Home Care FAQ

What is home care?
The terms "home care" or “home health care” are used interchangeably to refer to skilled clinical treatments, such as nursing, physical therapy or medication management that are provided at home, as differentiated from treatment in a hospital or rehabilitation center. These terms are also used to describe a variety of non-medical services that support people at home, such as homemaking, housekeeping, personal care and household chores.

What types of home care services does Selfhelp provide?
Our team of highly skilled professionals provides a vast array of comprehensive home care services:

Our Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) provide skilled services that can only be performed safely and effectively by professional personnel. Some of these services include:

• Injections and Intravenous Therapy
• Wound Care
• Education on Disease Treatment and Prevention
• Patient Assessments

RNs have received two or more years of specialized education and are licensed to practice by the state. They are fully trained to deal with the challenges of each client’s individual needs and work closely with our clients’ doctors to assess their medical conditions, evaluate home care requirements, supervise care plans and monitor ongoing care needs.

LPNs have one year of specialized training and are licensed to work under the supervision of registered nurses. Each client’s medical condition and required course of treatment determine whether care should be provided by an RN or can be provided by an LPN.

Our Physical Therapists (PTs) work to restore the mobility, strength and coordination of patients who are limited or disabled by physical injuries through the use of exercise, specialized equipment and other techniques to improve and restore function.

Our Occupational Therapists (OTs) help individuals who have physical, developmental, social or emotional problems that prevent them from performing the general activities of daily living (ADLs). OTs instruct patients on using specialized rehabilitation techniques and equipment to improve their fine motor function for basic household routines and tasks such as eating, bathing and dressing.

Our Speech Therapists and Speech Language Pathologists work to develop and restore the speech of individuals with communication disorders that may be the result of traumas such as surgery or stroke. Speech therapists also help retrain patients in breathing, swallowing and muscle control.

Our Social Workers evaluate the social and emotional factors affecting ill and disabled individuals and provide counseling. They also help clients and their family members identify available community resources.

Our Dietitians provide counseling services to individuals who need professional dietary assessment and guidance to properly manage an illness or disability.

Our Personal Care Aides and Home Health Aides assist patients with activities of daily living such as getting in and out of bed, walking, bathing, toileting and dressing. home health aides can also assist with medication management and wound care.

Our Homemakers and Housekeepers perform light household tasks such as laundry, meal preparation, general housekeeping and shopping. Their services are directed at maintaining patient households rather than providing hands-on assistance with personal care.

Our Special Family Home Care Program provides overall care for families living with HIV/AIDS. Specially trained Registered Nurses supervise care plans that include mental health services, client education, medication management and disease management including wound care, diabetic care management and regular visits by home health aides to assist with personal care needs.

Our innovative use of Client Centered Technology such as remote sensor and telehealth technologies enable us to monitor our clients’ health and safety 24/7.

Selfhelp Community Services offers ALL of the above services to our clients. We operate two home care agencies that can take direct referrals for care. The difference between them is in the type of client each agency takes and the form of payment each is able to accept.

Selfhelp’s Certified Home Health Agency (CHHA) serves individuals and/or families who are affected by HIV/AIDS and non-HIV/AIDS clients who currently receive other services from Selfhelp. When there is an HIV/AIDS diagnosis, payment is made through Medicaid, Medicare, the Alcohol and Drug Awareness Program (ADAP) and other insurance. Non-HIV/AIDS clients, who are already receiving other Selfhelp services, are eligible for CHHA services providing the insurance is accepted by the program.  To receive services from our CHHA, a medical diagnosis and physician’s orders are required.

Selfhelp’s Licensed Home Care Services Agency (LHCSA) can take any client who can pay for the services privately. It does not accept private insurance directly, but clients may find that their insurance companies will reimburse them for services rendered after they have been paid. To receive services from our LHCSA, a medical diagnosis and physician’s orders are required, except for homemaking and housekeeping.

Who sets standards and regulates home care?
Both New York State and the federal government set standards and regulate home care. 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 Centers for Medicare and 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.

Who Pays for these Home Care Services?
Our clients pay for home care services that don’t meet the criteria of third-party payors individually.

Medicare
Most Americans older than 65 are eligible for the federally funded Medicare program. If an individual is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services, they may be eligible for services provided by a Medicare-certified home health agency like Selfhelp. Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational, and speech therapies; medical social work; Home Care Association (HCA) services; and medical equipment and supplies. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be intermittent or part time and provided through a Medicare-certified home health agency such as Selfhelp.

Medicaid
Medicaid is a joint federal-state medical assistance program for low-income individuals and is administered by individual states. Each state has its own set of eligibility requirements, however, states are only mandated to provide home health services to people who receive federally assisted income maintenance payments, such as Social Security Income and Aid to Families with Dependent Children (AFDC), and individuals who are "categorically needy." Categorically needy recipients include certain aged, blind, and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels. Individuals younger than 21 who meet income and resources requirements for AFDC, but are otherwise ineligible for AFDC, also qualify as categorically needy. Under Medicaid rules, coverage of home health services must include part-time nursing, HCA services, and medical supplies and equipment. At the state's option, Medicaid may also cover audiology, physical, occupational and speech therapies, and medical social services. Hospice is a Medicaid-covered benefit in 38 states, including New York. The Medicaid hospice benefit covers the same range of services that Medicare does.

Private Third-Party Payors/Commercial Health Insurance Companies
Commercial Health Insurance Companies typically cover some home care services for acute needs, but benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross/Blue Shield and others, generally pay for skilled professional home care services with a cost-sharing provision. Such policies occasionally cover personal care services. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost-sharing varies with individual policies, but often is not required. Individuals sometimes find it necessary to purchase Medigap insurance or long-term care insurance policies for additional home care coverage.

Medigap
This insurance is designed to bridge some of the gaps in Medicare coverage. Some Medigap policies offer at-home recovery benefits, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder's physician must order this personal care in conjunction with the skilled services. Home care coverage in Medigap policies is not designed to cover extended long-term care. This type of coverage is most helpful to individuals recovering from acute illness, injuries, or surgery.

Long-term care insurance
Long-term care insurance was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. As the need and preference for home care has grown, private long-term care insurance policies have expanded their coverage of personal care, companionship, and other in-home services.

Considerable care should be taken in selecting a long-term care insurance policy, as home care benefits vary greatly among plans. Consumers should be aware of limitations on coverage, such as prior hospitalization requirements, and pre-existing condition exclusions. Some policies may only pay for services that are already covered by Medicare.

Managed Care Organizations
Managed Care Organizations (MCOs) and other group health plans sometimes include coverage for home care services. MCOs contracting with Medicare must provide the full range of Medicare-covered home health services available in a particular geographic area. These organizations only pay for services that are pre-approved.

How do I determine what level of service my family member needs? What if circumstances change? How can I be sure the services will remain appropriate?
Our private home care professionals work as a team, providing a multi-disciplinary approach to each client’s care. A Selfhelp registered nurse performs the initial in-home assessment and consults with your loved one's physician to learn about their medical history and current needs. She continues ongoing supervision during the course of care, overseeing the services of home health aides and coordinating the care plan with gerontological social workers, providing seamless transitions to new levels of care as needed. These continual assessments ensure that hours and services are appropriately adjusted over time.

My family member has special needs. Can you provide special services?
Our specially trained and licensed personnel are professionally trained and experienced in helping people with a variety of special needs, including Alzheimer's and other dementia-related illnesses, HIV/AIDS protocols, and special nutritional requirements including kosher diets. Spanish speaking aides are also available.