What is Home Care?
Home care encompasses a wide range of health and social services. These services are delivered at home to recovering, disabled, chronically, or terminally ill persons in need of medical, nursing, social, or therapeutic treatment, and/or assistance with the essential activities of daily living. Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends.
Home care is available to:
- Older people electing to live independent, non-institutionalized lives;
- Younger adults who are disabled or recuperating from acute illness;
- Chronically ill infants and children who are receiving sophisticated medical treatment in their loving and secure home environments; and,
- Adults and children diagnosed with terminal illnesses are also being cared for at home, receiving compassion and maintaining dignity at the end of life.
As hospital stays decrease, more patients/clients require highly skilled services when they return home. Other patients/clients are able to receive safe and effective care at home from the outset.
Home care is cost-effective. Numerous studies have shown that home care is generally the most cost-effective care option. Used prior to, in place of, or after hospitalization, home care can reduce the length-of-stay and save money over the course of an illness.
Home care keeps people independent. With assistance, persons of all ages can continue to function as viable members of the community.
Home care keeps families together. The joy of being with loved ones is particularly important in times of illness, and keeping families together has a positive social and economic impact on our communities.
Home care is patient-centered. Home care involves the individual and the family in the care that is delivered. Care in the home setting empowers individuals and their families to assume greater responsibility for their own health, and to assist them to make informed health care decisions.
Understanding the different types of services available for home care can be confusing, to say the least. The following list is designed to clear up some of the confusion.
Length of Care
- Hourly – Hourly care can be provided by a companion or homemaker, certified nursing assistant (CNA), home health aide (HHA), licensed practical nurse (LPN), or registered nurse (RN). The caregiver can provide care available under their licensure/certification as well as companion/homemaker services. A minimum of five hours of care is required. RN, LPN, and bed-and-bath visits are also available.
- Live-in – Care can be provided by companions/homemakers, CNAs, HHAs, LPNs, or RNs 24 hours a day, seven days a week. The caregiver can provide care available under their licensure as well as companion/homemaker services. A live-in caregiver must be able to have eight hours of uninterrupted sleep. For individuals who need full 24-hour attention, seek shift-work care.
- 24-Hour Care – This level of care and service is when a home care professional is awake and ready to attend to a patient's/client's needs 24 hours a day. The level of service usually, with rare exceptions, applies to HHA-level care. This level of care requires multiple shifts by care providers over the 24-hour period. Provision of this service is via private pay and the use of long-term care insurance.
- Visits – A visit is when the health professional, aide, or nurse, comes into a patient's/client's home or residence and performs certain specific tasks or duties. A visit can last up to an hour but is defined, time-wise, by the completion of the required duties. When the tasks have been performed and completed, the visit is over. An example of a skilled nursing visit includes removing a dressing on a wound, documenting the wound in the patient's/client's medical record, treating the wound, applying a new dressing on the wound, and monitoring the general health of the patient/client. An example of a visit by an HHA includes assisting the patient/client with undressing, helping the patient/client bathe, and helping the patient/client get dressed and change bed linens.
Types of Care
- Homemaker/Companion/Sitter – A homemaker/companion is a person who cares for an elderly, disabled, or convalescent individual or couple and can accompany them on trips, outings, and appointments, as well as prepare and serve meals. Companions are available to provide care per hour, shift, or on a live-in basis. Typical duties of homemaker/companions/sitters include but are not limited to companionship and conversation; sorting and reading mail; arrange appointments; assistance with walking; letter writing and correspondence; reading; meal planning and preparation; making the bed; answering the phone and door; basic grooming; apparel selection assistance; caring for indoor house plants; appointment reminders; entertainment (playing cards, sewing assistance, etc.); monitoring diet and eating habits; grocery shopping; and, medication reminders.
- Certified Nursing Assistant/Home Health Aide – CNAs and HHAs have a nursing assistant certificate. A person receiving care from a CNA or HHA should be under the care of a physician and/or supervised by an RN. Nurse aides assist with bathing, dressing, toileting, grooming, eating, physical transfer, and those normal daily routines the patient/client could perform for him/herself if he/she were physically capable. Nurse aides can also perform all the services of a companion or homemaker and are available hourly, for shift-work, or on a live-in basis.
