FAQ

Common Question

What is In Home Care?

In-home care refers to a range of services provided in a person’s home to assist with daily living activities or medical care needs. This type of care is typically for individuals who are aging, recovering from surgery, chronically ill, or disabled, allowing them to remain in the comfort of their own homes rather than moving to a nursing facility or hospital.

Who qualifies for In HomeCare Services?

Qualification for in-home care services depends on an individual’s specific needs, health condition, and circumstances. Generally, people who qualify for in-home care services fall into the following categories:

1. Seniors/Aging Adults:

Individuals who want to age in place rather than move to an assisted living facility or nursing home.
Seniors needing assistance with activities of daily living (ADLs) like bathing, dressing, eating, and mobility.

2. People with Chronic Illnesses or Disabilities:

Individuals with chronic health conditions such as diabetes, heart disease, arthritis, or dementia, which make it difficult to manage daily tasks independently.
Disabled individuals who need ongoing support for their physical or cognitive limitations.

3. Post-Surgery or Hospital Discharge Patients:

Patients recovering from surgery, injury, or a hospital stay, who require temporary care at home for rehabilitation and recovery.
People needing medical care, such as wound dressing changes, medication management, or physical therapy.

4. Individuals with Terminal Illnesses:

Those requiring palliative care or hospice services to manage pain and provide comfort in their final stages of life.

5. New Mothers and Families:

Mothers who need help during the postpartum period, especially in cases of complications or multiple births.
Families needing assistance with newborn care or home support after birth.

Eligibility Criteria for In-Home Care Services:

For Non-Medical In-Home Care:
- Often private pay or covered through long-term care insurance.
- In some cases, Medicaid may cover non-medical services, depending on the state and specific program.

How do we pay for In Home Care?

Paying for in-home care can vary depending on the type of care needed, insurance coverage, and personal financial resources. Here are several common ways to pay for in-home care:

1. Private Pay (Out-of-Pocket):

Many families choose to pay for in-home care services directly using personal savings, income, or family contributions.
This option allows flexibility in choosing care providers and the level of care, but it can become expensive for long-term care.

2. Long-Term Care Insurance:

Long-term care insurance policies often cover non-medical in-home care services, such as help with activities of daily living (ADLs) and home health aides.
Each policy is different, so it’s essential to review the specific benefits, waiting periods, and coverage limits.

3. Medicare:

Medicare does not cover non-medical in-home care services (e.g., personal care, homemaking), but it does cover medical in-home care if certain criteria are met:
- The care must be deemed medically necessary and prescribed by a doctor.
- The patient must be homebound.
- Services include skilled nursing, physical therapy, occupational therapy, or speech therapy.
Medicare typically only covers short-term, intermittent care following a hospital stay or medical condition.

4. Medicaid:

Medicaid, a federal and state program, may cover in-home care services, including both medical and non-medical care, depending on the state’s Medicaid program.
Coverage varies by state, but it often includes home health services, personal care services, and long-term care for low-income individuals.
Medicaid waivers (often called HCBS Waivers) allow states to offer in-home care as an alternative to nursing home placement.

5. Veterans Affairs (VA) Benefits:

Veterans who qualify for VA benefits may be eligible for in-home care services through programs such as Aid and Attendance or Housebound benefits.
VA Home Health Services can provide skilled care, homemaker services, or personal care for veterans needing assistance.

6. Pension or Life Insurance Conversions:

Some life insurance policies allow policyholders to convert the policy into cash that can be used to pay for in-home care.
Certain pensions, especially for veterans, may also provide additional funds for those needing in-home care.

7. State and Local Programs:

Some states and counties offer assistance programs for seniors or individuals with disabilities to help pay for in-home care services. These may be need-based or have specific qualifications, such as age or income requirements.

8. Reverse Mortgages:

A reverse mortgage allows homeowners aged 62 and older to convert home equity into cash without selling their home, which can be used to cover in-home care expenses.
This option comes with risks and should be carefully considered with professional financial advice.

9. Non-Profit and Community Organizations:

Certain non-profit organizations, religious groups, or community programs may offer financial assistance or free in-home care services, particularly for seniors, low-income individuals, or those with specific conditions like cancer or Alzheimer’s.

10. Employer and Union Benefits:

Some employers or unions offer benefits or discount programs for in-home care services. Employees should check with their HR departments for details.

