Home care is a wide range of health and social services delivered at home to persons recovering from an illness or injury, or persons who are disabled and/or chronically ill. Agencies who deliver such care are generally known as “home health agencies.”

They provide “skilled services” such as nursing, social services and therapeutic treatments (physical, speech and occupational therapy). They also provide non-skilled services like help with bathing, dressing and eating. Medical equipment such as wheelchairs, walkers and oxygen may also be provided.

Home health services can be purchased privately by an individual expending his/her own funds; private health insurance may cover home health services; they can be paid for by Medicare and Medicaid. As with any insurance, coverage of certain benefits will vary and it is best to check your benefits when deciding on care options.

– Helps reduce medical costs without loss of quality.
– Allows patients to remain in their homes, proud and independent.
– Allows for early discharge from hospitals and prevents/postpones care in a long term facilities.
– Can be personalized to meet the needs of each individual.
– Patients remain connected to healthcare providers, which allows them to feel confident in the quality and continuity of care, while they are also independent at home.
– Physicians find many patients recover sooner and more comfortably in the familiar surroundings of their home than they do in a hospital.

Home health agencies can be for-profit or not-for-profit. They may be operated by hospitals or even local health agencies, such as county nursing services or local health departments.

Certified Home Health Agencies

It is recommended to consider choosing a “certified” home health agency, even if you are not eligible for Medicare or Medicaid. If you are on Medicare or Medicaid, you can only use a certified agency. Certified agencies provide safeguards because they meet specific standards established by the federal government and are monitored by the state through the Colorado Department of Public Health and Environment’s Health Facilities and Emergency Medical Services Division.

Medicare/Medicaid Recipients: Eligibility for Home Health Services

Medicare and Medicaid’s home health benefit allows people with restricted mobility to receive needed care at home. Services and supplies are provided by nurses, aides and therapists under a physician’s plan of care.

Medicare will pay for home health services if your physician certifies that you:

• Are homebound — i.e. confined to home except for infrequent or short absences or trips for medical care, and
• Require one or more of the following services: physical therapy, speech-language pathology, or skilled nursing.

If you need only personal or custodial (non-skilled) care, you do not qualify for the Medicare home health benefit.

If you have Medicaid, you may be eligible for both skilled and non-skilled services. To find out more about Medicaid home health benefits, phone your local county department of Social Services or the Colorado Department of Health Care Policy and Financing at 303-866-3864.

Medicare is a federal government-sponsored healthcare program primarily for seniors. Medicaid is healthcare for low-income families and is managed by both the state and federal governments. Medicare and Medicaid differ in terms of who they cover, how they are funded and governed.

Information about home health agencies

Hospital Discharge Planners or Health Plans: If you are leaving the hospital and need home care, your doctor, the hospital discharge planner or a social worker can help you choose an appropriate agency. Your health plan may require you to use certain agencies.

Health Department Information: The Health Facilities and Emergency Medical Services Division has complete lists of all certified home health agencies in Colorado. The department’s files, which contain survey results and summaries of complaint investigations, are available for your review at the division at 4300 Cherry Creek Drive.

Questions to Ask When Choosing An Agency:

1. a) Is the agency certified?
2. b) How long has it provided care in your area?
3. c) Has it provided care for people with needs similar to yours?
4. d) Can you contact the agency after hours?
5. e) Will it provide references from others who are familiar with its services?
6. f) Does it provide the client with a care plan that specifies what services will be provided and by whom?

Are the people who provide services licensed to do so?

Does it check references and do criminal background checks before hiring employees?

What to expect with a certified home health agency

Anyone from the agency is a guest in your home. You and your property should be treated with respect.

On the first visit, you should receive, as part of your admissions packet, a written notice of your rights. The state’s Home Health Hotline number should also be disclosed at that time.

On the first visit, a registered nurse will evaluate you and develop a care plan. You have the right to participate in planning your care and to be informed in advance when changes to your care plan are made.

Before services start, you should be advised about the extent to which Medicare and Medicaid will pay for services and which services you may likely have to pay for yourself.

The agency should inform you about advance directives and your right to specify how you want medical decisions to be made, should you become ill and unable to make such decisions.

The agency must observe confidentiality regarding your medical records.

Remember, the agency is responsible for all of the care that you receive, from their employees, or from others they may contract with to provide your care.

Essential Medical Services is an agency that provides both Medical and Non-Medical Services.

Medical: Skilled services provided by medical home health agencies offer nursing care, physical, occupational, speech, and respiratory therapy as well as social services and hospice care. Following a specific plan of care, and under the supervision of a skilled discipline such as a nurse or therapist, a certified home health aide may provide personal care for a limited time. These skilled services are provided on an intermittent basis, with scheduled home visits to homebound clients only, under a plan of treatment ordered by a physician.

Non-Medical: Supportive services, provided by non-medical home care agencies, offer assistance with personal care such as bathing, grooming, dressing, in addition, to help with meal preparation, housekeeping, and shopping. Assistance with self-administered medications, ambulation and exercises, and transportation to medical appointments. These supportive services can be arranged for any amount of time needed including up to 24/7 or on a respite or temporary basis.