FAQ's

What are my options for caring for my loved one?

There is no place like home, there are however a number of options for living if home is no longer an option. Nursing Homes, Assisted Living Facilities, and Personal Care Homes all vary in location, amenities, and cost. They are all licensed and closely regulated by the state. Medicare does not provide funding for any of the above options. Medicaid and some long term care insurances will cover living expenses with certain restrictions.

Home Health Care

What is Home Health Care?
Home Health Care includes a wide range of health and social services provided in your home. Home may be settings such as a house, with friends or family; an assisted living facility; personal care homes; remember ‘home is where the heart is‘.

Generally home health care may be necessary for a time following a hospital stay to help facilitate recovery. Home health is also able to provide care at home to help prevent a hospital stay. This may include IV therapy; wound care; physical or occupational therapy in your home to prevent Services may be provided in other settings, such as in an assisted living or nursing center. Home health care is often provided following a hospital stay to help speed healing and recovery.

How Do I Select the Right Home Care Provider?
Once you acquire the names of several providers, you will want to learn more about their services and reputations. Following is a checklist of questions to ask providers and other individuals who may know about the provider's track record. Their insight will help you determine which provider is best for you or your loved one.

How long has this provider been serving the community?
Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish patients with a detailed "Patient Bill of Rights" that outlines the rights and responsibilities of the providers, patients, and caregivers alike. An annual report and other educational materials also can provide helpful information about the provider.

How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?

Are nurses or therapists required to evaluate the patient's home care needs? If so, what does this entail? Do they consult the patient's physicians and family members?

Does this provider include the patient and his or her family members in developing the plan of care? Are they involved in making care plan changes?

Is the patient's course of treatment documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan, and do the caregivers update it as changes occur? Does this provider take time to educate family members on the care being administered to the patient?

Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? If so, how often do these individuals make visits? Who can the patient and his or her family members call with questions or complaints? How does the agency follow up on and resolve problems?

What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?

What procedures does this provider have in place to handle emergencies? Are its caregivers available 24 hours a day, seven days a week?

How does this provider ensure patient confidentiality?

In addition, ask the home care provider to supply you with a list of references, such as doctors, discharge planners, patients or their family members, and community leaders who are familiar with the provider's quality of service.

Contact each reference and ask:

Do you frequently refer clients to this provider?

Do you have a contractual relationship with this provider? If so, do you require the provider to meet special standards for quality care?

What sort of feedback have you gotten from patients receiving care from this provider, either on an informal basis or through a formal satisfaction survey?

Do you know of any clients this provider has treated whose cases are similar to mine or my loved one's? If so, can you put me in touch with these individuals?

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What types of services do home care providers deliver?
Home care providers deliver a wide variety of health care and supportive services, ranging from professional nursing and HCA care to physical, occupational, respiratory, and speech therapies. They also may provide social work and nutritional care and laboratory, x-ray, and medical equipment and supply services.

Services for the treatment of medical conditions usually are prescribed by an individual's physician. An individual may receive a single type of care or a combination of services, depending on the complexity of his or her needs.

Home care services can be provided by the following professionals; Physicians visit patients in their homes to diagnose and treat illnesses just as they do in hospitals and private offices. They also work with home care providers to determine which services are needed by patients, which specialists are most suitable to render these services, and how often these services need to be provided. With this information, physicians prescribe and oversee patient plans of care. Under Medicare, physicians and home health agency personnel review these plans of care as often as required by the severity of patient medical conditions at least once every 62 days.

Registered nurses (RNs) and licensed vocational nurses (LVNs) provide skilled services. These services may include injections, intravenous therapy, collecting lab specimens; wound care, education on disease treatment and prevention, and patient assessments.

Physical therapists (PTs) work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage, and other methods. PTs often alleviate pain and restore injured muscles with specialized equipment. They also teach patients and caregivers special techniques for walking and transfer.

Social workers evaluate the social and emotional factors affecting ill and disabled individuals and provide counseling. They also help patients and their family members identify available community resources. Social workers often serve as case managers when patients' conditions are so complex that professionals need to assess medical and supportive needs and coordinate a variety of services.