Each payment method has its limitations and requirements, so it’s often helpful to consult with a financial advisor or elder care planner to explore the best options based on the individual’s or family’s situation

Is In Home Care provided 24/7?

Yes, in-home care can be provided 24/7, depending on the needs of the individual. There are several options for around-the-clock care, which can be customized based on the level of care required. Here are some common arrangements:

1. 24/7 Live-In Care:

A live-in caregiver stays in the home 24 hours a day, providing continuous support. They typically work a full day and sleep at night but are available for emergencies.
The caregiver may need personal time for meals and sleep, so families sometimes arrange for backup care during those hours.
Live-in care is a good option for individuals who need help with activities of daily living (ADLs) and companionship but don’t require constant medical attention throughout the night.

2. 24/7 Shift-Based Care:

In a shift-based model, multiple caregivers work in rotating shifts (e.g., 8- or 12-hour shifts) to ensure that the client receives continuous care, day and night.
This is often used when an individual requires more intensive or frequent assistance, including nighttime monitoring or medical care.
Since caregivers are rotated, they remain alert and responsive throughout their shifts, ensuring constant supervision.

3. Overnight Care:

For individuals who primarily need help at night, overnight care can be arranged where a caregiver is present during nighttime hours.
This option is ideal for people who may not need 24-hour care but require assistance with tasks like getting to the bathroom, repositioning in bed, or monitoring for medical needs during the night.

4. On-Call 24/7 Support:

Some agencies offer on-call services, where a caregiver is available for emergencies but may not be physically present at all times. This is often used in situations where the individual only needs occasional help.
It’s a more flexible and cost-effective solution for those who require periodic assistance but don’t need constant supervision.

When 24/7 Care is Typically Needed:

Individuals with advanced dementia or Alzheimer’s disease who may wander or become confused at night.
Patients requiring ongoing medical care or monitoring, such as those with chronic conditions, post-surgical needs, or terminal illnesses.
Seniors with limited mobility or high fall risk, ensuring they have assistance when moving around their home.
People who need constant personal care and supervision to prevent accidents, such as those recovering from major surgery or living with significant disabilities.

How and When Does In Home Care begin?

In-home care can begin once a person or their family determines that support is needed, whether for medical or non-medical reasons. The process typically involves several steps, which can vary depending on the type of care (skilled nursing or non-medical assistance) and how it’s funded (private pay, insurance, or government programs).

Steps for Starting In-Home Care:

1. Assess the Need for Care:

Signs that care is needed may include difficulty with activities of daily living (ADLs) like bathing, dressing, or meal preparation, a decline in health, or recovery after surgery.
This assessment is often done by family members, doctors, or healthcare professionals who recognize that the individual could benefit from additional support.

2. Get a Doctor’s Evaluation (for Medical Care):

If skilled medical care is needed, a physician’s referral is usually required. The doctor will assess the patient’s medical condition and determine the level of care needed, such as skilled nursing, physical therapy, or medical treatments at home.
The doctor will provide a plan of care detailing the specific medical services required, which is often necessary for insurance or Medicare/Medicaid coverage.

3. Select a Home Care Agency:

Contact an in-home care agency, like PremiumCare, that offers the type of care needed (medical, non-medical, or both).
The agency will typically conduct a free consultation or assessment to understand the specific needs of the individual. This may include evaluating the home environment and determining the hours of care needed.
During this process, the agency will also explain the costs, discuss payment options, and develop a customized care plan based on the client’s preferences and health requirements.

4. Create a Personalized Care Plan:

After the initial assessment, the agency will create a care plan tailored to the individual’s needs. The plan outlines the type of care, frequency (hours or days per week), and specific tasks to be performed by the caregiver.
If medical care is involved, the care plan will be more structured and may include scheduled visits from RNs, LVNs, or other healthcare professionals for treatments and monitoring.

5. Schedule Caregivers and Begin Service:

Once the care plan is approved, caregivers are assigned to start providing services, whether on a part-time, full-time, or 24/7 basis.
For medical care, services will typically begin as soon as the physician approves the plan and the agency coordinates with licensed professionals.

