Many people call me to inquire about getting home care for a family member who often do not know what services are available or what may be an appropriate level of care for their loved ones. If this describes you do not feel alone.
If you are looking for Home Care rather than institutional care there are basically three levels of home care and different types of providers for each level. In Florida there are Companion Agencies which are authorized under the state regulations to provide services such as grocery shopping, escort service, ironing, housekeeping, cooking and companionship. Companionship may include things like take the client for a walk daily, assist the client to write letters, and help in organizing papers and items in the home. Many times an elderly client just needs someone to assist him or her to write down the dates and times for physician office visits and provide escort to doctors offices. These services are very helpful to many seniors. You should know however that a Companion Agency is limited in the scope of their care to only non-personal care services. A Companion Agency can provide stand-by assistance with bathing and grooming as long as the caregiver does not need to physically touch the person for whom they are assisting. A person who requires more personal care requires a higher level of care.
A Home Health Agency under Florida regulations is authorized to hire home health aides to provide personal care such as bathing, dressing, grooming, toileting and incontinence care. The same home health aide may also do the grocery shopping, cooking, ironing, housekeeping, escort services, and companionship. A home health aide is either a Certified Nursing Assistant who has had specialized training to assist patients within the home or people who have had 40 to 75 hours of specialized training to provide home health assistance to patients within the home. Home health aides in Florida are required to have training in areas such as the prevention of skin breakdown, caring for patients with Alzheimers disease or dementia, infection control measures, fall prevention, and caring for seniors with hearing loss or vision loss. Home health aides are also limited in the scope of their practice. For example they are not trained to do wound care or give injections or do blood glucose checks and are not permitted under Florida law to do so. The services which home health aides provide are custodial care services.
A Home Health Agency may provide skilled nursing services to assist patients with things like medication management, wound care and the management of diabetes etc. Nurses are trained to assess patients health status and in doing something like wound care a nurse is able to assess the wound for signs or symptoms of infection or non- response to care. Home Health Agencies include Private Duty Home Health Agencies, Nurse Registries, and Home Health Agencies which are paid through Medicare or Major Medical Insurance. Private Duty Home Care Agencies provide services which are for the most part paid for directly by the patient. Some patients have Long Term Care Insurance which will pay for home care services. A Private Duty Home Care Agency hires home health aides and nurses who are employees and who are supervised by the agency directly. The agency is responsible for the employee taxes, any injury which the employee may have on the job, the patient's liability, and the employee is bonded through the agency. Florida law requires that background screening is done for each employee every two years and that the employee has references from former employers. Nurse Registries find home health aides and nurses who are then hired by the patient. The patient is then responsible to supervise their own care and monitor the performance of the home health aide or nurse. Nurse Registries also provide services which are paid for by the patient directly. The patient as the employer is ultimately responsible for the employee taxes and liability. The Florida Agency for Health Care Administration conducts oversight audits over Private Duty Agencies and Nurse Registries every two years.
Home Health Agencies which receive funding through patients major medical insurance for the most part provide skilled nursing services. These companies are usually monitored and audited by national accrediting agencies. Sometimes I have a client or family member tell me that their Major Medical Insurance will provide for a Home Health Aide to assist in bathing and grooming. This is true for as long as the patient has a need for skilled nursing in the home. When there is no longer a need for a skilled nurse the insurance company will not cover the home health aide. Insurance will not cover custodial care service with no skilled care in the home.
Home Health agencies which receive funding through Medicare for the most part provide skilled nursing care as well. Some home care agencies provide both Medicare covered services and Major Medical Insurance covered services. A Medicare funded agency is regulated under federal guidelines usually through a national accrediting agency. Medicare will not cover custodial care as well. Which do you choose? I always advise clients to have Medicare pay for what Medicare will pay for. Then if the patient has major medical insurance and needs skilled nursing arrange for home health care with a company who can accept major medical insurance. Ask your insurance company who is a preferred provider in your area. If you need only custodial care, does your mom or dad have Long Term Care Insurance? I have had children arrange for custodial care for their parents and then find out months later that their parents have Long Term Care Insurance which would have paid for services! If you are looking for a Private Duty Home Health Agency or Nurse Registry you should ask for a copy of the state license and for references. Companion Agencies also provide a wonderful service for seniors for a limited time. You should ask for the agency state registration with the Agency for Health Care Administration, ask how the employee taxes are withheld and a copy of their liability insurance and workers compensation declaration page. Home care agencies can assist your loved ones to stay in their homes safely and in good health for much longer than they would without the support they need.
At any level of care if at all possible make a personal visit to the agency offices. When visiting the office of an agency look at how well organized the office is. Does the office appear to be a vital place of business? Consider how professional an agency deals with you. If you are hiring a company does the company representative ask you a series of questions regarding your specific needs before quoting you a price for services, or do they just quote you a price? Although cost is always important - Be very aware of low prices. Unlike milk or gasoline, good human resources are a rare commodity.
Carol S. Howland, R. N. is the owner of Comfort Keepers in Clearwater, Palm Harbor, Oldsmar, Florida which is a Private Duty Home Health Agency providing custodial care services and Comfort Staffing home health in Clearwater, Florida which is a Home Health Agency providing skilled nursing. For more information and our free offer Link to comfortkeepers.com/caregivers/115 comfortkeepers.com/caregivers/115
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