NO COST, NO CO-PAY
HOME CARE SERVICES FOR
MEDICARE BENEFICIARIES

1 800-HOME-CARE
1 800-768-4663

FAX: 586-585-0209

FAQ

Experts in Home Health Management, Inc. believes you should be informed of your home care options. Please take a moment to explore the following information. Also review our Notice of Privacy Practices document.

Experts in Home Health Management Inc, FAQ Contents

Expert Home Care Inc, FAQ

What is home health care?

Imagine being disabled, too ill to care for yourself or having a condition that requires regular medical attention. Most people assume that a hospital or nursing home is the only option for care. However, with assistance from a home health care agency, you can receive care in the comfort of home. Home health care is an excellent, cost-effective alternative to hospital or other institutional care. Service is based on the individual's need.

What are the advantages of home health care?

In many cases, home health care permits a person to be discharged earlier from a hospital, reduces hospital admissions, assists with a more rapid recovery and fosters patient/physician relationships. Most importantly, the patient is often happier at home and receives more care and attention from family, friends and home health care professionals.

Who uses home health care services?

People of all ages use home health care services—from senior citizens to young children. Some examples include:

  • Those who are able to be discharged from a hospital or nursing home but need additional care;
  • Those who are terminally ill and want to live their final days with dignity surrounded by their loved ones in the comfort of their own home;
  • Those who have short-term health needs; and
  • Those who need assistance, due to age or disability, to remain at home.

Who provides home health care?

In Michigan, there are two main types of home health care agencies— certified agencies and private duty agencies.

Certified Agencies

Certified home health care agencies comply with Medicare and Medicaid regulations. An individual's Medicare benefit defines the conditions that qualify for service. The need for service typically arises after hospitalization or a significant change in medical condition. Care is prescribed by a physician and is generally restricted to skilled services that may include nursing; physical, occupational or speech/language therapy; medical social work; and/or home health aides to assist with personal care needs. While a physician must prescribe care, the patient has the right to select the provider of his/her choice.

Private

Private duty agencies offer a wide variety of services including medical and non-medical care. For example, private duty services, in addition to nursing, could include assistance with shopping, laundry, meals and companionship. The patient/family generally incur the cost of care, although some insurance plans may also cover all or a portion of it.

What types of professionals comprise the home health care team?

The home health care team consists of physicians, nurses, home health aides, medical social workers and therapists who coordinate care based on an individual's needs.

Physicians

Physicians may recommend home health care services. They also authorize a coordinated treatment plan and periodically review services.

Nurses

Nurses provide skilled services for the patient, supervise other caregivers and coordinate patient care with the physician. They may also train family members and friends to assist the professional caregivers and to help care for the patient.

Home Health Aides

Home health aides assist with a patient's personal care needs and are supervised by a nurse from the home health care agency. Typical assistance may include bathing, dressing, grooming, companionship, meal preparation and light housekeeping.

Medical Social Workers

Medical social workers assist the patient and family in a variety of ways by providing counseling services and directing them to other resources relevant to their situation. For example, medical social workers may help the patient obtain financial assistance or help him/ her meet certain emotional needs.

Therapists

Physical, occupational, speech/language and respiratory therapists provide essential services based on the individual patient's needs. The therapist also may train other caregivers to assist the patient with exercises and routine care.

Other Home Health Care Services

Dietary services, transportation, chore services, homemaker services, home-delivered meals, companionship, home medical equipment and intravenous therapy products are also available in a home setting. Your home health care agency can provide information and may be able to make the necessary arrangements for you.

Hospice

If a patient is terminally ill, hospice care may be available in an institutional setting or in a patient's home. Services focus on keeping an individual as comfortable and pain free as possible. Hospice services also assist the patient and family members with respite care, bereavement care. Most home health care agencies can either provide hospice service or refer you to a hospice in your area.

Who pays for home health care?

Medicare, Medicaid or other health insurances may cover the cost of home health care services. Some insurance policies will not cover all home health care services unless certain conditions are met. You can still obtain care without insurance coverage through a private duty agency on a private pay basis. Additionally, some agencies may have funding to help people who cannot afford the private pay option. The home health care agency will be able to assist in determining if the services you need are covered or if you need to make other arrangements.

Please review the differences between private duty and certified agencies as defined on pages 1 and 2 of this guide. Your insurance policy may specify what type of agency will be covered.

How is service initiated?

A physician, patient or family member can initiate service. However, Medicare, Medicaid and most insurances require physician involvement. Once the physician prescribes home health care, he/she authorizes a coordinated treatment plan, commonly called a "plan of care," and periodically reviews services and the patient's progress. If a physician does not prescribe home health care, but the individual still desires services, a private duty agency can suggest a plan of care to meet a wide variety of needs and budgets.

