Home Health Agencies and Personal Care Agencies

by Casey Rydbick

Published: 5 years ago

As you’re looking into the various options for senior care, it is easy to get overwhelmed by the many different homes and living communities if you are not sure what is needed yet. The world of senior care can be confusing as you sort out the details of each facility’s services and whether or not those services are covered under insurance or government programs. If you are weighing the option of home care for your senior loved one, consider choosing a home health agency or a personal care agency over a senior residential community.

What Is Home Care?

Home care includes both long-term and short-term care services, and is exactly what it sounds like: caregivers will assist the senior in their activities of daily live (ADL) in the comfort of their homes. The caregiver will assist in meeting the needs of the senior, anything from companionship to managing their medication. Caregivers will either be clinical or non-clinical professionals, with many working through agencies rather than independently. One benefit of these home care agencies is that they will save you the time it takes to find a certified caregiver. There are primarily two types of home care agencies: home health agencies and personal care agencies.

Home Health Agencies

Home health agencies are distinguished from personal care agencies by the type of caregivers these agencies work with. Home health agencies work with medically skilled caregivers. These agencies will provide skilled medical professionals such as registered nurses, nurses’ aides, and licensed therapists to those in need.

According to the Centers for Medicare & Medicaid Services, there are over 33,000 home care agencies serving over 12 million people in the United States. Home health agencies are also Medicare certified. However, due to the nature of the work, which involves caring for with those with serious medical conditions, home health agencies are heavily regulated in the United States.

Home health agencies provide a number of services to seniors with different needs. For instance, these agencies can provide medical staff such as nurses and occupational therapists to visit your home and provide assistance and rehabilitative care on a short-term basis. Every year, hundreds of thousands of people suffer from falls, accidents, or medical emergencies such as strokes, which can debilitate a person and make it hard for them to carry out day-to-day activities. Although many of these serious cases are involve a critical need for medical assistance and rehabilitation, the costs of hospitalization can be too overwhelming for many families and individuals. Even in cases of chronic illnesses, when hospitalization is ruled out as a feasible option, many people will hire for assistance and medical services from home health agencies. For many, reasons such as costs, convenience, and personalized care make home health agencies a viable option.

Services Provided by Home Health Agencies

Home health agencies focus on providing skilled medical care for the care recipient. For instance, while skilled medical staff can help with eating and bathing. They will not help with housekeeping such as laundry and or with preparing meals. Services provided by home health agencies include:

Medication management
Therapies services (speech, physical, occupational, etc)
Identify and arrange for needs such as day care and support groups
Specialized care for Alzheimer’s and dementia
Monitor vital signs such blood pressure, pulse, and temperature.
Watch nutritional intake and prescribe a balanced diet.
Administer medication in emergencies
Monitor how the person is responding to treatment
Use feeding tubes and catheters when needed

Personal Care Agencies

Personal care agencies fall under the umbrella of non-medical home care agencies. This means that personal care agencies primarily provide services through non-medical or non-skilled caregivers. Personal care helpers assist with a person’s activities of daily living, which include tasks such as cooking, eating, bathing, getting dressed, and more. Although these agencies focus on providing these personal care services, just like home health agencies, there are some personal care agencies that also provide skilled medical staff such registered nurses, aides, and certified nursing assistants. Whereas home health agencies have medically certified caregivers, personal care agencies can provide non-certified nurse aides and home aides who can provide companionship and care to look after your loved ones. Personal care agencies are sometimes referred to as in-home care, companion care, and non-medical care.

