Right Choice Index

Page Contents

What is it?

Who provides it?

Finding qualified services

What does it cost?

What else can you do?

Site Contents

Patients & visitors

Medical professionals

Yale-New Haven
Children's Hospital

Yale-New Haven
Psychiatric Hospital

General information

Calendar

Online resource

Press information

Phone Numbers

Directory assistance
(203) 688-4242

Patient Information
(203) 688-4177

Adult emergency
(203) 688-2222

Children's emergency
(203) 688-3333

Admitting
(203) 688-2221

Children's admitting
(203) 688-3331

Psychiatric admitting
(203) 688-9907


Mailing address:

Yale-New Haven Hospital
20 York Street
New Haven, CT 06510-3202

Getting the most out of home health care

A growing number of people are looking at home health care as an alternative to nursing home care for the elderly, the chronically ill or the disabled. There are several good reasons to do so. Studies show that home-based health care costs less than institutional health care, gives more satisfaction to those who receive it because they can remain in familiar surroundings, and often results in fewer and shorter hospital stays. As interest in home-based health care increases, the need also grows for information about what services are offered, who pays for them, and how to find qualified home health providers.

What is home health care?

Home health care is medical support or personal care provided at home on either a long-term or short-term basis. Some conditions in which home health care would apply include:

• recent hospitalization or surgery
• high-risk pregnancy
• newborn with medical complications.
• alternative to nursing home care for the elderly or disabled
• chronic or deteriorating condition (asthma, congestive heart failure, kidney failure)

Home health care can also be used to give family caregivers time to recoup their energy after extended time caring for someone who is ill or disabled.

Who provides home health care?

Home health care may involve the services of a registered nurse, nutritionist, physical therapist, speech/language therapist, occupational therapist or social worker. Medical services may include wound care, ostomy management, dialysis, physical therapy, IV therapy, blood pressure checks or glucose monitoring. Keep in mind, however, that because a service can be performed at home does not necessarily mean your insurance plan will cover it. For more on this topic, see "What does home care cost?" further in this issue.

You may also receive help from a home health aide or companion. Home health aides provide nonmedical services such as help with bathing, grooming, getting in and out of bed, preparing meals and performing light housekeeping. Companions are nonmedical assistants who are hired to keep you company and take you to and from doctor's appointments when needed. Although companion services are growing, this area of home-based care is relatively new and unregulated, so be very careful to qualify any agency you select.

Finding qualified services

If you are considering home health care, keep your physician involved. Health insurance plans that cover home-based care (including Medicare and Medicaid) require a physician's orders before they will pay for covered services. If you wish to supplement physician-ordered services on your own, for example, by hiring a private duty nurse, it's best to hire someone from an agency recommended by your local hospital or state Department of Social Services (in Connecticut: 1-800-994-9422). The home care agency can perform important functions for you such as verifying credentials, checking references, conducting a background check and drug test, and arranging for a substitute or replacement so that your care is not interrupted.

Once you have the names of qualified agencies, you may want to check how they compare to other home care providers in your state by logging onto www.medicare.gov. Introduced in November 2003, this web site reports on Medicare-certified agencies and how well they accomplish tasks such as helping patients improve dressing, bathing or walking skills. The reports do not cover all aspects of home care services, but can be used in conjunction with other sources of information about the agency. When you are ready to contact a home health agency, here are some helpful questions to ask:

1. What accreditations does the agency have? An agency may be accredited by the Joint Commission for the Accreditation of Health Organizations (JCAHO) or by the Community Health Accreditation Program (CHAP). Both have rigorous standards and review processes.
2. What are the agency's hiring standards (e.g. background checks, drug tests, etc.)?
3. How does the agency monitor the quality of care for the services it offers?
4. What fees are charged? Are additional fees charged for extra services such as transportation, caring for two persons in the same household, or working evenings, weekends or holidays?
5. If services are to be covered by Medicare, is the agency Medicare-certified (approved to bill and accept payments from Medicare)?
6. If you are paying on your own, how often will the agency bill you? Does the agency offer a sliding fee scale for patients in financial need? Will they set up a payment plan?
7. Does the agency have a back-up procedure to assure that care is not interrupted?
8. What are the agency's problem resolution procedures?