- Licensed Practical Nurse – LPNs have practical nurse licenses and are under the supervision of our registered nurse or a physician. An LPN maintains the medical plan of treatment created by the registered nurse and approved by the physician. An LPN can also perform the services of a CNA, homemaker, and companion.
- Registered Nurse – RNs are licensed and maintain clinical records for patients/clients receiving nursing care. An RN develops medical plans for treatment and can maintain them or supervise their maintenance. RNs supervise LPNs and CNAs/HHAs, as well as manage patient/client medications. RNs are available on an hourly, per shift, per visit, or on a live-in basis.
Home care is paid for by a variety of sources. Benefits and requirements vary greatly, however. Major home care payment sources include:
- Patient/Private Pay – Home care services can be personally paid. The scope of services and the charges are negotiated between the patient/client, his/her family, and the agency. For those whose resources do not cover home care, some agencies offer a sliding-scale fee schedule so that a family only pays what it can afford.
- Private Health Insurance – Coverage varies, but private insurance coverage is generally limited to physician-directed medical services and equipment. The patient/client and family should check with their insurance agent to determine coverage specifics.
- Medicare – The patient must be under a physician's plan of care, homebound, and in need of part-time or intermittent skilled nursing care or occupational/physical/speech therapy. Eligible patients/clients may receive a range of services which include skilled nursing, personal care services, occupational/physical/speech therapy, medical social work, and medical supplies/equipment. Click here to learn more about the Medicare home health benefit.
- Medicaid – Jointly administered by the federal and state government, this medical assistance program provides services similar to Medicare for low-income individuals. No prior hospitalization or "skilled" level of service is required to qualify. Unlike the Medicare program, Medicaid does not require homebound status to be eligible for services.
- Social Bervices Block Grants – Federal Title XX funds are available for in-home personal care.
- Older Americans Act – Title III of the Older Americans Act provides in-home services including home-delivered meals and personal care.
- Workers' Compensation – Any person needing home care as a result of an injury on the job is eligible under workers' compensation. To determine eligibility, refer to your workers' compensation representative.
- Health Maintenance Organizations (HMOs) – HMOs and Comprehensive Medical Plans (CMP) with Medicare contracts must provide the full range of Medicare-covered services that are available in a geographic area, including home care services.
- Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) – 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.
By the Numbers
- 279,715 – Number of Florida Medicare beneficiaries who accessed home health services in 2020
- 205,216 – Number of Florida Medicaid recipients who accessed home health services in 2020
- 2,300 – Approximate number of home care agencies in Florida spanning from the Panhandle to the Florida Keys
- 88 – Percentage of adults aged 50-80 who believe it's important to age in place
- 2 – Percentage of home- and community-based services patients nationwide who contracted COVID-19 compared to nursing homes (37%) and assisted living facilities (14%)
- $745,000,000 – Annual savings by providing care in the home rather than a facility-based setting (before adjusting for inflation)
- $5,411 – Medicare savings per patient when home care is used as the first post-acute care setting for a hip fracture
- $120 – Median daily cost for aide or companion services, compared to $244 for a semi-private nursing home room
- 424 – Percentage of savings realized by the Veterans Administration using home care
- HCAF Home Care Provider Directory
- Agency for Health Care Administration Consumer Guide: Home Health Care in Florida
- Compare Florida Home Health Agencies – Compare all Florida-licensed home health agencies
- Florida Department of Elder Affairs Resources
- How to Choose the Best Health Care Agency for Your Needs (South Florida Reporter, 12/25/20)
- How Does Home Health Care Work? (Forbes, 8/11/21)
- How to Hire a Caregiver (AARP, 11/7/19)
- Medicare Home Health Compare – Compare all Florida Medicare-certified home health agencies
- Resources, Gadgets, and Tools to Care for an Older Adult at Home (AARP, 11/3/21)
- Useful Links & Acronyms