Families considering home care for a frail loved one are faced with several decisions. One important factor to understand is the type of agency you need. Will you need assistance through a certified home care agency or through a licensed home care agency? Both offer different types and degrees of care. They both must be registered with the state and must comply with state and federal regulations. The differences are in the details.
Certified Home Health Agencies
A Certified Home Health Agency (CHHA) provides nursing services and other skilled care to patients on a temporary basis. This care can include physical, occupational, and speech therapy, social services and medical equipment. A CHHA can provide some custodial home care as well but only intermittently.
Certified agencies primarily provide care after a hospital stay. A nurse might come by the home daily to change bandages, give injections, and check on vitals. She will continue the visits until the patient is well enough to get by on his own. There are times when a CHHA will provide nursing care to a patient over extended periods of time. This might be for homebound patients who need continual observation for chronic conditions like diabetes or cardiac monitoring.
CHHAs can provide some home attendant services for personal care. Home health aides can be assigned to visit a home and help a patient with bathing, dressing, eating, and some housekeeping, but this care is only for short periods of time. The aides are not expected to stay all day. In fact aides that are assigned through a CHHA can work no more than 35 hours a week.
Before a patient can be offered CHHA services, a licensed medical doctor must authorize the need. The physician fills out an assessment form that describes the patient’s medical conditions and the type of care required. The assessment must be submitted to a certified home care agency within 30 days.
A CHHA is regulated by the New York State Department of Health and is paid through Medicare and Medicaid. All home attendants must complete government certified training programs. Upon completion of the course work, the applicants are screened for any legal infractions and immigrant status. To insure that a CHHA complies with federal and state regulations, professional survey teams make annual unannounced assessments of all agencies, write up any infractions and publish the results.
Licensed Home Care Service Agencies
A Licensed Home Care Service Agency (LHCSA) is a private company that offers custodial care. A LHCSA is regulated by the state and provides hourly personal care services through home health attendants with oversight by a nurse. A nurse and social worker first develop a care plan for the client then assign a home health aide to assist the client with daily activity like bathing and dressing. The aides can also perform light housekeeping, shopping, meal preparation, and laundry. They cannot provide any skilled care, handle medications or provide medical treatment. Only a nurse can preform medical tasks.
The home health aides require the same accreditation training as aides in a certified agency and go through the same background checks. Licensed home care service agencies are paid with private funds, either directly from the family or through long-term-care insurance. In theory this means a patient can receive as much home care as they desire, as long as they can afford the services. Licensed home care service agencies in New York City often charge as much as $25/hour.
Like certified agencies, licensed agencies are regulated by the state. The process can often take up to two to three years. Before being licensed the firm must comply with employment regulations, offer workers’ compensation and carry general and professional liability insurance. They must keep confidential written records on all their patients and document any accidents and incidents.
One important requirement of a LHCSA is to develop a written emergency preparedness plan for every client. The plan describes a course of action that will keep the patient safe in case of a natural or manmade disaster. The plan could recommend a client to have a backup power source that supplies electricity for medical equipment in case of a utility outage. It must also indicate a hospital where a client can be taken if an aide is unable to reach her.
In short, both licensed and certified home care agencies help patients stay in their home. The biggest difference is in the degree of help they provide and in how they are paid. Certified agencies provide a higher level of medical care than a licensed agency. Their service is usually temporary and intermittent and is paid through Medicare and Medicaid. A Licensed Home Care Service Agency offers long-term custodial care and is paid privately. Both are important in helping care for frail aging family members but it is important to understand how each operates in order to get the requisite care.
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