Tips:

• If you are hospitalized, bring up the subject of home health care with staff as early as possible. Waiting until you are ready to leave the hospital may not give you enough time to make the arrangements you need. A referral for home care can often be accommodated on a same-day basis, but sometimes it may require at least 24 hours. An initial call for physical therapy may take up to 48 hours.
• When you receive home-based nursing care, the nurse will encourage you to learn some of the procedures. Take advantage of this opportunity or if you are unable to perform the procedure, ask a trusted person to do it for you. This way you have a back-up plan when your insurance coverage expires or something prevents the home care professional from making a scheduled visit.
• When not prepared adequately, older people often resent and resist those who are hired to help them. Share your concerns with them and if possible, involve the elderly person in the planning process before the health care provider comes into the home.
• If you have arranged services for someone else, stop by at unscheduled times to see if duties are being carried out as expected. The person receiving care may be reluctant to complain or may not know what services are expected, so count on your own observations.

What does home care cost?

Here is an example of some of the fees you may encounter for home health services:

* Figures are accurate as of October 2003. Source: Visiting Nurse Association of South Central Connecticut, Inc. and CareSource, its private duty affiliate.

Your health insurance plan, Medicare or Medicaid may cover some of your home-based health services. You must pay for any services that exceed your insurance coverage or that you arrange on your own.

• Medicare
  Home-based health care services covered by Medicare include skilled nursing care, therapy (speech/language, occupational, physical) and part of the cost for renting medical equipment such as wheelchairs, walkers or oxygen equipment. Personal care may be covered by Medicare if you are also receiving skilled nursing care or therapy at home. To find out about Medicare's guidelines for covering home health services, call Medicare toll-free at 1-800-633-4227. If you are in the Original Medicare Plan, you can also contact your Regional Home Health Intermediary (in Connecticut, 1-888-896-4997). For Medicare-approved suppliers of durable medical equipment, call 1-800-842-2052. You can also check the "Helpful Contacts" section on Medicare's Web site, www.medicare.gov.
• Medicaid
  Medicaid covers at-home health services for those who meet certain income and asset guidelines. Some of the services that may be covered are outpatient hospital services (therapies administered at home are considered outpatient services), skilled nursing care and transportation. For information about Medicaid coverage in your state, call the Medicaid office at your state Department of Social Services (in Connecticut, 1-800-385-4052).
• State Programs
  In Connecticut, the Department of Social Services' Home Care Program for Elders pays for home-based services for seniors who are either eligible for Medicaid or nearly eligible in terms of income and assets. The Home Care Program pays for nonmedical services such as a homemaker or companion, home-delivered meals or, if funds are available, minor safety modifications to the home such as installing an emergency response system. Call 1-800-445-5394 toll-free to find out if you qualify for services and to ask for an at-home assessment.
• Veterans
  Veterans who have had at least 90 days of wartime duty qualify for temporary financial assistance when they are ill from the Veterans' Administration's Soldiers, Sailors and Marines Fund. Covered services may include medical supplies, homemaker services, a home health aide or respite care for family members who care for veterans at home.

What else can you do?

• Arrange for Meals on Wheels
  Volunteers deliver two meals daily, a hot noon meal and a cold meal for later in the day, five days a week. Fees are based on income. To find local chapters, contact you state department on aging. To search by Internet, visit www.mowaa.org and click on "Search for a Program" for alphabetical listings in each state.
• Order catalogs on specialty clothing
  Specially designed clothing or simple devices to make dressing and grooming easier for people with age related disabilities are available by catalog. To find out where to get catalogs, call your state department on aging, the physical therapy department of your local hospital or use the online catalog at www.eldercorner.com.
• Take steps to prevent accidents at home
  Making the home safer for an ailing family member may be as simple as making sure hallways and pathways around the house are well lit and rugs have non-skid backing. The Center for Disease Control's "Check for Safety" program includes simple steps to take throughout the home to prevent slips and falls. To request a free copy, call Yale-New Haven Hospital toll free at 1-888-700-6543.
• Buy “assistive” devices for your home
  The New England Assistive Technology Marketplace (NEAT) has a large inventory of preowned assistive devices that have been sterilized and reconditioned for sale to consumers at discounts up to 50 percent or more. The inventory changes regularly but may include items such as shower and bath chairs, commodes, grab bars, electric hospital beds, etc.

This publication was jointly developed by Yale-New Haven Hospital and the Visiting Nurse Association of South Central Connecticut, Inc., 203-777-5521 or www.vnascc.org.

Last revised: April 23, 2004 (cfs)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.