. To decide whether you’re eligible for home health care, Medicare defines part-time or intermittent as "skilled nursing care that’s needed or given on fewer than seven days each week or less than eight hours each day over a period of 21 days (or less) with some exceptions in special circumstances." Hour and day limits may be extended in exceptional circumstances when your doctor can predict when your need for care will end.
What services are not covered by Medicare?
- 24-hour-a-day care at home.
- Meal preparation or meals delivered to your home.
- Housekeeping services such as shopping, cleaning and laundry when this is the only care you need.
- Personal care provided by home health aides, such as bathing, dressing and using the bathroom when this is the only care you need.
HealthTouch, a VNA of Care New England affiliate is a private pay home care agency that may provide these services and many more.
Will my private insurance or managed care cover the cost of home care services or private pay home care services?
Home health care services are covered under Medicare and most private insurances. Medicare Advantage Plans or other Medicare health plans may require that you get home health services from agencies they contract with. It is best to contact your insurance company directly to determine what services are covered under your plan.