New York Home Care Providers | Quality Home Care Services | New York Adult Care

What is home care?
What types of services do home care providers deliver?
What kinds of home care does Selfhelp provide?
How can I get Selfhelp home care?
Who sets standards and regulates home care?
What types of other agencies provide home care?
Who pays for home care services?
Tips for choosing a good home care agency

What is home care?
Frequently, the term "home care" or “home health care” is used to refer to skilled clinical treatments, such as nursing, physical therapy or giving of medications at home, as opposed to in a treatment facility. But the terms are also often used to describe a variety of non-medical services that support those at home, such as: homemaking, housekeeping, personal care, hygiene, and the use of adaptive devices to prevent slips and falls. Home care has become increasingly complex because of the many different kinds of care, provider agencies, payment options, insurance issues, and regulatory constraints.

What types of services do home care providers deliver?
In general the types of services fall under the following categories
Nursing
- registered and licensed practical nursing
Therapy
- physical, occupational, and speech language pathology
Social Work
- help obtaining social services, benefits, entitlements, managing care
Nutrition
- diet management
Personal Care
- bathing, shaving, toileting, dressing
Home Health Care
- medication reminder, wound care assistance
Homemaking and Chores
- meal preparation, light housekeeping, chores
Companionship
- reading, spending time, comforting, escorting to appointments

Registered nurses (RNs) and licensed practical nurses (LPNs) provide skilled services that cannot be performed safely and effectively by nonprofessional personnel. Some of these services include injections and intravenous therapy, wound care, education on disease treatment and prevention, and patient assessments. RNs may also provide case management services. RNs have received two or more years of specialized education and are licensed to practice by the state. LPNs have one year of specialized training and are licensed to work under the supervision of registered nurses. The intricacy of a patient's medical condition and required course of treatment determine whether care should be provided by an RN or can be provided by an LPN.

Physical therapists (PTs) work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage, and other methods. PTs often alleviate pain and restore injured muscles with specialized equipment. They also teach patients and caregivers special techniques for walking and transfer.

Social workers evaluate the social and emotional factors affecting ill and disabled individuals and provide counseling. They also help patients and their family members identify available community resources. Social workers often serve as case managers when patients' conditions are so complex that professionals need to assess medical and supportive needs and coordinate a variety of services.

Speech language pathologists work to develop and restore the speech of individuals with communication disorders; usually these disorders are the result of traumas such as surgery or stroke. Speech therapists also help retrain patients in breathing, swallowing, and muscle control.

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 function in tasks such as eating, bathing, dressing, and basic household routines.

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

Personal care aides (PCAs) and home health aides (HHAs) assist patients with ADLs such as getting in and out of bed, walking, bathing, toileting, and dressing. Some aides have received special training and are qualified to provide more complex services under the supervision of a nursing professional.

Homemaker and chore workers perform light household duties 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.

Companions provide companionship and comfort to individuals who, for medical and/or safety reasons, may not be left at home alone. Some companions may assist clients with household tasks, but most are limited to providing sitter services.

What kinds of home care does Selfhelp provide?
Selfhelp Community Services has offers ALL of the above services to 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 infected or 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, ADAP and other insurances. Non-HIV/AIDS clients, who are already receiving other Selfhelp social services, may be eligible for Medicare, Medicaid or other insurance. To receive services from our CHHA, a medical diagnosis and physician’s orders are required. Referrals are made by calling 1-212-971-5471.

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, housekeeping, and companionship services. Referrals are made by calling 1-888-781-4300.

Selfhelp’s other home care programs serve individuals and families who have been referred through the contracting city agency. These include the Homemaking, Housekeeping, and Home Attendant Program.

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 Federal Centers 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.

How can I get Selfhelp home care?
Call 1-888-781-4300 and provide the following information in order to process a referral:

Clients name, address and telephone number

Emergency contact

Insurance name and ID number (not required if paying privately)

Social security number

Physician name, address and telephone number

(not required for companion or housekeeping services)

Reason for referral

Services being requested

A referral is complete only when all of the required information is obtained, the insurance has been verified and the physician’s verbal authorization to begin services has been obtained. Physician’s authorization and insurance verification are not required when referring for housekeeping or companion services.

