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 Care – 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 within the scope of 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 – 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 within the scope of their licensure, as well as companion/homemaker services. A live-in caregiver must have eight hours of uninterrupted sleep. For individuals who need full 24-hour attention, shift-work care is recommended.
24-Hour Care – This level of care and service involves a home care professional who is awake and ready to attend to a patient's/client's needs 24 hours a day. Typically, this applies to HHA-level care, with rare exceptions. Multiple care providers work in shifts to provide this service, which is typically paid for privately or through long-term care insurance.
Visits – A visit is when a health professional, aide, or nurse comes into a patient's/client's home or residence and performs 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. For example, a skilled nursing visit may include tasks like removing a wound dressing, documenting it in the patient's/client's medical record, treating the wound, applying a new dressing, and monitoring the patient's/client's general health. An HHA visit may involve assisting the patient/client with undressing, bathing, getting dressed, and changing bed linens.
Types of Care
Homemaker/Companion/Sitter – A homemaker/companion cares for elderly, disabled, or convalescent individuals or couples. They 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 include companionship, sorting and reading mail, appointment arrangement, assistance with walking, letter writing, meal planning and preparation, bed-making, answering the phone and door, grooming assistance, apparel selection assistance, indoor house plant care, appointment reminders, entertainment (playing cards, sewing assistance, etc.), diet and eating habit monitoring, grocery shopping, and medication reminders.
Certified Nursing Assistant/Home Health Aide – CNAs and HHAs hold nursing assistant certificates. Those 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 transfers, and other daily routines the patient/client could perform if capable. They 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 supervised by an RN or a physician. An LPN maintains the medical treatment plan created by the RN and approved by the physician. They 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. They develop medical treatment plans and can maintain or supervise their maintenance. RNs supervise LPNs and CNAs/HHAs and manage patient/client medications. RNs are available on an hourly basis, 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 governments, 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 Services 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
- 316,437 – Number of Florida Medicare beneficiaries who used home health services in 2021
- 82 – Percentage of Florida Medicare beneficiaries who used home health services and have three (3) or more chronic conditions
- 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
- 93 – Percentage of adults aged 55 and older who believe it's important to age in place
- 2 – Percentage of home- and community-based services (HCBS) 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)
- 76,468 – Estimated number of home health employees in Florida
- $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 home health aide or companionship 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 Member 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