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What is Home Health Care?
Increasing numbers of patients need continuing professional medical services when they return home. Professional home health care services includes a broad range of care and support services for those who are recovering from a hospital stay, who are disabled, chronically- or terminally-ill, and need medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Home care services are typically provided by home care organizations. There are a variety of home care organizations, including Medicare certified home health care agencies, Visiting Nurse Agencies (VNAs); hospices; area agencies on aging, homemaker agencies; staff and private duty nursing agencies. Other companies may be utilized to deliver specialized services and products such as medical equipment and supplies, pharmaceuticals, and drug infusion therapy.
Home health care agencies or Visiting Nurse Agencies (VNAs) care for patients of all ages, from infants to the elderly. They offer comprehensive services from maternal/child health programs to hospice care (link to hospice page). These services can include, but are not limited to the following:
  • Skilled nursing
  • Rehabilitation therapies: physical, occupational & speech-language
  • Medical social services and counseling
  • Case management
  • Home health aide services
VNAs can also offer specialized home health care such as:
  • Parental and enteral nutritional therapy
  • Infusion therapy
  • Behavioral and mental health counseling
  • Hospice and palliative care
  • Telemedicine
  • Vaccination
  • Home medical equipment
  • Educational advice
  • Wound care
  • Pain management
  • Home safety instructions
In addition to home care, VNAs provide an array of health promotion services and act as health educators in community settings. Community services include:
  • Immunization clinics: influenza, pneumonia, hepatitis A & B
  • Senior wellness programs
  • Adult day care centers
  • Meals-on-Wheels programs
  • Prevention: influenza treatments, vaccine education, etc.
  • School wellness programs
  • Travel health programs
  • Support groups for patients and families dealing with Alzheimer's, Cancer, HIV/AIDS, etc.
Who needs home health care?
  • Older Americans who have health problems, but who want to maintain their independence in their homes with the support of a professional caregiver.
  • Patients of all ages who return home after surgery, and need care, supervision or assistance.
  • Patients who have complex treatments that require use of medical equipment and/or medication monitoring. 
  • Mothers and newborns, home from the hospital after 24 or 48 hours who are in need of further education, support and clinical assessment skills of a trained nurse.
  • Young adults, recovering from accidents or injuries, who can manage on their own - if they know an experienced healthcare worker will be there when needed. 
  • Mentally ill adults who need support to remain in the mainstream of their community
  • Adults who want their parents to have quality care at home. 
  • And millions of Americans with chronic diseases and disabilities, like Alzheimer's, heart failure, kidney disease, or diabetes, who need careful monitoring but do not want or need to enter a nursing home or skilled care facility.
Selecting a Home Health Care Provider
There are many important factors to consider in choosing the best agency to meet your needs, most important of which is to assess what types of services you or your loved one will need.

If you chose a nonprofit home health care or VNA agency, then you receive care regardless of your complexity of condition or ability to pay. Nonprofit home health care agencies also provide a variety of community-benefits and by using them you are also giving back to your community.

When selecting an agency, it is important to ask the appropriate questions during your initial meeting. Below is a list of sample questions:
  • How many years has the agency been serving your community?
  • Does the agency offer printed material describing its services and costs? (i.e. brochures, flyers)
  • Is the agency an approved Medicare provider?
  • Is the agency accredited? In other words, has their quality of care been surveyed and approved by an outside accrediting organization (such as CHAP, JCAHO or Medicare)?
  • Is the agency licensed by your state (if required)?
  • Does the agency provide patients with a "Bill of Rights" that outlines the rights and responsibilities of the agency, patient, and caregiver alike?
  • Is there a written plan of care for the patient's treatment that the patient, physician and family participate in developing?
  • Is this plan updated over the course of the treatment?
  • Does the patient get a copy of the plan?
  • Does the agency staff educate the family members on the care being administered to the patient and ways they can assist?
  • Is the patient's course of treatment documented, detailing the specific tasks to be carried out by each professional? (i.e. medicines, exercises, daily activities)
  • Are supervisors assigned to oversee care to ensure that the patient receive quality treatment?
  • Are agency caregivers available seven days a week?
  • Does the agency have a nursing supervisor on call and available 24 hours a day?
  • Does the agency ensure patient confidentiality? How?
  • How are agency employees hired and trained?
  • Does the agency require criminal record background checks and communicable disease screens for its employees?
  • What is the procedure for resolving issues that may arise between the patient/family and home healthcare staff?
  • Who can you call with questions or complaints regarding patient care, caretaker issues or general questions?
  • What happens if a staff member fails to make a scheduled visit?
  • What should the patient do in this situation?
  • Who does the agency call if the agency caretaker cannot come when scheduled? (i.e. patient or family member)
  • What is the agency caretaker required to do? (i.e. inform patient, reschedule)
  • How does the agency handle billing? (i.e., will I be billed for services?)
  • Will the agency provide a list of references?
Questions to ask references for the home health care agency and/or caretaker?
  • Do you frequently refer patients to this agency?
  • (To a physician) Are your patients satisfied with the services?
  • Do you have a contractual arrangement with this agency? If so, are they required to meet special standards of care?
  • How long have you been working with this particular agency/caretaker?
  • What are some of the strengths and weaknesses of the agency/caretaker that you noticed?
If you purchase home healthcare services from an individual rather than through an agency, it is important to screen the individual person(s) providing the scheduled care. Interview the caregiver to be sure he or she is qualified for the job. It is helpful to ask for references, as well as, to have a list of required tasks the caretaker may have to perform with the patient (i.e. getting in and out of a wheelchair, bathing, administering specific types of medicine). This way you know that he or she can indeed perform these tasks.

Who is a Caregiver?
A caregiver assists an older relative or friend who has physical or mental impairment. The surviving spouse or common-law partner is often the primary caregiver; however, others, including adult children, neighbors or friends may also qualify as primary caregivers in some cases.

Some examples are taking someone to the doctor or shopping; assisting him or her with bill-paying; providing emotional support; and/or assisting with bathing or dressing. You do not have to be living with the person or providing 24-hour care to be considered a caregiver. 

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