A personal care agency can be the best solution for you if:

The care recipient does not have a need for heavy medical attention
The recipient needs help with daily tasks such as preparing meals, bathing, dressing, etc.
There is a greater need for companionship and personal care
Home care is a better option than an assisted living community

Services Provided by Personal Care Agencies

Personal care agencies provide services that differ from home health agencies. Personal care agencies provide services such as:

General housekeeping and maintenance
Laundry and linen services
Grocery shopping and meal preparation
Feeding, bathing, dressing, grooming, and toileting
Scheduling and planning activities for the day
Running errands
Taking the care recipient on outings
Taking the recipient to the doctor or other scheduled appointments
Provide emotional support as a companion
Help recipients perform any prescribed exercises and report progress
Supervision for daily medications and vitamins
Basic medical needs and support

Types of Caregivers

Depending on the kind of agency you opt for, the following skilled professionals will come to assist in your home: registered nurses (RNs), certified nursing assistants (CNA), licensed practical nurses (LPN), physical therapists (PT), occupational therapists (OT), speech-language pathologists (SLP), unlicensed assistive personnel (UAP), home health aides (HHA) and medical social workers (MSW), and personal care assistants (PCA). In home care, the most common caregivers are certified nursing assistants (CNA), home health aides (HHA), and personal care assistants (PCA).

Certified nursing assistants (CNA) are certified after passing an exam and receive first-hand training as well as medical education. Unlike other caregiver, CNAs can give proper medical assistance. However, home health aides and personal care assistants cannot. CNAs look after the care recipient’s vitals and medical condition. They administer medication and take notes on how the patient is progressing. CNAs can also help with basic personal care such like toileting and changing clothes but these tasks are primarily for HHAs and PCAs.

Home health aides (HHAs) are also state-certified medical professionals like CNAs. However, unlike CNAs, HHAs have limited medical training and education. HHAs will tasks that do not require the experience of a nurse. They can also serve as companions to the care recipient and will have more medical knowledge than a personal care assistant.

A majority of personal caregiving is comprised of personal care assistants and home health aides. Personal care assistants are also known as aides, companions, and caregivers. These individuals will visit homes and assist with activities of daily living (ADLs) and offer companionship. Personal care assistants do not have any medical education or standardized exams. For this reasons, PCAs cannot carry out any form of medical procedure. However, in many states it is mandatory for PCAs to have a set number of hours in caregiving training.

Costs of Home Care

The costs of home care are influenced by the types of service and caregivers, number of service hours, as well any additional costs for equipment and emergency medical services. Although many agencies calculate costs using an hourly rate, different agencies will have varying options. The hourly allows for a fairly flexible arrangement for cases where an elderly person needs less services. In cases where a senior is fairly independent but still needs some assistance, one can ask for a few hours of service instead of a full day. However, note that some agencies will have a minimum number of hours per day for caregiving services. As it would with long-term senior care, the costs of home care can vary from state-to-state. According to a survey conducted by Genworth Financial the average hourly rate for home health care in 2018 was $22 and the average rate for personal care service was $21.

In the case where a care recipient is suffering from a serious medical condition requiring around-the-clock care and supervision, agencies may charge using a daily rate. Services are also offered for overnight stays if the senior requires personal care or medical assistance in the middle of the night. For example, some seniors will require help to go to the bathroom in the middle of the night, or will need supervision to prevent any falls or wandering behavior due to Alzheimer’s or dementia. In some cases, overnight rates are charged lower than the daily rate. After assessing the amount of care that the senior requires, the agency will establish a daily rate for its services. The Genworth Financial survey quotes the daily median costs of personal care and home health services across the United States, which was $132 for personal care services and $138 for home health services. Although these statistics quote the median costs across the county, the actual costs may vary depending on your state and the services you require.

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Paying For Home Health Services

There are a few options when it comes to covering the costs of home health services. Unlike other senior living communities, home care will not require you to pay for any rent or utility costs. Instead home care fees are primarily comprised of service fees and additional equipment or emergency services. Here are some of the most common ways people pay for home health services:

Medicare

A large majority of Americans use Medicare to pay for home health services. Private health insurance can also cover in-home, short-term medical care, so ask your insurance provider about these benefits. However, Medicare will cover home health services for a 60-day periods. After every 60 days, a physician will evaluate the patient’s health condition and if the patient doesn’t require medical health, Medicare will discontinue coverage for home health services. In order to access the benefits of Medicare, one must meet its program requirements.

How to qualify for coverage under Medicare

In order to qualify for Medicare coverage, one must meets these requirements:

Recipient must be 65 years of age or older or have a disability.
A physician needs to prescribe home health services to the person. However, doctors may prescribe different services than what is covered under Medicare or what what is offered by a home health care agency.
The physician’s prescription must be updated every 60 days.
The recipient is homebound.

