About Home Care

»Download New York Home Care, a one-page overview about home care services in New York Types of Home Care Services

Types of Home Care Agencies in New York State

Who Provides Home Health Services?

Who Pays for Home Care Services?

How to choose a Home Health Care Agency?

"Home care" encompasses a broad spectrum of both health and social services that can be delivered in a more comfortable home environment to persons who are disabled, chronically ill or recovering from an illness. These services include the traditional core of professional nursing and home care aide services as well as physical therapy, occupational therapy, speech therapy, medical social services and nutritional services.

Home care is important whenever a person needs assistance that cannot be easily or effectively provided solely by a family member or friend for a certain period of time. There are many situations and conditions for which home care and hospice are especially appropriate. Advances in treatment and technology have allowed more people to leave institutions or never enter them. They can be cared for effectively and efficiently at home even if they have illnesses that at one time were only treatable in a hospital or institutional setting.

Home care services may benefit people who:

• Need additional assistance to live independently at home due to an illness or disability or because of advanced age;
• Have a chronic or life threatening illness and want to rest or even receive end-of-life care in the comfort of a home environment;
• Are able to be discharged from a hospital or nursing home but need additional care at home; and
• Require short-term assistance at home because of same-day or outpatient surgery or maternity-related incapacity.

Recent studies have shown that people improve and recover faster at home than in institutions. For instance, when chemotherapy is required for treatment of cancer, the smaller doses that can be administered at home cause fewer adverse reactions than massive doses delivered in hospital settings. Also, surveys consistently validate the fact that whenever people have a choice, they prefer home care.

Home care and hospice services are provided for people of all ages. A significant percentage of older people electing to live independently are taking advantage of home care and hospice services instead of spending their last years in a nursing home. Younger adults who are disabled or recovering from acute illness are choosing to be cared for at home whenever possible. Infants and children requiring even the most sophisticated treatment for serious childhood illness are often able to return to loving families and a secure home environment, thanks to advanced technology and pediatric home care services.

Types of Home Care Services

Home health agencies provide a wide range of services, including:

AIDS Program Companions, Continuous Care Nursing, Geriatric, Alcoholism Counseling, High Tech Therapy, Home Health Aide Services, Home Medical Equipment, Home Transfusion, Homemaker Services, Hospice, Housekeeping, I.V. Therapy, Industrial Nursing, Infant/Child Care, Infusion Therapy, Laboratory, Live-In Services, LTHHCP Waivered Services, Medical Social Work, Mental Health Services, Nursing Visits, Nutrition, Occupational Therapy, Paraprofessional Staffing, Pediatric Care, Personal Care, Personal Emergency Response, Pharmacy, Physical Therapy, Private Duty Nursing, Rehabilitation, Respiratory Care, Respite Care, RN/LPN Staffing, Shared Aide Program, Social Model Adult Day, Speech Therapy, Training, and Ventilator Dependent Services.

Types of Home Care Agencies in New York State

Home care services are provided by home care agencies or "home health agencies." Many home care organizations also provide a wide variety of other services, including physical therapy, occupational therapy, speech therapy, medical social services and nutritional services.

Home care agencies bring these services into the home, singly or in combination, in order to achieve and sustain an optimum state of health, activity, and independence for individuals of all ages. These individuals may require such services because of acute illness, exacerbation of chronic illness, or long term or permanent limitations due to chronic illness and disability.

Home care agencies in New York can be categorized into four main groups: Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs), Licensed Home Care Service Agencies (LHCSAs), and Personal Care Programs.

The following is a brief summary of each kind of agency:

• Certified Home Health Agencies (CHHAs) provide care and support services to individuals who, for the most part, have home health care needs for a limited duration. CHHAs provide nursing and home health aide services, and provide or arrange for other professional services, including physical and occupational therapy, speech pathology, medical social work and nutrition services. CHHAs participate directly in both the Medicaid and Medicare programs. Most of the CHHAs' reimbursement is through Medicare and/or Medicaid. Currently, the DOH has imposed a moratorium on the establishment of new CHHAs.
• Long Term Home Health Care Programs (LTHHCPs) operate under a specific Federal Medicaid waiver and are also known as "Nursing Homes Without Walls." LTHHCPs may be established by independent CHHAs, hospitals, and nursing homes. LTHHCPs offer health care and support services to the disabled and chronically ill who are medically eligible for admission to a nursing home, but who choose to be maintained at home. These programs provide a full range of professional and aide level health care services to those in need over a long period of time, at a budgeted amount of 75% of the cost of nursing home care. Currently, the Commissioner has imposed a moratorium on the establishment of new LTHHCPs, though additional patient capacity for LTHHCPs, also long subject to a moratorium, has recently been awarded in certain high-needs geographic localities.

