Q: Can you explain the difference between in home caregivers and home health care agencies?

A: Many people do not understand the difference between in home caregivers and Home Health Care Agencies that are covered by Medicare. It is important to understand the difference and the limits of each type of care, as well as the cost or coverage.

Generally, in home caregiving agencies are agencies where you can hire private caregivers to come to the home and provide care that is needed. This care can include what is called custodial care. This means care that does not require skilled medical care, but may provide assistance with activities of daily living. Activities of daily living include eating, preparing meals, bathing, dressing and general daily tasks.

These agencies are privately paid by the client. Right now, they charge, on average, between $32 and $35 per hour, and most agencies require a 4-hour minimum per day. If you have purchased a long-term care insurance policy, your policy may cover this type of care. Otherwise, families are responsible for these costs.

The Home Care Services Bureau (HCSB) is responsible for licensing Home Care Organizations. The agency must complete an application and register of their caregivers. This ensures that the agencies are running background checks on the workers, providing training, and are licensed and bonded. You can learn more at https://www.cdss.ca.gov/inforesources/community-care/home-care-services

Through this website you can also look up an agency or an individual worker. There is also a system for making complaints.

You may have heard of a program where the state pays for in home care workers for people who are on the Medi-Cal low-income insurance program. That program is called In Home Support Services (IHSS) and can be applied for if the person already receives Medi-Cal and is in need of custodial care at home. You can learn more at https://www.cdss.ca.gov/in-home-supportive-services or by calling 805-654-3260 for Ventura County and (213) 744 – 4477 for Los Angeles County.

Home Health Care agencies are different, as they are licensed to provide medical care at home and are paid for by Medicare for appropriate prescribed services. Most likely you have heard of this following a hospital stay or surgery. The doctor can prescribe Home Health Care for a patient who is considered homebound and requires follow up care. This includes physical therapy, occupational therapy, wound care and monitoring serious illness.

Once the physician orders the care, the Home Health Agency will send someone to the home to complete an assessment and determine the appropriate services, duration and frequency. Your doctor may have an agency in mind, but always know you have a choice of agencies. Most Medicare plans generally cover this service, but you always want to check first because many people have Medicare Advantage or Supplemental plans to consider. The Home Health Care Agency should be able to check on your coverage for you.

Often when someone gets discharged from the hospital, they will receive a referral for Home Health Care. It is important for the family to understand this is for specific medical related tasks, and not ongoing care in the home. The Home Health Care agency will not prepare meals or provide supervision and company in the home. For that, you will need to hire private in home caregiving.

Home Health Care can also be prescribed if a frail older adult has a fall. You should always report a fall to the doctor and suggest in home physical therapy. This is a great benefit. The physical therapist can a do a safety assessment and may have great suggestions on how to reduce fall risks at home.

Home care options can be confusing and vary based on the individual need. Understanding the basic differences between what is covered by health insurance and what is not is a great place to start. Ensuring you and your loved ones have the care they need is the most important thing.

Martha Shapiro can be reached at Senior Concerns at 805-497-0189 or by email at mshapiro@seniorconcerns.org.

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