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What is Home Care?
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The scope of home care is broad. It encompasses a wide array of both
health and supportive services delivered at home. Clients cross the
spectrum of care-from seniors who need assistance with activities of
daily living in order to remain in their homes, to new mothers, discharged
quickly following childbirth with a few post-partum nursing visits for
mom and newborn, to post-surgical patients needing assistance with wound
care, to the chronically ill who
are maintained with skilled supervision, support services and
equipment.
Frequently, the term "home health care" is used to refer to skilled
clinical treatments, such as the services of a registered nurse, or
physical therapist, or to receive in-home glucose monitoring or
intravenous therapies. In fact, the generic term "home care" is a more
apt description of the range of both medical and supportive services
designed to bolster the post-acute, chronically ill, disabled, and
elderly populations that home care providers serve. For such patients,
homemaking, personal care for nutrition and hygiene, and adaptive
devices to prevent slips and falls are as important to their
rehabilitation and functioning as the more sophisticated health
technologies that are also delivered at home. Both in-home clinical
care and support services are cost effective by reducing hospital
stays and by preventing or delaying institutionalization in a nursing
home.
New York’s Medicaid home care program provides this wide range of
services to over 175,000 homebound sick and elderly patients throughout
the State (2004 data) while over 188,000 New Yorkers receive home care
funded by the federal Medicare Program (2004 data). And of course,
thousands of New York State residents purchase home care services
privately and others receive home care services through private
insurance coverage in both indemnity and managed care benefit plans.
The average home care visit costs significantly less than a day of
nursing home or in-patient hospital care. Clearly, home care is the
solution to increasing health care costs, offering opportunities
for achieving real cost savings for a broad variety of patients.
New York has and must continue to look to home care as the primary source
of long term care services to keep patients in their homes and communities.
In an effective continuum of care we should expect to see increasing
levels of home care utilization, not as a result,
of "over-utilization" of home care, but as a result of shifting
utilization away from more costly settings into home care.
Types of Home Care Agencies
New York State licenses or certifies a variety of home care
program types. Home care agencies and programs differ in the services
they provide and the State agency that oversees their operation. The
New York State Department of Health (DOH) sets standards for and
regulates all home care agencies that provide health or medically
related services to people in their homes. DOH and the Federal Centers
Medicare & Medicaid Services (CMS) jointly regulate agencies
participating in the Medicare program. DOH regulations and standards
require that home care providers meet the same standards relating to
agency establishment, paraprofessional training, quality of care and
consumer protection standards including service delivery and personnel
requirements. The following types of home care agencies require either
a license or certification issued by DOH:
Licensed Home Care Services Agencies(LHCSAs) offer home care
services including all levels of nursing care, various therapies, home
health aides and personal care aides to clients who pay privately,
have private insurance coverage or are covered through a variety of
government payers. Many LHCSAs also
deliver services under contract with local departments of social
services or other service-authorizing agents. In particular, services
through the Medicaid Personal Care and Private Duty Nursing Programs
are delivered in this way. Licensed agencies also sub-contract with
other home care providers to deliver services to beneficiaries throughout
New York State. LHCSAs may offer a full range of services from skilled to
paraprofessional or may choose to focus on the delivery of one service or
population, such as high-tech pediatrics or aides to seniors.
Certified Home Health Agencies(CHHAs) provide care and
support services to individuals who, for the most part, have home health
care needs for a limited duration. These agencies provide nursing and
home health aide services, and provide or arrange for other professional
services, including physical and occupational therapy, speech pathology,
medical social work and nutrition services. They are generally reimbursed
through Medicare and/or Medicaid.
Long Term Home Health Care Programs (LTHHCPs), also known
as "Nursing Homes Without Walls" are CHHAs operating under a specific
Federal Medicaid waiver. They offer health care and support services to
the disabled and chronically ill who are medically eligible for admission
to a nursing home, but who choose to be maintained at home. These
programs provide a full range of professional and aide level health care
services to those in need over a long period of time, at a budgeted
amount of 75% of the cost of nursing home care.
Hospices offer home and inpatient care and counseling for
the terminally ill and their families. Hospices offer palliative care
rather than treating disease. Under the hospice program, dying persons
and their families receive physical, psychological, social and
spiritual support and care.
All together, there are approximately 900 home care agencies in New
York State, employing over 250,000 workers. In addition to professional
nurses, therapists, and assistants, home care agencies hire and train
workers as home health aides and personal care aides, and offer these
paraprofessionals additional opportunities for career growth.
Home Care Paraprofessionals
- Personal Care Aides (PCAs) provide services to persons needing
some or total assistance with everyday tasks, including such things as
personal hygiene, dressing, feeding, walking, meal preparation, light
housekeeping, and laundry. PCAs provide services to help clients stay
in the home and live independently. There are two levels of PCAs, Level
I and II. PCA I employees perform homemaker functions and have no
physical contact with the client. The PCA II employees are responsible
for all of Level I functions as well as personal care tasks, including
among other things assistance with personal hygiene, dressing, walking,
and transferring. PCA II employees are required to attend a 40-hour
basic training course and attend in-service training throughout
the year.
