Let’s start with the term home healthcare first. Home healthcare is provided by home health agencies usually Medicare certified, state licensed and often accredited by an accreditation organization. Home healthcare agencies provide medical care in the home environment under the direction of a physician who orders care to be performed by licensed healthcare professionals. Typically these medical care programs help the patient recover from an illness, injury, disease or exacerbation of a chronic condition and includes services such as wound care, infusions, invasive catheter care, assessments, patient/caregiver teaching, medication management and administration of complex meds like injections as well as in home rehabilitation for those that are homebound. Medicare will pay for these services under the Part A benefit however the services must be provided by:
- Nursing - RN and LPN
- Therapy - Physical, Occupational and Speech-Language Pathologist
- Social Work – MSW
Homecare is typically provided by residential care agencies that are state licensed and provide non-medical care also known as personal care service in the home environment under the direction of a licensed Registered Nurse (RN). The RN will develop a care plan for the individual requiring help in the home on a day to day basis. These programs tend to focus on the long term care needs of a patient and are considered alternative options to nursing homes. The intent of the personal care program is to keep the individual safely in the community for as long as possible. Personal care services typically consist of assistance with Activities of Daily Living (ADLs) including: bathing, dressing, grooming, shaving, medication reminders, feeding/meal preparation, toileting, linen changes, laundry and other activities to keep the patient in the home. Until recently Medicare did not cover this service but starting in 2016 this type of care will be covered. For more information visit the CLASS act that was included in the healthcare reform law. Many Elderly and Disabled Waiver programs under the Medicaid benefit will cover these services and the service must be provided by:
- CNA, Certified Nursing Assistant/Certified Nurses Aide
- HHA, Home Health Aide
- PCA - Personal Care Aide
- DCA – Direct Care Aide
It is important to recognize that a CNA or home health aide is not the same thing as a “nurse”. Often patients and even the aides will refer to themselves as nurses. Remember CNA/Home health aides do not have the same level of education, experience or training of a nurse nor do they take the same licensure exam or carry the same license as a registered nurse or licensed practical/vocational nurse carries. When you are shopping for in home services be sure that you are asking for the right type of personnel for the type of care needed.
Last there has been a significant increase in concierge homemaker care programs with the recent growth in the aging population. These agencies offer non-medical, no touch services which are typically provided under the direction of a non-licensed individual who develops client service plans for clients who wish to receive companion or homemaker services. Most agency requirements for a companion are a high school education or GED and the individual must be able to provide services like reading, transportation, conversation and socializing, activities and games, meal preparation, laundry, and light house keeping. Typically these services are paid out of pocket by the client or family as Medicare and Medicaid will not pay for these type of services. However I have experienced on occasion local social service agencies as well as local Veterans Affairs (VA) programs pay for these services on a limited basis up to 2 - 4 hours per week. Family members should be mindful that when their loved one "the client" starts requiring hands on service such as assistance with toileting, bathing or grooming, the individual should consider moving into a personal care program as home health aides have been trained and are more fully equipped to provide the more intensive hands on service.