Patient & Caregiver Resources

Home care is the original way people cared for their loved ones. Before doctors’ offices, hospitals, and nursing homes existed, most people received assistance and care in their own residence. Though institutional care received most of the attention as our health care system matured, home care has remained an essential component, quietly serving millions of Americans where they most want to be.

Formal home care started here in Massachusetts when public health nurses began traveling to patients’ homes to care for the sick, instruct families, and comfort the dying. Though home care continues to provide these services, changing family dynamics, new client needs, and technological advances have enabled it to expand its repertoire.

Today, home care encompasses a wide array of services but – at its core – always involves aides, therapists, and nurses providing care and assistance in clients’ residences. Depending on the situation, it can include everything from occasional help with household chores, to daily assistance with dressing and bathing, to around-the-clock medical care.

For example, some people use home care briefly to recover from injuries or hospitalizations. Others use it to supplement services from assisted living or retirement communities.  Still others use it to remain healthy and independent at home, despite chronic illness or diminished capabilities.  In all these situations, good home care recognizes that each client requires an individualized care plan. Services vary, but the objective is always to support independence and allow the client to remain at home.

The simplest way to pay for home care is to do so privately; i.e., out of pocket, as you would for any other service. This affordable option maximizes your flexibility and control over your care without requiring you to coordinate with third parties.

However, government programs and private insurance will pay for home care under specific circumstances:

Medicare covers home care when the client: 1) Cannot leave home without physical assistance; 2) Is under a physician's care; and 3) Requires skilled nursing or therapy services. The state Medicaid program covers home health for low-income individuals under similar requirements.

The Massachusetts Home Care program provides state-funded, non-medical services to elders and disabled individuals who meet certain financial guidelines. These supportive services enable frail elders to remain in their homes and target those at risk of needing nursing home care. They can be accessed locally through by calling (800) AGE-INFO or www.800ageinfo.com.

Commercial health insurance typically covers some home care services when a person is recovering from injury, surgery, or temporary illness, but will not pay for most chronic conditions. Benefits vary from plan to plan and usually contain a cost-sharing provision. Check your policy and insurer for details on coverage requirements, benefits, co-payments, and deductibles.

Long-term care (LTC) insurance policies almost always cover home care as an alternative to a nursing home. The home care benefits under these policies are usually capped at a certain dollar level per day, week, or month; as always, check your policy.

The Veterans Administration (VA) pays for home care services for veterans who are at least 50% disabled due to a service-related condition. A physician must authorize these services, which must be delivered through the VA's network; it only covers medical services.

MHA's Continuum of Care Council, which includes the Alliance, has created After the Hospital: A Guide to Post-Acute Care to inform patients and their caregivers of their options for care after a major change in a patient's health. The 64-page After the Hospital: A Guide to Post-Acute Care fulfills a long-standing need to educate the public and members of the healthcare community about the care options available to patients following a medical event or hospitalization.

The guide is intended to cut through the confusion to provide patients, their families, or the person entrusted with their care a roadmap that will assist them in:

• Understanding their care needs;
• Learning about services that meet their needs;
• Talking to their health insurance company;
• Finding out more about their providers; and
• Making the choice that is right for them.

For providers, After the Hospital: A Guide to Post-Acute Care lays out the elements of a successful post-acute process, the range of available post-acute care services, provider checklists to support care transitions, and a list of key terms and concepts.

The full guide, or individual sections, can be accessed here:

• After the Hospital: A Guide to Post-Acute Care (full report, 64 pages)
• For Patients and Families (31 pages)
• For Providers and Clinicians (10 pages)
• Post-Acute Care Resources (25 pages)

While most states offer a specific license for private pay home care agencies, Massachusetts does not. In order to establish quality standards and help consumers make informed choices, the Alliance created an Agency Accreditation Program with standards similar to those for licensure in most other states.

The accreditation program includes fifteen standards relating to: Client rights, privacy, and complaint procedures; Protections against abuse; Fair employment practices; Caregiver background screening; Competency, training, and supervision; Insurance coverage; and Compliance with all applicable federal, state, and local laws.

To become accredited, agencies must present documentation demonstrating that they meet each of these standards; the documents are then carefully reviewed by Alliance staff for proof of compliance. The Alliance only accredits agencies that meet or exceed all fifteen standards.

At the Federal level, Medicare Certification is an intensive process of review by the Centers for Medicare Services, a division of the Department of Housing & Human Services; only agencies with this certification can get reimbursed for Medicare and/or Medicaid-covered care.

Though Medicare Certification & Agency Accreditation are the simplest indicators of an agency’s competence, they are not the only ones: many other reputable organizations offer accreditation and/or certification programs, and many agencies without any form of accreditation or certification provide excellent, safe service.

They operate under completely different business models and offer different services.

Medicare Certified agencies can bill Medicare/Medicaid for their services, and some accept only Medicare patients.  To qualify for Medicare reimbursement, patients must be 1) home-bound, 2) have skilled medical need requiring a nurse or other trained professional, and 3) have a doctor’s order verifying these first two.

Private Care agencies can not bill Medicare, but accept pay from a variety of other source, including private insurance programs, and out-of-pocket.  Some Private Care agencies offer a combination of medically skilled and unskilled services, while others exclusively offer only non-medical.  All of this gives private care agencies far greater flexibility than their certified cousins.

When selecting a home care provider, ask questions; any reputable agency will give you clear answers. Doctors and hospital social workers can also be good sources of information, but the choice is up to you.

When you call an agency, "interview" them with the following questions:

• Does the agency have literature describing its services, fees, and billing? If so, will they send you copies?
• Does the agency work with the client to develop a written plan of care or service contract? If so, how often is this plan updated?
• Does the agency directly employ its workers or are they independent contractors? (They should be directly employed.)
• Does the agency pay workers’ compensation insurance and payroll taxes for its workers?
• Does the agency provide a written list of client & family rights?
• How does the agency screen and evaluate their employees?
• Are caregivers, supervisors, and backup available 24/7/365?
• How does the agency investigate complaints and/or resolve conflicts between its staff and clients?
• Can the agency document that it carries professional & general liability insurance?
• Will the agency provide a list of local references?

A full list of accredited agencies is available on this website. All Accredited Agencies are noted as such in our print directories, the Home Health Resource Directory and the Guide to Private Care Services. Accreditation is also indicated in the “Add’l Notes” section of each agency’s listing on our online Find An Agency search.

The Home Care Alliance of Massachusetts is a non-profit trade association that has promoted home care as an integral part of the health care delivery system for over forty years. To learn more about us, visit the About the Alliance page.