How Does One Select a Home Care Provider?

Most people prefer to live in the safety and comfort of their home as they age.  Home care providers can help one stay in their home, but first they must choose a provider that matches their needs.  The key to choosing the right provider is planning.  The 3 areas for you to consider are your financial, health, and social needs, or those of your loved one.

• First financial planning which will help one ensure that they have the money needed to maintain the quality of life that one desires.
• Secondly one must consider health care needs over time, therefore planning may involve home modifications, in home health monitoring, and Personal Emergency Response Systems. Proper home health care planning can help prevent falls or accidents.
• Third, but most important to quality of life are the social needs. This includes transportation to meet friends, doctor visits, hobbies, synagogue, or adult day care.

Armed with a plan one must understand the types of regulated home care providers available in Central Florida.  The laws and regulations that govern home care in Florida are designed to protect the patient and family. People may choose to hire an individual caregiver or contractor, but run the risk of elder abuse, fraud, as well as insurance and tax liabilities.

When it comes to home care for a loved one, you must understand what level of care is needed. Does your parent need personal care or homemaker assistance? Is assistance needed all-day or all-night, or just in the morning and/or evening?  Do you need help for your parent when a family member or friend is not there?  Assistance may also be planned for occasional respite care, or around holidays or vacations when family caregivers are not available.

You may want to define the types of home care assistance that you need.

• Household Care: cooking, light house keeping, laundry, transportation
• Personal Care: bathing, feeding, dressing, incontinence assistance
• Medical Care: medication reminders, medical advocacy, RN house calls
• Social Support: companionship, community activities, conversation
• Occupational Support: hobbies, Home Exercise Programs

The following chart is summation of key differences in regulated and non-regulated home health care providers as defined by the Florida Agency for Health Care Administration (AHCA)

Types of Provider ®  Regulation	Home Health Agency (HHA)	Medicare or Medicaid Certified Home Health Agency (HHA)	Nurse Registry (NR)	Homemaker  or Companion Organization (HCS)	Hiring an Independent Caregiver
What servicescan be IegaIIy provided?	Homemaker CompanionHome health aide Certified nursing assistant (CNA)Nursing (LPN, RN) Therapy: Physical (PT),Speech (ST), Occupational (OT)Home Medical EquipmentSocial Work Dietetics & Nutrition	Homemaker CompanionHome health aide Certified nursing assistant (CNA)Nursing (LPN, RN) Therapy: Physical (PT),Speech (ST), Occupational (OT)Home Medical EquipmentSocial Work Dietetics & Nutrition	HomemakerCompanionHome health aideCertified nursingAssistant (CNA)Nursing (LPN, RN)	Homemaker/Companion Organizationscannot provide hands on personal care.	A licensed health care professional may provide services withinthe scope of his or her professional license.
Are there standards for patient services?	Yes	Yes	Yes	No	No
Is insurance coverage required?	Yes. Liability and malpractice insurance is required up to $250,000 per claim	Yes. Liability and malpractice insurance is required up to $250,000 per claim	No – Nurse Registries only have independent contractors.	No	No
How are services provided?	The patient contracts with the home health agency for services. The home health agency provides services through its own employees or contracted personnel.	The patient contracts with the home health agency for services. The home health agency provides services through its own employees or contracted personnel.	The patient contacts nurse registry for a referral. The patient contracts directly with the worker and pays fees as an independent contractor. The worker pays a referral fee to thenurse registry.	The client contracts with homemaker or companion organization for services. The organization provides services through its own employees or contracted personnel.	The patient or family contracts and makes individual arrangements with the worker.
What are the primary funding sources?	Private insurance and personal funds	Medicare, Medicaid, Private insuranceinsurance and personal funds	Private insurance and personal funds	Private insurance and personal funds	Private insurance and personal funds
Is nursing supervision required?	No. RN supervisory visits are not required, but may be provided.	Yes. Supervisory visits by an RN are required. The RN must visit every 2 weeks if receiving skilled care, or every 60 days if receiving personal care.	No, but if a home health aide or CNA is referred the nurse registry must advise that an RN is available to make visits to the patient’s home for an additional cost.	No	No
Does the provider pay federal payroll fees?	Yes	Yes	No, Nurse Registries only have independent contractors.	Yes, if employees, No if independent contractors.	No

Once one chooses the type of provider that best meets their needs, they must evaluate the providers in that category.  A few common considerations are as follows:

• What is the minimum shift?
• Are caregivers employees or contractors?
• Are periodic RN visits made to the home?
• Do caregivers receive orientation prior to working in the home?
• Is transportation available?
• What level of support is available if you are a long distant caregiver?

The key is to stay involved with the health care team.  The best results occur when you work with the provider as part of the care team to ensure the highest quality of life possible.

Article provided by Hank Charpentier, MBA, MA, Certified Senior Adviser® and Co-founder of Partners in Healthcare, www.PartnersInHC.com

Click the following link to view a document that describes the different services available for home care Not all homecare is equal