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 in order 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 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 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 you need home health care, you will probably receive 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 certified by Medicare. If your insurance coverage is provided by a managed-care plan, your choice will be limited to agencies approved by your plan.
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 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 the agency’s staff is available. Are staff members 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 where to call if you have questions or complaints.
Ask how your care plan will be handled. You will want to be sure the agency can provide the services you need. Ask whether 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 ensure that you are receiving the services you require, ask who supervises the home care provider and how often that supervision will occur. Also ask whether the agency will be in regular contact with your doctor.
Ask about any services or supplies you might need. Will they be covered by your insurance? If not, ask 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.
Medicare one-stop shops: Area Agency on Aging offices in Ventura from 8 a.m. to 3 p.m. Wednesday and Thursday; Simi Valley Senior Center from 10 a.m. to 2 p.m. Thursday; Goebel Adult Community Center in Thousand Oaks from 9 a.m. to 3 p.m. Friday; Fillmore Senior Center from 10:30 a.m. to noon Tuesday; and South Oxnard Senior Center from 10 a.m. to noon Tuesday.
Holiday craft bazaar: 10 a.m. to 2 p.m. Nov. 1, Goebel Adult Community Center, 1385 E. Janss Road, Thousand Oaks.