Speech language pathologists work to develop and restore the speech of individuals with communication disorders; usually these disorders are the result of traumas such as surgery or stroke. Speech therapists also help retrain patients in breathing, swallowing, and muscle control.

Occupational therapists (OTs) help individuals who have physical, developmental, social, or emotional problems that prevent them from performing the general activities of daily living (ADLs). OTs instruct patients on using specialized rehabilitation techniques and equipment to improve their function in tasks such as eating, bathing, dressing, and basic household routines.

Dietitians provide counseling services to individuals who need professional dietary assessment and guidance to properly manage an illness or disability.

HCAs/home health aides assist patients with ADLs such as getting in and out of bed, walking, bathing, toileting, and dressing. Some aides have received special training and are qualified to provide more complex services under the supervision of a nursing professional.

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Will Medicare pay for home health services?
Medicare, Medicaid, and most private insurance plans pay for services that home health agencies deliver. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Individuals may opt to pay out of pocket for services that are not covered by other sources.  

Pharmaceutical and Infusion Therapy Companies
Pharmaceutical and infusion therapy supplies and services are almost always paid for by commercial insurance companies and Medicaid. Medicare covers the cost of nutritional supplements and certain medications when the situation meets strict coverage criteria.

Durable Medical Equipment and Supply Dealers
Fees for durable medical equipment and supplies are usually covered by Medicare, Medicaid, and commercial insurance programs, provided that the products are ordered by a physician and are medically necessary to treat an illness or injury.

Home Care can be paid for by the individual or family, private insurance, or a variety of public programs:

• Medicare
• Medicaid
• CHAMPUS
• Worker’s Compensation
• The Veterans Administration
• Some community organizations, such as local chapters of
• American Cancer Society
• Alzheimer’s Association

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How long will Medicare cover home health services?
Generally Medicare will pay for health care in the home if all of the conditions below are met. A plan of care is developed with your physician and routinely reviewed and updated as needed. Services are covered when the need for home care is determined to be medically necessary and reasonable for the homebound individual.

Homebound is defined as requiring considerable effort and assistance to leave home and requires care on an intermittent basis. Individuals are considered homebound if leaving home is infrequent; for relatively short periods of time and most often for a medical appointment. In some cases individuals with psychiatric disease may be considered homebound even if their physical ability is unimpaired, when certain conditions are met.

What do home health services cost?
Expenses vary for each individual receiving home care as billing is based on specific needs.

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What is the density of patients to caregivers?
Caregiver patient ratio is dependent upon the magnitude/acuity/severity of patients being cared for and in direct relation to distance required to travel. We attempt to keep individual case managers in close proximity to the clients they whose care they are assisting to manage; allowing them to be more accessible in case of need.

Who oversees home health services?
Home care agencies are licensed and regulated by the state and federal government. A license must be reapplied for and renewed yearly to remain within compliance.

Home care services are individually overseen on a routine basis by the patients and families who observe the care we provide to friends and families.

Who do I report suspected abuse to?
Our goal is to offer the highest level of care possible and remain mindful of our responsibility to our patients; physicians; community and employees. If a problem or concern develops, or you would like to issue a complaint, contact our administrator; the state health department or state Medicare hot line, and/or the local Better Business Bureau.

Although rare, cases of fraud do exist in some health care operations. These fraudulent activities waste valuable health care dollars. If you suspect fraud, even on the slightest scale, you should report these activities to your state department of health.

State Resources

TEXAS

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What Are my Rights as a Patient?
Federal law requires that all individuals receiving home care services be informed of their rights as a patient. Following is a model patient bill of rights the National Association for Home Care (NAHC) has developed, based on the patient rights currently enforced by law.Home care patients have the right to:

