A Certified Home Health Agency is a home care services agency that meets specific standards established by federal and state government regulations and is “certified” to provide services under the Medicare program.
This type of home care agency provides directly or arranges for the following services: intermittent skilled nursing; home health aide; physical therapy, occupational therapy, speech therapy; medical supplies; and medical social work.
In order to be eligible for certified home health agency services, a client must be homebound, under the care of a physician, and need services that are skilled and intermittent, rehabilitative, or restorative. The services are planned jointly between the professional who makes the initial home visit and the patient or family and physician. The plan of care that is prescribed by the physician must be reasonable and necessary according to Medicare. Finally, the services are generally short-term and are designed to treat an acute illness or an exacerbation of a chronic illness.
Chronic care is usually not provided by a certified agency.
CHHA services are paid for by Medicare, Medicaid, or private insurance companies. Private payment for services is available. In many cases, prior approval for services may be necessary.
Patients and families can choose from the Certified Home Health Agencies in the county.
Professional Geriatric Care Management was founded in 1986. Its goal is to plan appropriate care by trained persons for the elderly and their families. This can occur in one of several ways. A family member living at a distance from an older relative may contact a geriatric care manager in the relative’s community and request an assessment and evaluation of the relative and their living situation. The care manager will then submit a detailed evaluation and recommendations to the concerned family member. The family member at that point may choose some or all of the suggestions. The care manager may actually arrange the services or the family members may do this on their own.
Geriatric Care Management services usually charge a fee and generally these fees are not reimbursable by Medicare or private health insurance. Some private long-term care insurance, may cover this service.
For information about professional Geriatric Care Management services, the National Association of Professional Geriatric Care Managers, 3275 West Ina Road, Suite 130, Tucson, Arizona 85741-2198, (520) 881-8008 (mountain time). A web site can be visited at http://www.caremanager.org/.
Home care encompasses a broad range of services geared to an individual’s particular needs. The goal of any home care plan is to provide to the patient and family the support and care necessary to enable the client to stay in the community.
Home care begins with an objective assessment of the client’s present situation, including health status, environment, sources of assistance, and financial resources. A plan of care is developed by the home care assessment staff (nurse and/or case manager or social worker) in consultation with the client, informal caregivers, family and the physician. The care plan is goal oriented: designed to maximize a client’s strengths and to maintain independence.
Today’s home care clients can be helped by a great variety of services. A continuum of care ranging from custodial to highly skilled and technical, from short term to chronic, can be provided to clients of all ages. Clients often move within the continuum, based on their needs at any given time.
In Dutchess County, services are available from a variety of sources:
Each of these sources has been fully described under its appropriate heading in this directory.
Payment for home care services varies depending on the particular service(s) and the client’s health care insurance coverage.
Hospice provides a comprehensive continuum of medical and psycho-social programs and services for persons with a medical prognosis of six months or less as certified by a physician. Hospice also provides support for the patient’s family members.
Hospice can include such services as: medical director consultation; board-certified hospice nurses; pain and symptom management; medical-social workers; pastoral care; home-health aides; illness-related medications; medical supplies and equipment; physical, occupational, and speech therapy; hospital in patient care; nursing home hospice care; hospice care in the home; respite care; 24-hour on-call service; dietary counseling; bereavement counseling; music therapy and volunteer assistance.
Hospice also provides a comprehensive bereavement program. Counselors and group facilitators are specifically trained to work with patients, family members, and loved ones to help them deal with issues related to grief and loss. Counseling and educational programs are offered on a regular basis throughout the year and are open to the public, as well as to family members of hospice patients.
The cost of hospice care services is reimbursable through Medicare, Medicaid, and commercial insurance plans. Hospice, Inc. will not deny enrollment or service based upon age, race, color, religion, natural origin, ability to pay, or mental handicap.
Licensed Home Care Services Agencies (LHCSA) may be private or hospital-affiliated, operating for profit or not-for-profit. They provide a wide range of services in the home. Any agency providing hands-on care must be licensed by the State of New York. A LHCSA must be insured; some bond their employees.
Personal care is the most used LHCSA service. As provided by home health aides and personal care workers, it consists of assistance with bathing, dressing, toileting, mobility, feeding, meal preparation, shopping, light housekeeping, and laundry. Frequent components of such services are companionship, and respite for overstressed caregivers. These personnel are assigned and supervised by Registered Nurses.
Home health aides and personal care workers must complete state-mandated training classes, are required to undergo annual physical assessment and meet in-service requirements. New employees need to undergo a criminal background check. Payment for LHCSA services vary.
Consumers should be aware that not all providers of home care services are licensed or certified. There are agencies and individuals who advertise and provide such services without oversight by any responsible government agency.
Most LHCSAs doing business in Dutchess County are members of the Home Care Association of Dutchess County, whose members also include Certified Home Health Agencies, Long Term Home Health Care Programs, county agencies, and others concerned with ethical, high quality delivery of home care.
The Long-Term Home Health Care Program (LTHHCP) is a Medicaid waiver program that delivers home health care on a long term basis to the chronically ill or disabled person. The LTHHCP provides a comprehensive and coordinated plan of health and personal care services tailored to meet a person’s health, social, and environmental needs.
The disabled or chronically ill person over the age of 18 is eligible if he or she is medically eligible for nursing home care, can be safely cared for at home, has physician approval, is a resident of Dutchess County and has a care plan that costs 75% or less than the cost of a nursing home. Services vary according to individual need.
Medicaid is the usual payment source for the LTHHCP. For those care plans, Dutchess NY Connects is the authorizing agency. For clients who pay privately, all case management is provided by the LTHHCP. Care for clients of the HIV program is paid by Medicaid, Medicare, private insurance, and grants.
Respite care is the provision of short term, temporary care that provides relief for caregivers of the ill or disabled.
The goals of respite may include providing support and reducing the stress and pressures placed on family members and other caregivers by giving them time off to relax or take care of personal needs. It may also improve the mental and physical health of caregivers, thus providing a healthful environment for both caregivers and those they care for.
Levels of care range from minimal care to nursing level of care. Care may be provided in the home by trained volunteers or at Adult day care centers, adult homes, and nursing homes. Twenty-four hour institutional care may be provided by adult homes, foster care homes, family-type homes, nursing homes and residential programs. Licensed Home Care Services Agencies provide nurses or aides in the patient’s home at an hourly or daily rate.
Admission to a formal respite program usually involves an intake process, including determination of eligibility and identification of funding sources; determination of a care plan by a respite care case manager, caregivers, and the client; and sometimes a home visit.
Some providers of respite provide additional services, such as information and referral, and training for primary caregivers.