Learn more about LTHHCPs by downloading the "Nursing Home Without Walls" profile by former State Senator Tarky Lombardi, Jr., architect of the Long Term Home Health Care Program. This authoritative profile appeared in the May 1987 edition of Caring, a publication of the National Association of Home Care and Hospice (NAHC).

• Licensed Home Care Services Agencies (LHCSAs) offer home care services, including all levels of nursing care, various therapies, home health aides and personal care aides to clients who pay privately, have private insurance coverage or are covered through a variety of government payors. Many LHCSAs also deliver services under contract with local departments of social services or other service-authorizing agents. In particular, services through the Medicaid Personal Care and Private Duty Nursing Programs are delivered in this way. Licensed agencies also sub-contract with other home care providers to deliver services to beneficiaries throughout New York State. LHCSAs may offer a full range of services from skilled to paraprofessional or may choose to focus on the delivery of one service or population, such as high-tech pediatrics or aides to seniors.
• Personal Care Programs provide assistance with Activities of Daily Living (ADLs), such as personal hygiene, mobility, toileting, feeding, meal preparation, light housekeeping and laundry for people who require such support services based on a medical need. Personal Care program clients receive services based on a doctor's orders and plan of care. Local social services offices determine the need for these services. In New York City, the Home Attendant Program delivers these services through participating agencies and is regulated by the New York City Human Resources Agency.

Who Provides Home Health Services?

Home Health Agencies employ a variety of professional and paraprofessional staff, including:

• Nurses - Registered nurses (RN) and licensed practical nurses (LPN) provide direct skilled nursing services for the patient, supervise other caregivers as required, and coordinate patient care with the physician. They also train family members and friends in functions they can perform to assist the professional caregivers and maintain the patient when professional services no longer are necessary.
• Therapists - Another important component of the home care team is the professional therapist. Physical, occupational, speech and respiratory therapists provide essential services according to the needs of the individual patient. The therapist also plays a vital role in training nonprofessionals who may be available to assist the patient with exercises and routine care that can allow the patient to function in the home and recover more effectively.
• Home Health & Personal Care Aides - These trained paraprofessionals provide services associated with the personal care of the patient. When assistance with bathing, grooming, dressing, cooking and cleaning are needed, home care aide services can be indispensable. Home health and personal care aides are supervised by the nursing staff of a home care agency.
• Social Workers - These licensed professionals assist the patient and family in vital areas including evaluation of the financial circumstances and ability to pay for necessary home care services and directing them to local support systems. Social work in the home setting also involves making sure that the emotional needs of the patient and the family are fulfilled.
• Physicians - The physician is a key element in home care, as the doctor will be the one to initiate the plan of treatment. The physician may refer a patient returning home from a hospital or nursing home to a home health care agency or suggest that home care services could allow a patient with increasing disability to remain at home. In many cases the physician will periodically review the delivery and effectiveness of those services, sometimes recommending changes.

Who Pays for Home Care Services?

Home health care may be paid by various sources. The care may be paid by the individual or the family, with both private and public insurance programs covering some home care costs. For those whose insurance does not cover home care, some agencies offer a sliding-scale fee schedule so that a patient may pay only what they can afford.