How do I choose the right agency?

Information regarding home health care services can be obtained from many sources. The Michigan Home Health Association is an excellent reference and can be contacted at (517) 349-8090. Other resources include: hospital discharge departments, your physician, public health departments, telephone directory yellow pages under "home care," "home health care" or "nursing" or through Web site search engines using similar headings.

Below are some questions to ask a home health care agency. Also, a convenient check list of other considerations appears on page 6 of this guide. Take your time to find the agency that best meets your needs.

Does a nurse or therapist conduct an evaluation of the individual's needs in the home?

What is included? Are family members, patient's physician and other health professionals included?

Is there a written plan of care for services?

Does it include duties to be performed, by whom, at what intervals and for how long? Will it be explained to the family? Can you review it?

Does the agency provide written statements describing its services, eligibility requirements, fees and funding sources?

Do the admission documents outline client services, fees and admission guidelines? Does the marketing brochure or annual report offer helpful guidance on the agency?

Is the agency Medicare certified?

Medicare certification is a measure of quality because that agency has met federal requirements. You can review the agency's Medicare Survey Report at your local Social Security Office. However, non-participation in Medicare does not indicate that an agency provides poor care. For example, Medicare certification is not applicable for private duty agencies.

Is the agency accredited?

Accreditation, a voluntary process conducted by nonprofit organizations, means that the agency has met basic standards, including personnel requirements, supervision and accountability. Agencies that provide skilled nursing services may be accredited by the Community Health Accreditation Program (CHAP, ACHC) and/or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Does the agency send supervisors to visit the home and evaluate the quality of care periodically?

How does the agency choose and train its employees?

What arrangements are made for emergencies?

What arrangements will be made if your financial resources are exhausted?

Patient rights and responsibilities

Patients with a certified home health care agency have specific rights and responsibilities regarding their care. The Statement of Patient Rights is available through home health care agencies and in several languages through the Michigan Home Health Association. Many non-certified home health care agencies have similar documents outlining their patients' rights and responsibilities.

What are some other sources of information?

Michigan Home Health Association (517)349-8090

Established in 1981, the Michigan Home Health Association (MHHA) is the state trade association for home health care providers. MHHA provides a unified voice for all components of home health care and promotes high standards of patient care in the delivery of home health care services. It is an advocate of home health care services within the total health care system.

In addition MHHA:

  • sponsors and promotes education programs, cost-savings projects and research in home health care;
  • promotes understanding, cooperation and communication among home health care providers; and
  • serves as a liaison with other organizations at local, state and national levels

National Association of Homecare

www.nahc.org

Patients with a certified home health care agency have specific rights and responsibilities regarding their care. The Statement of Patient Rights is available through home health care agencies and in several languages through the Michigan Home Health Association. Many non-certified home health care agencies have similar documents outlining their patients' rights and responsibilities.

National Hospice and Palliative Care Organization

www.nho.org

Patients with a certified home health care agency have specific rights and responsibilities regarding their care. The Statement of Patient Rights is available through home health care agencies and in several languages through the Michigan Home Health Association. Many non-certified home health care agencies have similar documents outlining their patients' rights and responsibilities.

What is Homebound Status?

Homebound status is required for us to provide care. Following examples may help you determine the homebound status.

  • Chairbound/Bedbound
  • Severe shortness of breath
  • Pain restricting movement
  • Needs assistance to move
  • Server functional limitations
  • Requires maximum assistance for all activities
  • Severe immune supression
  • Impaired mental status
  • Confusion level precedes safe leaving of home without supervision
  • Severe weakness, unsteady gait, holds onto funiture or walls for support Angina with activitiy
  • Lower extremity edema that impairs ambulation
  • Cannot safely leave the home without assistive device
  • Medically restricted due to risk of infection, post-op
  • Weakness due to chemotherapy or radiation treatments

What is Private Duty Home Care?

Private duty home care is personal care given by a home health aide or nurse who will stay with your loved one for as many hours as needed through private pay.

Are your staff members friendly and qualified?

All of our staff members are orientated to all of our policies and procedures before they are allowed out in the field. They are all qualified and their skills have been verified.

Is there someone I can call if I have questions or concerns?

Our office will be open from 9:00am to 5:00pm Monday through Friday and there will be a person on call 24 hours a day for any question you may have. 1-800-HOMECARE or 1-586-585-0201

Does my insurance cover your services?

Some private insurance will cover our services but most is private pay. For your convenience we will contact your insurance agent for you.

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