Consumer's Guide to Home Care

What is Home Care?

Home care includes a category of services which are provided to an individual in a place of temporary or permanent residence used as an individual’s home. Home care is health care brought to your home to maintain or restore your health and well-being.

Home care services include:  Nursing Services and Duties, Physical Therapy, Speech Therapy, Occupational Therapy, Medical Social Work Services, In-Home Aide Services, Infusion Nursing Services, Companion Services, Sitter Services, Respite Services, Clinical Respiratory Services and Home Medical Equipment and Supplies.

Why Home Care?

Care provided in the comfort and security of your home through a licensed agency gives you, your family and friends a sense of control and peace of mind.  Home care provides a wide range of health care and social services to the patient and teaches families to help care for their family member.

How Do I Access Home Care Services?

Patients and/or family members may directly contact home care agencies in order to access services. Your physician may also make recommendations about home care and, if needed, will provide the necessary medical orders for home care services. Many agencies are listed in the yellow pages of your telephone directory.

Who Provides Home Care?

Home Care services are provided by a variety of organizations, including licensed home care agencies, certified home health agencies, councils on aging, county departments of social services, therapy companies, (PT, OT & ST) home medical equipment companies and infusion (IV) nursing agencies.

Who pays for Home Care Services?

Many home care services are reimbursed by Medicare, Medicaid, worker’s compensation, private or group health insurance, HMOs, Veteran and military benefits (VA/Champus), or through other special funds such as block grants. Also, private payment may be arranged with many home care agencies on an individual basis. When services are reimbursed by either public sources of funding or through insurance, it’s important to understand the eligibility criteria for reimbursement.

While the Medicare and Medicaid home health programs reimburse home care services for homebound patients, other Medicaid programs also cover in-home services. These include, Medicaid Personal Care Services (PCS), Medicaid Home Infusion Therapy (HIT), Medicaid Community Alternatives Programs (CAP), Medicaid Durable Medical Equipment (DME), and Medicaid Private Duty Nursing (PDN).

What is the Medicare Home Health Benefit?

Medicare certified home health services are included under the larger umbrella of home care and are available to Medicare recipients who meet certain eligibility criteria including:

When the above conditions are met, physicians may also order home health aide services or medical social worker services.

Medicaid also has a home health program with similar qualifying criteria, but Medicaid does not cover medical social worker services.

Who Oversees Home Care?

Home care agencies must meet state and federal regulations that govern the delivery of home care services. In North Carolina, all home care agencies must be licensed under the oversight of the North Carolina Department of Health and Human Services, Division of Health Service Regulation.

For agencies who provide Medicare home health services, the federal government requires a process called certification. The Division of Health Service Regulation makes on-site survey visits to licensed and certified home care agencies to assess the quality of agency services, unless an agency has been granted "deemed status" by meeting a higher level of accreditation standards (which requires on-site surveys by the accrediting agency).

In addition, agencies conduct criminal background checks on employees. Licensed home care agency employees will either be professionally licensed, registered with the state on the nurse aide registry, or work under a health care professional to whom the employee must demonstrate ongoing competency.

The state maintains a registry to ensure aides have adequate training and to also allow the public and employers access to complaints about nurse aides. Nurse aides listed on N.C.'s Nurse Aide Registry work under the supervision of professionally licensed nurses.

In addition to regulatory requirements, agencies may also be accredited which means they have demonstrated that they meet an additional set of standards. For more information about home care, contact your local home care agency, Department of Social Services, or aging agency.