The main payment sources include Medicare, Medicaid, private health insurance, Veterans Administration, workers' compensation, health maintenance organizations (HMO), TRICARE, and some social services organizations. The following is a summary of the various payer sources:

• Medicare - For those 65 and over, this federal health program pays for home health services, some kinds of homemaking services and agency-provided medical supplies and equipment if the patient meets the following requirements: the patient must be under a physician's care; homebound; and in need of part-time or intermittent skilled nursing care, or physical or speech therapy. Once the patient meets those requirements, he or she is eligible for a range of services including skilled nursing, home health aide, speech therapy, occupational therapy, medical social work and medical supplies and equipment. Medicare also reimburses for hospice benefits that include palliative and support services delivered to terminally ill patients. The plan of care must be designed and periodically reviewed by the physician. The services provided must be part-time or intermittent (that is, not full time). The illness or condition must be of a nature that will respond favorably to a physician's treatment. Services must be provided through a Medicare-certified home health agency.
• Medicaid - This program assists low-income people through a joint federal-state program administered by the state. Each state has its own set of eligibility requirements. Under Medicaid, home health services must include part-time nursing, home health aide assistance, medical equipment and supplies at the state's option, and it may cover therapy services. States are required to provide home health services to all categorically needy recipients 21 years and older and to all other Medicaid recipients who are entitled to skilled nursing benefits under the state plan. States are permitted to offer home health services to all other recipients. In addition, in 1981, Congress authorized certain waivers to expand Medicaid by allowing states to provide a broad range of home- and community-based services to individuals who otherwise would require, and have paid for by Medicaid, institutional care.
• Patient / Private Pay / Private Health Insurance - Home care services and expenses are often paid from out-of-pocket sources. The scope of services and the price are worked out between the family and the agency. If the cost of a family's home care program is to be reimbursed, the agency will bill its insurance source directly. The patient, or responsible party, will receive a bill only when a portion of a bill is not paid by the insurer, as in the case of deductibles. Private health insurance coverage varies. Generally, private insurance coverage is limited to physician-directed medical services, courses of therapy and medical equipment. Patients still must be aware of limitations on coverage, such as prior hospitalization and pre-existing conditions. Many policies only cover services that already are covered by Medicare. No matter how home care is being paid for, patients should keep accurate records. Home care costs qualify as medical expenses and are tax deductible, within certain limits, from federal income tax.
• Health Maintenance Organizations - HMOs and Comprehensive Medical Plans (CMP) with Medicare contracts must provide the full range of Medicare-covered services that are available in the geographic area, including home health services. Coverage is usually limited to physician-directed medical services and therapy. In exchange for comprehensive services, the patient agrees to restrictions on the use of providers outside the plan.
• Veterans Administration - Veterans with a 50% or more service-connected disability are eligible for home health care coverage. Services must be authorized by a physician to be eligible and are provided through the VA's own network of VA hospital-based home care units. Since 1981, the VA does not authorize payment for non-medical services provided by home care aides.
• Workers' Compensation - Any person needing home care services as a result of injury on the job is eligible. Workers' compensation representatives have information on eligibility.
• Tricare - On a cost-shared basis this program covers skilled nursing care and other professional medical home care for dependents of active military personnel, retirees and their dependents and survivors.
• Social Service Organizations - Organizations that operate with private charitable funding, such as United Way, may offer a wide range of services encompassing most of the health and supportive home care services. Depending on eligibility, agencies may require some payment, or a donation, or provide service at no charge.

How to choose a Home Health Care Agency?

It is not difficult to find the best home care provider to fit your needs, or a loved one's, with just a little research. The Find Homecare in NY feature on our website can assist you in finding a home health agency in New York State.

You have the right to choose any home care provider who is qualified to provide the services you need, although that choice may be restricted somewhat if you are enrolled in a managed care plan (such as a Medicare HMO). The following are some questions to consider when deciding which home care provider is best for you:

• How long has the provider been serving the community and what services does the provider offer?
• Does your physician know the reputation of the provider?
• Is the provider certified by Medicare? Only Medicare-certified agencies can provide services covered by Medicare.
• What kind of agency is it? Is it subject to New York State certification requirements?
• Does the provider have written statements describing its services, eligibility requirements, fees, patient rights, confidentiality, complaint procedures, hours of service and emergency arrangements?
• Does the provider ensure that its workers are functioning under written personnel policies, clinical protocols and malpractice insurance? What back-up systems are in place to ensure continuity of care?
• Will the agency continue to provide services if Medicare or other sources of reimbursement are exhausted?