How To Choose A Home Health Care Agency
There are currently no mandatory national accreditation requirements for home health care organizations. To ensure that you receive the highest quality of care, look for an agency that meets the following criteria:
- State license
- Certification from an agency that reviews quality
- Provides the services you need
- Has reasonable costs
- Satisfies your other considerations
NOTE: Medicare has a Home Health Compare Web tool which allows you to compare local agencies and to compare their quality against state and national averages.
All states require licensing of home health care organizations (usually under the direction of the state health department), except: Idaho, South Dakota, and Vermont. To confirm that an agency has met state licensing requirements, contact your state health department. To find contact information, seewww.fda.gov/oca/sthealth.htm .
If an agency is supposed to have a state license, but doesn't -- look for another agency.
Certified by Medicare/Medicaid
Medicare and Medicaid will only paid for home care provided by a certified home care agency. In order to obtain certification, all home health care agencies that are approved for Medicare / Medicaid payment must meet specific state and federal requirements for patient care and financial management. Non-certification could indicate a problem.
Certified by Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
JCAHO is a not-for-profit organization that reviews quality of service. JCAHO provides voluntary accreditation for hospitals, nursing homes, home health care agencies, hospices, and other medical facilities. Accreditation may indicate a commitment to providing quality care.Ability To Provide Services
- Does the agency service the area in which you live?
- Can the agency provide all the services you need? For instance, if you require durable medical equipment (such as oxygen, a hospital bed or a wheel chair) in the home setting, can the agency make arrangements for delivery and maintenance? Can the agency provide training for use by family caregivers?
- If your condition requires specialized services such as x-rays, lab tests, or dialysis, does the agency have qualified people to provide such services?
Check out the following considerations to determine whether a particular home health care agency is right for you:
History: How long has the agency has been providing home health services? How long in your area? The longer the better.
Professional References: The homecare agency should provide, upon request, several professional references, including hospitals and social workers that have used their services. Obtain the specific names of individuals and their telephone numbers, and call them.
- What has their experience been with the agency? If there have been problems, what kind of problems have there been? Were they resolved satisfactorily? Was it a hassle to get the problems resolved?
- Would they recommend the agency over other home care agencies in your area? Why or why not?
- If not, would they tell you the service they would recommend? (If they do, ask if there if the individual or company with which you speak has a financial interest in any home care agency. A conflict of interest could produce a bias.)
- Understanding that in order to protect confidentiality, permission from the individual will be required, can the hospital, social worker, or home care agency give you the name and telephone number of patients who have the same or similar diagnosis and medical needs as yours or caregivers who have worked with such patients? If they won't divulge the information, would they ask the person to call you? If you make contact, ask about their personal experiences -- both good and bad. Would they recommend the agency?
The Admission Process:
- What's involved in the admission process?
- How long does it take to complete the admission process?
Most homecare agencies should be capable of starting care within 24 hours after being contacted. If not, they may be too busy to give you the care you need.
Involvement Of Your Caregivers:
- Is the involvement of family/loved ones as caregivers a requirement for the agency's agreeing to help you?
- What responsibilities will your caregivers have?
- If caregivers will have to operate or supervise medical equipment, will the agency train them?
- Do you have caregivers who can meet the needs?
Employee Qualifications And References
- Does the agency require and verify employee references? It is good practice for the agency to require at least two references.
- Do the employees receive special training related to caring for home health patients?
Written Description of Services:
The homecare agency should provide you a written description of services that includes:
- An outline of the services offered, including those designed to meet your medical, physical, and psychological needs. Preferably, a home care agency should be capable of addressing all of these needs or at least making arrangements with other organizations to do so.
- Cost of care and payment options, including billing methods. Hopefully, the agency will take care of all billing to your insurance provider for you.
- Employee qualifications and their specific job descriptions.
- Whether services are available 24 hours a day, 7 days a week.
The Agency should provide confirmation or proof of malpractice and liability insurance.
Initial Patient Evaluation: In order for an agency to do its job, it first must make an evaluation of you and your needs. The following are important considerations in the patient evaluation process.
- Does an experienced registered nurse or social worker, rather than an agency clerk, do the evaluation?
- Is your family, or those who will be providing day-to-day care, consulted?
- Who determines what personal services you can provide for yourself, such as bathing and grooming? If you and/or your family caregivers are not directly consulted, it may be assumed that you are capable of performing certain tasks for which you may actually require assistance.
- When determining your needs: Is the evaluation conducted in your home, rather than on the telephone? Viewing your physical living space may provide the evaluator with a better sense of your personal home needs. For example:
- Whether you will require the services of a home health aid to safely get in and out of the shower or bathtub.
- Whether a standard size hospital bed, walker, or other durable medical equipment, will fit and function properly in your home.
Are there other changes the evaluator might suggest to make functioning in your home safer or more comfortable?
Plan of Care: The homecare agency should provide an initial personalized plan of care designed to meet your individual needs and requirements as determined by your doctor, your family caregivers, the home care agency and you. The Plan will be revised and updated as needed. Everyone involved in your care should receive a written copy.
- The Plan of Care should include special consideration for pain management, if needed. To learn more see Pain.
- The Plan of Care should include a list of specific medical services (skilled nursing, rehabilitation therapies, durable medical equipment/supplies), and social services (counseling, accessing community resources) to be performed or provided by the agency staff, including the days and work hours in which they are to be provided.
- The Plan should include the name and telephone number of the supervisor in charge of your care. This will be useful in the event that a worker does not arrive as scheduled, if you believe you are not receiving adequate care, or if you have other questions or concerns.
Costs, including out of pocket expenses, can vary depending on your needs. Obtain all financial arrangements in writing and review them thoroughly before signing. Be certain to keep a copy.
- Are you required to use the services for a minimum number of hours per day or per week?
- What are the costs?
- How much of the cost will be covered by your insurance coverage and how much will you have to be pay out-of-pocket? When will you have to pay?
- Does the agency waive any co-payment you would be expected to pay if you have Medicare or a private sector health insurance policy?
- If you have to pay part of the costs:
- Will the agency work on a sliding scale so that you are charged less than the full amount if you have a limited income?
- Does the agency provide payment plan options?
- If you require financial assistance, what sort of resources can the agency provide or recommend?
If you make the decision to change homecare agencies, are you allowed to retain any durable medical equipment such as a hospital bed or wheel chair that you may currently be using?
Home health agencies often contract with medical equipment suppliers and may insist on providing their own equipment. However, obtaining new equipment can be disruptive to your life. (Just think about the hassle of removing a hospital bed and replacing it with a new one -- especially if the process involves two different companies.)
Confirm with a new agency that you will be allowed to continue with any durable medical equipment you may already have. We know of an individual who was able to make these arrangements by appealing directly to the agency administrator.
What plan does the agency have for emergencies?
Will the agency still be capable of providing services in the event of a power outage or natural disaster? This can be especially important if you are using medical equipment that requires electrical power.
What is the process for filing and resolving complaints?
- Who should you speak with?
- What are the mobile and landline phone numbers?