About Home Health Care

Non-Medical care refers to custodial care and includes help with activities of daily living. This can include assistance with bathing, medication reminders, meal preparation, eating, laundry and shopping. In most states, non-medical home care does not require orders from a physician or nurses supervision and can be performed by non-certified workers, often called companions. Most non-medical home care is private pay, but may also be paid for through certain insurances, such as long term care insurance and respite programs.

Medical home care is supervised by a nurse and depending on the source of payment, may require orders from a physician. Activities of daily living are performed by a certified aide, either a home health aide (HHA) or certified nurses aide (CNA)  Higher levels of care are also available including nurses (RN, LPN) and therapists such as physical, speech and occupational therapists. A growing trend is to also have home care physicians come out for those who are unable to make it into the doctors office. Medical home care can be paid for privately, but is more often paid for through Medicare, Medicaid or private insurance.

There are currently to models of home care agencies, the employee based model and the registry. The registry model has been around since the civil war. With this model, an agency does all the background work, such as reference checks, criminal background checks and interviews and any other checks they feel necessary. Once a candidate has been approved by the agency, the registry will refer them to the person in need. In this situation, the caregiver is considered an independent contractor by the agency and not supervised directly by the agency. This is also called the consumer directed model, as the consumer is the person in charge.

The other type of agency is referred to as the employee based model. In this situation, the agency does similar types of background screening, but instead of referring the caregiver to the consumer, the agency employs them. Each model has its pros and cons.

Pros of the registry model include:

*cost of the service is generally lower than agency model

*caregivers usually earn more, which tend to attract a higher quality of caregiver

*consumer is in total control. They decide what gets done, when it gets done and how it gets done. They decide if the caregiver stays on the job or needs to be replaced.

Cons of the registry model include:

*person is not supervised by agency nurse

*caregiver is not covered by workers compensation insurance

*family may be the employer and may need to take out payroll taxes

Pros of the agency model include:

*caregivers are covered by workers compensation insurance and bonded by agency

*caregivers are supervised by an agency nurse

*agency is always the employer and deducts appropriate taxes

Cons of the agency model include:

*caregivers do not earn as much as those with a registry

*agency has control over when and where caregiver performs their duty. Agency can pull    a caregiver if they are needed for a different case

There are supporters of both agency models. It is up to the consumer to decide which type of business is right for them.