Choosing the right type of agency will pay off

Just like the price of a new automobile can vary, so does the price of home care. The cost of care depends on the licensure of the agency, the length of time services are needed and sometimes the day of the week.

There are a few different types of home care…

Traditional home health services are comprised of speech therapy, occupational therapy, physical therapy and wound care. This care is primarily given by nurses and therapists. Skilled home health is covered by Medicare and traditional health insurance  for a period of time based on the patient’s diagnosis. These nurses and therapists will visit the patients home anywhere from a few times a day to once per week, depending on diagnosis. In order to receive home health from a Medicare certified agency you must have a referral from your physician. Medicare certified home health agencies do not provide ongoing assistance with activities of daily living.

Private duty home health agencies specialize in providing assistance with activities of daily living. They provide assistance in the form of Certified Nursing Assistants and Home Health Aides. These licensed caregivers visit the patient’s home and provide assistance with things like bathing and hygiene assistance, meal preparation, transportation, escort services and medication reminders. Many times, it is helpful to have private duty home care, also referred to as non-medical home healthcare, in conjunction with skilled home health to make sure that all of a patient’s needs are being met.

Private duty home care is performed by agencies that have one of three types of licensure.

  1. Home Health Agencies- This is the highest level of licensure a non-medical home care agency can possess. These agencies have a Director of Nursing that oversees all care as well as an Administrator that is a physician, RN or has completed the required accreditation courses. Home health agencies are licensed to provide “hands on” or personal care to their clients. Home health agencies employ all of their own caregivers; this means that all of the caregivers are bonded and insured by the agency, taking the risk from the patient. They also abide by strict quality assurance standards and are overseen by the Agency of Healthcare Administration (ACHA). One way to tell if a company you are considering working with has this level of licensure is to ask them for their license number, if it begins with “HHA” they are a fully licensed agency. Private duty home care agencies are typically marginally more expensive than agencies of other licensures because of the insurance they carry on their employees and the oversight they provide. Hourly costs range from $20-$27.
  2. Nurse Registries- This type of agency is not required to have a Director of Nursing to oversee patient care. Nurse registries must have oversight by a qualified Administrator and are regulated by ACHA. Like home health agencies, nurse registries are licensed to provide personal care to their clients, however the agency is not required to oversee the care of their clients. These agencies are set up to provide a caregiver to be hired by a senior individual. The senior or family member is then responsible for managing and overseeing the care and quality of work of the caregiver. Another major difference between a fully licensed home health agency and a nurse registry is that nurse registries do not employ their caregivers. The caregivers are sub-contractors, because of this the agency is not required to carry liability insurance on the caregivers. This means that if an accident were to happen in the home, the homeowner, not the agency, would be responsible. Nurse registries have a license number that begins with “NR”. Nurse registries are typically a bit less expensive when compared to a fully licensed agency. Hourly costs range from $15-$20.
  3. Companion Agencies- These companies are able to provide  homemaking, sitter services  and transportation services only. They are not legally able to provide any “hands on” or personal care. These agencies are not required to have oversight by a Director of Nursing or any other qualified being. Additionally, their employees do not necessarily go through any sort of training to provide care in the home setting and they do not required to cover their employees with any type of liability insurance. Companion agencies are not licensed or regulated by ACHA. They are typically the least expensive of the three types of agencies but are only able to provide limited services. Hourly costs range from $12-$16.

The length of time services are needed often impacts the cost of home care. Some private duty home care providers have a required minimum number of service hours. Most agencies that have a minimum, require 4 hours per day. Some agencies also have rates that fluctuate based on blocks of time. For example the price for 2-4 hours of care may cost more than care for a 6 hour block of time. Additionally, some home care providers charge a premium for providing care after normal business hours, on the weekends or on holidays.

Who pays for home healthcare?

Home healthcare services can be paid for in one of three ways, depending on the care required, type of insurance the patient has, and the patient’s financial circumstances.

Some funding is available through public third- party payers such as: Medicaid, Medicare, Veterans Administration, and Social Services grant programs. Some local community organizations also provide funding to help pay for home healthcare services.

Assistance is also available through private third-party payers which include: health insurance companies, long-term care insurance, managed care organizations, and workers’ compensation.

As a rule of thumb it is safe to assume that skilled home healthcare (nursing and therapy) can be paid for through insurance. Private-Duty home healthcare on the other hand is usually only paid for through long-term care insurance or directly out of pocket.