Q: I am going to need in-home health care and wonder how to go about selecting an appropriate agency. Is there anything in particular I should focus on and does Medicare have any special requirements for the care to be covered?
A: Medicare Part B covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy.
A doctor, or certain health care professionals who work with a doctor, must see you face-to-face before a doctor can certify that you need home health services. A doctor must order your care and it must be provided by a Medicare certified home health agency.
You must be homebound to qualify for this type of care. That means that you have trouble leaving your home without help because of an illness or injury and leaving your home isn’t recommended because of your condition, and you are normally unable to leave your home because it is a major effort.
Understanding all aspects of your health care is very important and selecting an in-home health care agency is no exception. There are many in-home health care agencies and as you shop for an agency you will find that no two are exactly alike.
Which in-home health care agency is best for you depends on the type of care you will need. An agency that serves the needs of a neighbor or friend may or may not be the agency for you.
When your doctor determines that you need home health care you will probably be provided with a list of in-home health care agencies in your area. This list can serve as the starting point of your selection process.
Since your health care insurance is Medicare it will be necessary to select an agency that is certified by Medicare. If your insurance coverage is provided by a managed care plan (HMO) your choice will be limited to those agencies that are approved by your HMO.
Before selecting a home health care agency there are several areas you will want to explore. You will want some background information about the agency itself and how it operates. You will also want to know how your care plan will be handled and what, if anything, you will be required to pay. You should inquire about whether the caregivers are employees of the in-home agency or independent contractors and what that difference means to you.
Ask how long the agency has been serving your community. Determine when staff is available. Are they on duty 24 hours a day, seven days a week? If not, how can you get in touch with personnel when the office is closed? What happens if your assigned caregiver doesn’t show up when scheduled?
You will also want to know how emergencies are handled and who to call if you have questions or complaints.
Ask about how your care plan will be handled. You will want to be sure that the agency can provide the services you need. Ask if you and your family can be part of the team deciding your care plan. Will the agency teach family members about the type of care being given?
To insure that you are receiving the services you require ask who supervises the home care provider and how often that supervision will occur. Also ask if the agency will be in regular contact with your doctor.
Ask about any services or supplies that you might need. Will they be covered by your insurance? If not how will you be billed for those items.
Good luck on your search. There are many excellent in-home health care agencies out there and I am sure you will find one that meets your needs.
Tuesday: 4-6 p.m. — Presentation — The Empowered Caregiver Series — “Legal Information for Elders (LIFE) — at Senior Concerns Day Care Center, 401 Hodencamp Road in Thousand Oaks. Mike Williams from Grey Law will help family caregivers understand important legal documents. Reservations are required and can be made by calling 497-0189.
March 2: Presentation — “Skin Cancer and Sun Protection — What Every Senior Needs to Know” at Thousand Oaks Council on Aging Meeting at the Civic Arts Plaza Board Room, 2100 E. Thousand Oaks Blvd. in Thousand Oaks. The speaker will be Dr. Jenny Hu with the UCLA Division of Dermatology.
March 15: 1:30-3 p.m. — Seminar — “How to Improve Your Driving Skills” at Simi Valley Senior Center, 3900 Avenida Simi in Simi Valley. To be facilitated by the Senior Advocate. For reservations call the Simi Center at 583-6363.