Home health care agencies - services, costs and selection

What it is

A home health care agency provides services that require a licensed professional - for instance, a registered nurse, physical, respiratory or occupational therapist - and a physician's prescription. These services can involve long-term or temporary care, as in the case of a person recovering from surgery or other health issues. A home health care agency will send a licensed professional to assess home health care needs and develop a complete home health care plan.

A home health care agency employs the healthcare professionals sent to the home and must be licensed by the state. Many seek additional accreditation to assure consumers that they have met quality standards. Two common accreditations are Accreditation Commission for Health Care (ACHC) and The Joint Commission (TJC).

What’s the cost and is it covered?

The average hourly rate for a licensed home health aide is $19 per hour and ranges from $12–$38 per hour, depending on where in the country the services are offered. Medicare does not cover all forms of home health care, so be sure when you interview an agency to ask whether they are certified by Medicare and what services are covered given your circumstances. Long term care insurance and Medigap plans may also cover some costs of a home health aide; check with the long term care insurance providers to find out.

How to find a home health care agency

Home health care agencies can be found in the phone book or online under Home Health or Home Health Care. Whenever anyone on Medicare is discharged from a hospital and is prescribed home health care services (for example, physical therapy following a hip fracture), a hospital social worker or case manager will present the individual with a list of Medicare-certified agencies to consider. When you find an agency, make sure it has been certified by Medicare, so that if the services qualify, Medicare will cover some or all of the costs for a designated period of time. Medicare certification also means the agency has met federal minimum requirements for quality patient care and management.

Be sure to find out whether the agency you use actually employs the caregiver or if it is a registry. A registry will refer, match or place a home health care worker in your home, but the worker is not an employee of the agency. Because registries do not employ the caregiver, it means that the caregiver often acts as a 1099-contract labor employee and that you are responsible for reporting this payment to the IRS as part of your income tax return. Depending upon your arrangement with the agency, you may also be responsible for employment tax withholdings. Some registries provide Workers' Compensation coverage, but make sure you know the extent of the coverage to ensure that the caregiver is appropriately covered while working for you or you may be responsible for obtaining appropriate insurance coverage.

You can look up how well a home health care agency performs by going to Medicare’s Home Health Compare tool. If you cannot go online, call 1.800.MEDICARE.

What to ask

When you interview a home health care agency, there are a number of important questions to ask:

Are you certified by Medicare?
Do you have any accreditations from professional organizations? If so, please tell me about them.
Are the workers you send your full-time employees or are you a registry?
What type of background checks do you conduct on your employees?
If the worker does not show up when scheduled, will you send a replacement immediately?
What type of progress reports can I expect from each type of professional providing care?
Are you licensed by the state?
Will you send a replacement if the worker is not compatible with the person receiving care?
What can I expect to pay, if services are not covered by Medicare, Medigap, Medicaid or a long-term care insurance policy?
Whom do I speak to regarding care status?
How do we appeal to Medicare if we think more care is needed?
Do you handle claims to Medicare?
Can you put me in touch with someone who has used your services?

The bottom line

A home health care agency provides the services of licensed health care professionals who treat people on a long- or short-term basis at home. In order to access services, you must obtain a physician’s prescription.
A home health care worker can provide temporary rehabilitation care at home or ongoing medical treatment, including nursing care, occupational, respiratory or physical therapy.
If the home health care agency has been certified by Medicare, some of the costs may be covered. Long-term care insurance and Medigap plans may also cover some services. In either case, ask about your specific needs to be sure.
Web resources for further research: To find Medicare-certified agencies nearest you and to determine the level of quality performed, go to medicare.gov, click the Resource Locator and then choose Home Health Agencies. Or you can call Medicare at 1.800.MEDICARE. Also, the National Association of Home and Hospice Care at nahc.org offers a list of member agencies nearest you with details on their Medicare-certification, accreditation status and contact information.