6. Ongoing Monitoring and Adjustments:

Care is monitored and reviewed regularly by the agency to ensure it meets the client’s evolving needs.
Adjustments to the care plan can be made as the individual’s health or personal circumstances change. For medical cases, doctors and nurses will also review progress to make any necessary changes in treatment.

Do state and federal reviewers inspect and evaluate In Home Care agencies?

Yes, both state and federal reviewers inspect and evaluate in-home care agencies to ensure they comply with regulatory standards and provide safe, high-quality care. The extent of these inspections and evaluations depends on the type of services offered (medical vs. non-medical) and whether the agency is Medicare/Medicaid certified.

State Inspections and Evaluations:

State regulatory agencies are primarily responsible for licensing and monitoring in-home care agencies. The rules and frequency of inspections vary by state, but common oversight responsibilities include:

Licensing Requirements:
- In most states, in-home care agencies must be licensed to operate. This typically includes meeting specific standards for staff qualifications, care procedures, and business practices.
- The state licensing authority (often the Department of Health or a similar entity) conducts initial inspections as part of the licensing process and may require periodic renewals.
Regular Inspections:
- State agencies typically perform routine inspections, either annually or biannually, to ensure ongoing compliance with health and safety regulations.
- Inspectors review the agency’s care protocols, employee credentials (e.g., RNs, LVNs, CNAs), training, record-keeping, and client care plans.
Complaint Investigations:
- If a complaint is filed against an in-home care agency, the state may conduct an unscheduled inspection to investigate the issue.
- Violations of state regulations may result in fines, sanctions, or, in severe cases, the loss of the agency’s license to operate.
Medicaid Oversight:
- For agencies that accept Medicaid, additional state oversight ensures that services provided meet Medicaid requirements and billing practices are compliant with federal guidelines.

Federal Inspections and Evaluations:

Federal oversight applies primarily to agencies that are Medicare-certified and offer skilled medical services, such as nursing care or therapy. The Centers for Medicare & Medicaid Services (CMS) sets and enforces federal standards for home health agencies.

Medicare Certification:
- To be Medicare-certified, home health agencies must meet the Conditions of Participation (CoPs) set by CMS, which outline the standards for patient care, staff qualifications, and operational practices.
- The agency must undergo an initial survey by either a state agency or an accrediting organization (e.g., The Joint Commission or CHAP) to ensure compliance with these conditions.
Ongoing Federal Oversight:
- CMS contracts with state survey agencies to conduct unannounced inspections of Medicare-certified home health agencies. These surveys assess the agency’s adherence to federal regulations, including the quality of care, patient rights, and safety standards.
- Surveys are typically conducted every 36 months but may occur more frequently if issues arise or complaints are filed.
CMS Quality Ratings:
- Medicare-certified home health agencies are evaluated based on Home Health Compare ratings, which measure patient outcomes and satisfaction. These star ratings are published on Medicare’s website to help consumers choose high-quality providers.
- Agencies are assessed on various performance metrics, such as how well they manage pain, prevent hospital readmissions, and improve patient mobility.
Accreditation (Voluntary):
- Some in-home care agencies choose to seek accreditation from organizations like The Joint Commission or the Community Health Accreditation Partner (CHAP).
- Accreditation is not required by law, but it often represents a higher standard of care. Accredited agencies undergo rigorous evaluations and regular surveys to maintain their status.

What Inspectors Look For:

Patient Safety and Quality of Care: Ensuring that the care provided is safe, appropriate, and meets clinical standards.
Employee Credentials: Verifying that caregivers (e.g., RNs, LVNs, CNAs) are properly licensed and trained.
Care Plan Management: Reviewing how care plans are created, updated, and followed, ensuring that each client’s individual needs are met.
Record-Keeping and Documentation: Inspecting medical records, treatment documentation, and agency logs to ensure accuracy and compliance.
Infection Control: Especially important post-COVID-19, ensuring proper infection prevention and control practices are in place.
Patient Rights: Ensuring that clients are treated with dignity and respect, and that their rights (including privacy) are protected.

Consequences of Non-Compliance:

Fines and Penalties: Agencies that do not meet state or federal standards may be fined or penalized.
Loss of License or Certification: Repeated violations can lead to the suspension or revocation of the agency’s license or Medicare/Medicaid certification.
Corrective Action Plans: Agencies may be required to submit a plan to correct deficiencies and make improvements to regain compliance.

FAQ

FAQ