One important note is that Medicare also does not cover long-term health care service. Generally, Medicare’s home health care coverage is a short-term option that is limited according to a person’s improving health condition. The program will enable caregivers to look after a recovering individual until they are in a state that does not require constant medical attention. Once the individual has improved in health, Medicare will discontinue its home health coverage and the individual may need to recruit for personal care service.

As of 2019, Medicare may cover non-medical care services or personal care services under specific circumstances. If the beneficiary is enrolled in the Medicare Advantage plan, it is possible the program can cover personal care services. You can read a summary of the benefits of Medicare here.

Medicaid

Medicaid is a joint federal-state insurance program for low-income individuals. The program can cover non-medical and in-home care services, such as personal care services. However, because Medicaid is administered at the state level, eligibility requirements will vary from state to state.

How to Qualify for Personal Care Services Under Medicaid

To qualify for the Personal Care Services Program under Medicaid, one needs to meet the following criteria:

Recipient must have a disability, physical or mental illness, or a chronic health condition.
Recipient must have a Practitioner Statement of Need that is signed by a certified medical practitioner (physician, advanced practice nurse, or physician assistant) who has examined the recipient in the last 12 months.
Recipient needs help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) based on the Personal Care Assessment Form (PCAF).
Recipient must have a legitimate reason for why their guardian cannot help with ADLs and IADLs.

Private Pay and Insurance Plans

If you’re looking for long-term and non-medical care, you may not qualify for government assistance. In these cases, private pay and long-term insurance may be the best options. A large percentage of the people pay out-of-pocket for long-term care and some may decide to use their retirement funds, savings, etc. to pay for their in-home care. One can also use a long-term insurance plan if the care recipient has been contributing to a long-term care insurance company, which can cover up to 20 percent of the bill.

When To Look for A Home Care Agency

Many people will contact home health agencies for rehabilitative care after a surgery, medical emergency, or a progressing medical condition such Alzheimer’s or Dementia. However, in most cases, people will reach out to a home care agency for their aging loved one.

As a loved one ages, he or she may try to deny any help in completing day-to-day activities. However, when a loved one begins to have mobility issues, struggle with forgetfulness, or have difficulty taking care of themselves, external assistance is mandatory for a improved quality of life. In order to evaluate whether or not your loved one is in need of that extra support, one should set up a formal evaluation with a family physician, who can correctly gauge the mental and physical capacities of your loved one. One way to find out whether or not your loved on is in need of in-home care is to see if they have difficulty completing activities of daily living (ADL) and instrumental activities of daily living (IADL).

Businesswoman Writing On Checklist

Activities of Daily Living

ADLs are day-to-day tasks that are needed in to maintain a basic personal care and a healthy quality of life. These task include bathing, dressing or undressing, toileting, eating, walking and more.

Instrumental Activities of Daily Living

IADLs are more complex activities but just as important for living an independent life. IADLs include skills such as managing finances, managing transportation, grocery shopping, meal preparation, general housekeeping, medication management, and clear communicating.

If your loved one is having difficulty completing any ADLs or IADLs, then it may be time to look for assistance for these needs.

Hiring Individual Caregivers

Apart from home care agencies, one can also consider an option for long-term senior care: private caregivers, also known as individual caregivers. Hiring an individual caregiver may be more cost effective. However, you may miss out on some key benefits that agencies provide through their own vetting process. Agencies are able to provide caregivers who have been given a background check, are state certified and trained, and can be offer substitute caregivers in case the original caregiver is unable to come.

Additional notes on home care:

As you are looking for an agency, make sure it is Medicare certified, which means that the agency has met specific federal guidelines and criteria.
Medicare Certification is not very common. Out of the estimated 33,000 home care agencies nationwide, only 14,500 are home health agencies (certified).
It’s mandatory for home health agencies to be licensed, whereas, personal care agencies can operate without any licensing.
Home health care may be a better but pricier alternative to nursing homes.

To read more on financing senior care, visit our blog and our articles on senior living.