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Hiring Someone to Help With Home Care

Finding an agency, costs, and questions to ask

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Most questions about family caregiving can't be answered with a simple yes or no. But the question of whether home care agencies are all alike is one of the few that can.

And the answer is a definite no.

Here's some information you'll need if you're considering using an agency to help you find in-home help.

First, you should know there are two basic kinds of home-care services that Medicare and other insurers cover: skilled care, which is provided by a health care professional, primarily a nurse, therapist (physical, occupational or speech) or social worker; and personal care, such as help with bathing, grooming or other such tasks, provided by home health aides, also called personal care workers or attendants.

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Second, you should also be aware that Medicare only pays for a home care worker — skilled or personal — for a short period, typically following a hospital stay. To qualify a patient for Medicare coverage, a doctor will have to verify that the patient is homebound and needs part-time help. If the patient qualifies for skilled care, the Department of Health & Human Services booklet "Medicare and Home Health Care" (PDF) can help you determine whether he or she can also qualify for personal care. Medicare does not cover just personal care, if this is the only care the patient needs. Medicaid, the benefit for lower-income people, does cover some home care for longer periods of time, but coverage varies from state to state. Private insurance generally follows Medicare guidelines.

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These are the various kinds of agencies you may encounter:

Medicare-Certified Home Health Agency (CHHA)

These agencies are certified to provide skilled services by Medicare and Medicaid and are licensed by the state. Medicare will only pay for those services provided through a Medicare-certified agency. These agencies may also provide personal care through their own home health aides or through another agency, usually a licensed agency, with which they have a contract.

Licensed Home Care Agency

This type of agency is licensed by the state and can provide nursing and personal care services. Some provide long-term personal care to patients through contracts with Medicaid. Most services, however, are paid for by the patient or the family.

Non-medical or Companion Agency

These agencies are not licensed, and their services are not covered by insurance. Companion or home helper services include keeping the person company and doing chores like picking up prescriptions from the pharmacy. Workers have varying levels of experience and training. Frequently these agencies are small, locally run businesses that are franchises of large, national companies.

Employment or Registry Agency

These agencies provide names of available nurses and aides. You contact and pay the person directly. Your state may also maintain a registry through its department of health. Or you can ask friends and neighbors for recommendations. Hiring on your own can work well but also carries additional responsibilities for financial management, supervision and arranging backup.

Many family caregivers do not investigate home care agencies until there is a crisis like a fall or an unexpectedly short hospital stay. Even in these situations, you should ask questions about the agency before you sign an agreement. "Medicare and Home Health Care" mentioned above includes a helpful checklist with questions you should ask when you are contacting various agencies. Be especially careful to find out how the agency screens, trains and supervises home care workers. Ask about the agency's rules for what aides can and cannot do.

Establishing a set of "house rules" that respect both your family member's privacy and your own, as well as the home care worker's needs, will help create a good working relationship.

You can find general quality comparisons of Medicare-certified agencies in your area at Medicare's Home Health Compare website. This site won't tell you about important aspects of care such as workers' reliability and communication skills, but it may help you to narrow down the choices.

For another source of information, visit United Hospital Fund's Next Step in Care website, particularly its For Family Caregivers page.

Bringing someone into your home or your family member's home can help to ease the burden on you. But in order to choose the right home care agency for your family member's needs, you will need to do the research to ensure you have reliable information on your options, including how to manage the type and duration of the services that will be provided, as well as the costs.

Also of interest: Understanding long-term care insurance.

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Long-term care expert Elinor Ginzler discusses choosing an agency for in-home care of a loved one.

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