- Home Health Aides (HHAs)
are the highest level of
paraprofessional in home care. HHAs are responsible for health-related
as well as personal care tasks. These health-related tasks include
monitoring the client's health status by taking temperature, pulse,
respiration, and blood pressure, and assisting with basic health
tasks that allow the client to remain at home. HHAs must follow a
plan of care and perform tasks outlined by a registered nurse, and
if problems or changes in the client's condition, they are responsible
for immediately notifying the supervising nurse. HHAs are required to
complete a 75-hour training program, which includes both classroom and
laboratory/in-home training, and attend in-service training throughout
the year.
Home Care Programs and Services
The Centers for Medicare & Medicaid Services (CMS) regulates home care agencies that
provide Medicare home health services to Medicare beneficiaries. The New York State
Department of Health (DOH) regulates the
home care service programs that are available to certain
Medicaid-eligible people under the State's
Medicaid program.
- Medicare Home Health Benefit provides care to Medicare beneficiaries who are unable to
leave their homes without considerable effort or assistance and require part-time or intermittent skilled
care to treat their illness or injury. Skilled care may include nursing and/or therapy and may be
accompanied by aide services or social work. Medicare pays for home health benefit services based
on a 60-day episode of care.
- The Personal Care Program provides assistance with Activities
of Daily Living (ADLs), such as personal hygiene, mobility, toileting,
feeding, meal preparation, light housekeeping and laundry for people
who require such support services based on a medical need. Personal Care
program clients receive services based on a doctor’s orders and plan of
care. The local social services offices determine the need for these
services. In New York City the Home Attendant Program delivers these
services through participating agencies and is regulated by the New York
City Human Resources Agency.
- Private Duty Nursing Services provide fee-based
skilled nursing care (RN and LPN)to home care recipients. Many pediatric, disabled,
and AIDS beneficiaries receive services through this program. Agencies
delivering this type of care must receive prior approval from DOH and
their local social services district.
- CHHA Services parallel the part-time, intermittent, post-acute
care services that are offered and delivered under the Federal Medicare
home health benefit. Medicaid beneficiaries can receive a wide-variety
of medically-necessary services including home health aide, skilled nursing, and therapies,
to assist in their recovery from an illness, surgery or hospitalization.
- Care at Home (CAH) is a Medicaid Model Waiver Program that
enables physically and developmentally disabled children to be cared
for at home at costs that are lower than those of institutional care.
The CAH waivers enables middle-income families, who would not ordinarily
qualify for Medicaid, to obtain nursing care, case management and other
support services for their children. This program may also be accessed
through the Office of Mental Retardation and Developmental Disabilities
(OMRDD).
- Consumer Directed Personal Assistance Program (CDPAP) is a Medicaid
personal care program for disabled adults and patients with long-term chronic illness who are
self-directing. In the CDPAP, patients participate in care planning and are responsible for
the hiring, training and supervision of workers to provide their care while home care agencies
or other facilities act as a fiscal intermediary between the worker and the Medicaid program for
payment. Local social services offices must conduct an assessment to determine if CDPAP is
appropriate for the patient and also authorizes hours of service, in much the same manner as
the Personal Care Program.
The New York State Office for the Aging (SOFA) regulates home care
programs that are provided through county offices for the aging,
including the Expanded In-Home Services for the Elderly Program for
elderly people who do not qualify for Medicaid.
Other Services
In addition to the specific programs described above, home care
agencies provide a wide range of services, including the following:
AIDS Program
Companions
Continuous Care (Pvt. Duty) Nursing
Geriatric Alcoholism Counseling
High Tech Therapy
Home Health Aide
Home Medical Equipment
Home Transfusion
Homemaker Services
Hospice
Housekeeping
I.V. Therapy
Industrial Nursing
Infant/Child Care
Infusion Therapy
Laboratory
Live-In Services
LTHHCP Waivered Services
Medical Social Work
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Mental Health Services
Nursing Visits
Nutrition
Occupational Therapy
Paraprofessional Staffing
Pediatric Care
Personal Care
Personal Emergency Response System
Pharmacy
Physical Therapy
Rehabilitation
Respiratory Care
Respite Care
RN/LPN Staffing
Shared Aide Program
Social Model Adult Day Care
Speech Therapy
Training
Ventilator Dependent Services
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Seminars / Grants & Demonstrations / CHC Forum / About CHC / HOME
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Community Health Care Services
Foundation, Inc.
99 Troy Rd, Suite 200
East Greenbush, NY 12061
518/463-1167 fax: 518/463-1606
chc@chcforum.org
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