Caregiving Challenges, Different Sources of Home Care

There are several means of receiving in-home care and it can be difficult to tell the difference or determine what's needed.

Helpful Highlights

  • While "home health" and "home care" may sound interchangeable, they are actually different services. Home health is ordered by a physician and includes skilled care from licensed professionals.

  • Home care is generally for assistance with activities of daily living (ADLs) provided by unlicensed caregivers, though some home care agencies also have private-duty nursing.

  • Hiring private in-home care (i.e., not through an agency) can be less expensive, though comes with many other important considerations.

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What's the difference between home health and home care? Do I have to go to an agency to hire home care? Where does "private duty" fit in? My state has a registry, what does that mean? Are online services the same as home care agencies?

It can be so confusing!  You are looking for assistance for your loved one and there are so many agencies, so many names.  Without understanding, it is difficult to determine what your loved one needs or what you are accepting. Here we have references to the various in-home care providers and what they offer.

Medicare-certified home health or, simply, home health agencies

  • The predominant provider of home health services is a Medicare-certified home health agency. And when someone says "home health agency," they are usually referring to those that are Medicare certified.

  • Medicare certification means the agency complies with all the rules and regulations required by CMS (Centers for Medicare & Medicaid Services).  This is a federally guided and reimbursed program – the agency bills Medicare for the services provided.

  • The term "home health agency" therefore means an organization that meets the criteria to provide skilled services.  Skilled services are nursing, physical therapy, occupational therapy, speech therapy, and medical social work.  Home health agencies also offer non-skilled services such as home health aides, provided they are overseen by nursing or physical therapy and services performed directly support care plan goals.

  • In order to receive home health, it must be deemed medically necessary and certified by the member's treating provider. The member must also meet CMS criteria for what's called "homebound" status.

  • There are some, but not many, home health agencies that provide these same skilled services and do not participate in the Medicare certification program. Therefore, they cannot bill Medicare, most Medicare Advantage plans, or Medicaid. They may bill other payers such as commercial or private insurance (employer- or pension-supported plans, for example), as well as bill you directly.

  • Most states require state licensure for home health agencies, whether Medicare-certified or not.  Medicare-certified agencies follow both Medicare and state regulations.  Agencies that are not Medicare-certified follow only state regulations. These include screening and background checks of employees, as well as robust annual training.

Home care agencies and private duty agencies

  • These agencies are not Medicare-certified and cannot bill Medicare.

  • These agencies are predominantly private pay and typically bill you directly.

  • There are some exceptions, as they may have contracts with other insurance providers/third-party payers, long-term care insurance providers, the Veterans Administration, and in rare cases - Medicare Advantage programs. What these payers do not cover, however, will be billed to you directly.

  • Both home care and private duty agencies may provide skilled nursing if permitted in your state (not all states allow for this) and they choose to take advantage of that. Very few, however, offer any therapy services.

  • The primary services offered by home care and private duty agencies are home health aides (personal care, ADL) and homemakers (household care, IADL).

  • Most states also require state licensure for home care and private duty agencies, and the agency will follow state regulations. These include screening and background checks of employees, as well as some level of annual training.

    • Some states also require that an RN conduct the initial assessment and oversee the home care service plan, even if skilled nursing services are not provided.

Registries

  • Sometimes called a private duty registry, independent contractor agency, or staffing service. In-home care registries are employment services that do not directly employ anyone providing the care.

  • They serve as a middleman, connecting you with a list of possible caregiver candidates in your area, and who come at a cheaper rate than those at an agency. Pricing is the most compelling reason to use a registry.

  • Registries assume little responsibility, and zero risk or liability related to the caregiver you hire. Therefore, there are several things for you to consider prior to hiring from a registry, including responsibilities such as supervision and performance, payroll taxes, and handling work-related injuries.

  • Some registries may require a one-time screening and background check, though due to a lack of state regulation, it can be hard to determine exactly if and what checks are done on the home health aides with whom you're connected. Annual training is not required.

Care services arranged online

  • Care services arranged online are a lot like registries. A search will provide you with a selection of caregivers in your area that you can filter according to many criteria - age, gender, years of experience, services offered, distance, hourly fee, and more.

  • Online services may require a one-time screening and background check to register with them, though due to a lack of state regulation, it can be hard to determine exactly if and what checks are completed on the caregivers.

  • Online services bear no risk or liability for the caregiver you hire.

  • A major difference between online care services and registries is that caregiver payment and payroll taxes can be handled through the online service.

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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