Guide to Choosing a Home Health Care Provider

by Ryan Miller

What is Post-Acute Care

Post-acute care is all the health-related services that patients receive after, or in some cases instead of, care at the doctor’s office or hospital.

Types of Post-Acute Care

Home Health Care – agencies that send medical professionals to patients’ homes so patients can receive skilled nursing and rehabilitation without going to a hospital or residential facility. Common services provided through home health care are wound care, physical therapy, and injections.
Skilled Nursing Facilities – short-term residential healthcare locations for patients who no longer need to be in a hospital but require a higher level of medical care than can be provided at home. Common services provided at a skilled nursing facility include physical/occupational rehabilitation, speech and language therapy, and complex wound care.
In-Patient Rehabilitation Facilities – residential healthcare locations that provide intensive hospital-level care for patients with complex conditions such as spinal cord diseases or traumatic brain injuries. Common services provided through inpatient rehabilitation facilities include physical therapy and stroke rehabilitation.
Long Term Care Hospitals – long-term residential locations that offer the same level of round-the-clock care as traditional hospitals or intensive care units, but over a longer period of time (usually a month). Common services provided at long term care hospitals include ventilator care, intravenous (IV) therapy, and dialysis.

More Details About Home Health Care

Home health care (also referred to as home care, domiciliary care, social care, or custodial care) is supportive care provided in the home. This care may be provided by licensed healthcare professionals who provide medical treatment or by professional caregivers who provide daily assistance to ensure the activities of daily living are met. These caregivers and professionals are usually supplied by a home health agency.

What is the difference between home health care and home care?

Home health care is often confused with non-medical home health care, more commonly known as home care. Home health care services are medical in nature and assist patients recover after a hospital stay or illness. Home care services, on the other hand, are non-medical in nature and are typically used on an ongoing basis to support aging individuals complete day-to-day tasks in their own home.

Examples of non-medical home care services:

Meal preparation
House cleaning
Helping dressing, bathing and grooming
Transportation
Reminders to take medicine
Help with bill paying

Examples of medical home health care services:

Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status
Therapy and skilled nursing services

How to Start Your Home Health Care Search and What To Look For

Understand Your Medical Needs
- Meet with a medical professional to make sure that home health care is the best follow up care option for you or your loved one.
- Home health care is the best fit for patients who require follow-up care that is medical in nature but can still be provided in the home setting
- If the patient does not have any significant medical needs and instead requires custodial care, non-medical home care is more appropriate that home health care.
- If the patient has a specific medical need (diabetes, chronic disease, wound care, etc.), you can narrow down your search by evaluating home health agencies based on what specialty care they can provide.
Verify Your Insurance Coverage
- Using repisodic, you can search home health agencies in your insurance network by geographic region and compare the facilities based on photos, patient reviews, and Medicare quality data.
- The insurance verification is simple to complete and does not require any sensitive personal information.
Compare Facilities Based on Quality Measures
- Different qualities to compare are how often the home health team began their patients’ care in a timely manner, how often patients got better at walking or moving around, how often patients’ wounds improved or healed after an operation, and what percent of patients who would definitely recommend this home health agency to friends and family.
- repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.
Talk to the Agency and Staff
- You have the right to choose a home health agency that gives you the care and services you need. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency.
- Ask the agency how different situations are handled and how the patient care plan and needs will be addressed with their services. Below is a checklist of common and important questions to ask when choosing a home health agency.

Things to Consider when Choosing a Home Health Agency

Before you start your care:

Medicare/Medicaid certification
Offers the specific health care services I need, like skilled nursing services or physical therapy?
Meets my special needs, like language or cultural preferences?
Offers the personal care services I need, like help bathing, dressing, and using the bathroom?
Offers the support services I need, or can help me arrange for additional services, like a meal delivery service, that I may need?
Has staff that can provide the type and hours of care my doctor ordered and start when I need them?
Is recommended by my hospital discharge planner, doctor, or social worker?
Has staff available at night and on weekends for emergencies?
Explained what my insurance will cover and what I must pay out-of-pocket?
Has letters from satisfied patients, family members, and doctors that testify to the home health agency providing good care?

After you start your care:

The staff is polite and treats me, and my family members, with respect.
The staff explains my plan of care to me and my family, lets us participate in creating the plan of care, and lets us know ahead of time of any changes.
The staff are properly trained and licensed to perform the type of health care I need.
The agency explains what to do if I have a problem with the staff or the care I am getting.
The agency responds quickly to my requests.
The staff checks my physical and emotional status at each visit.
The staff respond quickly to changes in my health or behavior.
My home is checked and suggestions are made to meet my special needs and to ensure my safety.
The staff have told me what to do if I have an emergency.
My privacy is protected.

Paying for Home Health Care

When selecting a home health agency, it’s important to consider your payment options and understand what your insurance policy will and will not cover. There are three main types of insurance policies that provide varying degrees of coverage with regards to home health care.

Medicare

If you have Medicare, you can get home health care benefits if you meet all the following conditions:
- Your doctor must decide that you need medical care at home, and make a plan for your care at home
- You must need at least one of the following: intermittent skilled nursing care, or physical therapy or speech-language therapy, or continue to need occupational therapy
- You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort.
- The home health agency caring for you must be approved by the Medicare program (Medicare-certified)
If you meet all four of the conditions above for home health care, Medicare will cover
- Skilled nursing care on a part-time or intermittent basis by a licensed nurse
- Non-medical home health aide services on a part-time or intermittent basis to provides services that give additional support to the nurse, such as bathing, using the toilet, or dressing

Medicare Advantage

Patients who are covered under a Medicare Advantage Plan instead of the traditional Medicare plan will have policies and coverage very similar to the Medicare coverage policies described above.

Private, Commercial, and Employer Sponsored Insurance

These plans vary widely in their coverage and policies for home health care. The majority of plans typically provide some sort of coverage for intermittent home care if the services are necessary following a hospital stay or illness.
Private insurance companies will usually only pay for home health care through agencies that are considered “in-network.” Some policies will cover services from providers that are “out-of-network,” but they usually do not cover as much of the cost and can leave patients with additional out-of-pocket costs. For this reason, it is imperative that patients verify if a home health agency is part of their insurance network.

Remember, health insurance payment options and programs that cover home health care services are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for. repisodic encourages all patients to consult with their insurance company or administrator for final determination of what post-acute care or home health services their policy covers.

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