be fully informed of all his or her rights and responsibilities by the home care agency; choose care providers; appropriate and professional care in accordance with physician orders; receive a timely response from the agency to his or her request for service; be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed; receive reasonable continuity of care; receive information necessary to give informed consent prior to the start of any treatment or procedure; be advised of any change in the plan of care, before the change is made; refuse treatment within the confines of the law and to be informed of the consequences of his or her action; be informed of his or her rights under state law to formulate advanced directives; have health care providers comply with advance directives in accordance with state law requirements; be informed within reasonable time of anticipated termination of service or plans for transfer to another agency; be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements; be referred elsewhere, if denied service solely on his or her inability to pay; voice grievances and suggest changes in service or staff without fear of restraint or discrimination; a fair hearing for any individual to whom any service has been denied, reduced, or terminated, or who is otherwise aggrieved by agency action. The fair hearing procedure shall be set forth by each agency as appropriate to the unique patient situation (i.e., funding source, level of care, diagnosis); be informed of what to do in the event of an emergency; and be advised of the telephone number and hours of operation of the state's home health hot line, which receives questions and complaints about Medicare-certified and state-licensed home care agencies.

NAHC's affiliate, the Hospice Association of America, has developed the following model bill of rights for all individuals receiving hospice care. It also is based on the patient rights currently enforced by law.

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Insurance

What is long term care insurance?
Long term care insurance is a policy that pays a benefit for long term custodial care in a nursing home or in your own home through home health care services. Premiums are based upon the desired deductible, length of stay, commencement of benefits payments, current health and other factors. Long term care insurance may be considered an integral part of financial planning. For more information get a copy of A Shopper's Guide to Long-Term Care Insurance from your State Insurance Department or contact the National Association of Insurance Commissioners.

Will my health insurance cover home health services?
There are some situations where health insurance will cover some home health services. There may be eligibility requirements and limitations on the duration of services. Generally, health insurance will cover only medically necessary conditions. Check with your health insurance company for details.

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What does a long term policy cost?
Costs can vary considerably depending on your age, health and desired benefits reimbursement choices. Start by acquiring a copy of A Shopper's Guide to Long-Term Care Insurance from your State Insurance Department or contact the National Association of Insurance Commissioners.

What is Medicare?
Medicare is a health insurance program for people age 65 or older, some people with disabilities under age 65 and people with end-stage renal disease. Medicare is composed of two parts. Part A encompasses hospital insurance. Most people do not have to pay for this part. Part B is a medical insurance part paid for by most people monthly. Request the handbook Medicare & You 2001 at 1-800-633-4227 or visit www.medicare.gov for more detailed information.

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Does Medicare cover home health care services?
Yes, but there are certain criteria that must be met and the services provided may be specific. There are limitations on number of home health hours available and the duration of the services. Request the handbook Medicare and Home Health Care at 1-800-633-4227 or visit www.medicare.gov

Does Medicare cover long term care by a caregiver?
Generally no. Most long term care is considered custodial care. The Medicare program was only designed to cover medically necessary conditions.

Does Medicare cover the cost of a nursing home stay?
Some nursing home services are covered but there are eligibility requirements and the duration of a stay is limited. Medicare does not generally cover long term care in a nursing home. Request the handbook Medicare Coverage of Skilled Nursing Facility Care at 1-800-633-4227 or visit www.medicare.gov

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Nursing Homes

How do I know I'm choosing a good nursing home?
The Medicare web site has a checklist to be used in determining which nursing home may be the best for you. To see the checklist click here. Nursing homes are inspected about every year and a half or so. The records of these inspections are available to the public. To search the Medicare web site for inspection reports, click here. Although a facility may have a good inspection report, it doesn't always mean that the care is what you would want. By all means, visit the facility and utilize the Medicare checklist. For additional information go to www.jeffdanger.com/gettingbestcare.htm

Who do I report suspected abuse to?
Nursing home residents are protected by the Nursing Home Reform Act of 1987. In the event that abuse, neglect or fraud is observed, in Texas call 1-800-458-9858. For other states, refer to your state Health and Human Services Department for guidance.

How much does a nursing home cost?
The average cost is about $3,300; however, depending upon the geographic area and the skill level required to care for a patient, this can be considerably higher. For a look at averages by state click here.

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Will Medicare cover the cost of a nursing home?
Yes, but eligibility requirements must be met and at present, it will only pay if the visit follows a 3 or more day stay in a hospital and then it may only cover a few weeks. Request the handbook Medicare & You 2001 at 1-800-633-4227 or visit www.medicare.gov for more detailed information.