Consumer Resources

Understanding the different types of services available for home care can be confusing, to say the least. The following list is designed to clear up some of the confusion.

Length of Care

• Hourly Care: Hourly care can be provided by a companion or homemaker, certified nursing assistant (CNA), home health aide (HHA), licensed practical nurse (LPN), or registered nurse (RN). The caregiver can provide care within the scope of their licensure/certification, as well as companion/homemaker services. A minimum of five hours of care is required. RN, LPN, and bed-and-bath visits are also available.
• Live-in Care: Care can be provided by companions/homemakers, CNAs, HHAs, LPNs, or RNs 24 hours a day, seven days a week. The caregiver can provide care within the scope of their licensure, as well as companion/homemaker services. A live-in caregiver must have eight hours of uninterrupted sleep. For individuals who need full 24-hour attention, shift-work care is recommended.
• 24-Hour Care: This level of care and service involves a home care professional who is awake and ready to attend to a patient's/client's needs 24 hours a day. Typically, this applies to HHA-level care, with rare exceptions. Multiple care providers work in shifts to provide this service, which is typically paid for privately or through long-term care insurance.
• Visits: A visit is when a health professional, aide, or nurse comes into a patient's/client's home or residence and performs specific tasks or duties. A visit can last up to an hour but is defined, time-wise, by the completion of the required duties. When the tasks have been performed and completed, the visit is over. For example, a skilled nursing visit may include tasks like removing a wound dressing, documenting it in the patient's/client's medical record, treating the wound, applying a new dressing, and monitoring the patient's/client's general health. An HHA visit may involve assisting the patient/client with undressing, bathing, getting dressed, and changing bed linens.

Types of Care

• Homemaker/Companion/Sitter: A homemaker/companion cares for elderly, disabled, or convalescent individuals or couples. They can accompany them on trips, outings, and appointments, as well as prepare and serve meals. Companions are available to provide care per hour, shift, or on a live-in basis. Typical duties include companionship, sorting and reading mail, appointment arrangement, assistance with walking, letter writing, meal planning and preparation, bed-making, answering the phone and door, grooming assistance, apparel selection assistance, indoor house plant care, appointment reminders, entertainment (playing cards, sewing assistance, etc.), diet and eating habit monitoring, grocery shopping, and medication reminders.
• Certified Nursing Assistant/Home Health Aide: CNAs and HHAs hold nursing assistant certificates. Those receiving care from a CNA or HHA should be under the care of a physician and/or supervised by an RN. Nurse aides assist with bathing, dressing, toileting, grooming, eating, physical transfers, and other daily routines the patient/client could perform if capable. They can also perform all the services of a companion or homemaker and are available hourly, for shift work, or on a live-in basis.
• Licensed Practical Nurse: LPNs have practical nurse licenses and are supervised by an RN or a physician. An LPN maintains the medical treatment plan created by the RN and approved by the physician. They can also perform the services of a CNA, homemaker, and companion.
• Registered Nurse: RNs are licensed and maintain clinical records for patients/clients receiving nursing care. They develop medical treatment plans and can maintain or supervise their maintenance. RNs supervise LPNs and CNAs/HHAs and manage patient/client medications. RNs are available on an hourly basis, per shift, per visit, or on a live-in basis.

Home care is funded through various sources, each with different benefits and requirements. Major payment sources for home care include:

• Patient/Private Pay: Home care services can be personally funded. The scope of services and fees are negotiated between the patient/client, their family, and the agency. For those whose resources are limited, some agencies offer a sliding-scale fee schedule to ensure affordability based on the family's financial situation.
• Private Health Insurance: Coverage varies widely, but private insurance typically covers physician-directed medical services and equipment. Patients and families should consult their insurance provider to understand the specifics of their coverage.
• Medicare: To qualify for the Medicare home health benefit, the patient must be under a physician's plan of care, be homebound, and need part-time or intermittent skilled nursing care or therapy (occupational, physical, or speech). Eligible patients can receive services such as skilled nursing, personal care, therapy, medical social work, and medical supplies/equipment.
• Medicaid: Administered jointly by federal and state governments, Medicaid provides services similar to Medicare for low-income individuals. No prior hospitalization or "skilled" level of service is required, and homebound status is not a prerequisite for eligibility.
• Social Services Block Grants: Federal Title XX funds are available to support in-home personal care services.
• Older Americans Act: Title III of the Older Americans Act offers in-home services, including home-delivered meals and personal care.
• Workers' Compensation: Individuals requiring home care due to a work-related injury are eligible for coverage under workers' compensation. Eligibility details can be obtained from your workers' compensation representative.
• Health Maintenance Organizations (HMOs): HMOs and Comprehensive Medical Plans (CMPs) with Medicare contracts must provide the full range of Medicare-covered services, including home care, available in their geographic area.
• Civilian Health and Medical Program of the Uniformed Services (CHAMPUS): On a cost-shared basis, CHAMPUS covers skilled nursing care and other professional medical home care services for dependents of active military personnel, retirees, and their dependents and survivors.