How Can I expedite a home care referral?
The referral process can be expedited by notifying the physician in advance that a referral is being made to home care. The client should also be aware that a referral to home care has been made.

What types of agencies provide home care?
Certified Home Health Agencies
Certified Home Health Agencies are Medicare/Medicaid-certified agencies that have met federal minimum requirements for patient care and management. Due to regulatory requirements, services provided by these agencies are highly supervised and controlled. Some agencies deliver a variety of home care services through physicians, nurses, therapists, social workers, homemakers and home health aides, durable medical equipment and supply dealers. Others limit their services to nursing and one or two other specialties. Certified home health agencies recruit and supervise their personnel and as a result, they assume liability for all care.

Licensed Home Care Agencies
Licensed Home Care agencies employ home health aides, personal care aides, companions and chore workers who support individuals through meal preparation, bathing, dressing, housekeeping and companionship. Personnel are assigned according to the needs and wishes of each client. New York State requires these agencies to be licensed and meet minimum standards established by the state. Most Licensed Home Care agencies recruit, train, and supervise their personnel and thus are responsible for the care rendered. Licensed agencies may also provide nursing and therapy services.

Staffing and private-duty agencies (NOT regulated)
Staffing and private-duty agencies generally are nursing agencies that provide individuals with nursing, homemaker, home care aide, and companion services. The important thing to know about these agencies is that they are not regulated or licensed by the state. Some staffing and private-duty agencies assign nurses to assess their clients' needs to ensure that personnel are properly assigned and provide ongoing supervision. These agencies recruit their own personnel. Again, responsibility for patient care rests with each agency.

Registries (NOT regulated)
Registries serve as employment agencies for home care nurses and aides by matching these providers with clients and collecting finder's fees. These organizations are not usually licensed or regulated by the government. Registries are not required to screen or background-check the caregivers, but some do undertake these tasks routinely. In addition, although not legally required to, some registries offer procedures for patients to file complaints. Clients select and supervise the work of a registry-referred provider. They also pay the provider directly and must comply with all applicable state and federal labor, health, and safety laws and regulations, including payroll tax and social security withholding requirements.

Independent providers (NOT regulated)
Independent providers are nurses, therapists, aides, homemakers and chore workers, and companions who are privately employed by individuals who need such services. Aides, homemakers, chore workers, and companions are not required to be licensed or to meet government standards except in cases where they receive state funding.In this arrangement, the responsibility for recruiting, hiring, and supervising the provider rests with the client. Finding back-up care in the event that the provider fails to report to work or fulfill job requirements is the client's responsibility.Clients also pay the provider directly and must comply with all applicable state and federal labor, health, and safety requirements.

Hospices (licensed and regulated)
Hospice care involves a core interdisciplinary team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for the terminally ill and support for patients' families. Hospice care also includes the provision of related medications, medical supplies, and equipment. It is based primarily in the home, enabling families to remain together. Trained hospice professionals are available 24 hours a day to assist the family in caring for the patient, ensure that the patient's wishes are honored, and keep the patient comfortable and free from pain. Most hospices are Medicare certified and licensed according to state requirements.

Managed Long Term Home Care Programs
Managed long-term care (MLTC) helps people who are chronically ill or have disabilities and who need health and long-term care services, such as home care or adult day care, stay in their homes and communities. The MLTC plan arranges and pays for a large selection of health and social services, and provides choice and flexibility in obtaining needed services from one place. There are two basic models of managed long-term care in New York State: Programs of All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care Plans

1. PACE Organizations
A PACE organization provides a comprehensive system of health care services for members age 55 and older who are otherwise eligible for nursing home admission. Both Medicare and Medicaid pay for PACE services (but have caps on the amount). PACE members are required to use PACE physicians and an interdisciplinary team develops care plans and provides on-going care management. The PACE is responsible for directly providing or arranging all primary, inpatient hospital and long-term care services required by a PACE member. PACE Organizations are approved by the U.S. Centers for Medicare and Medicaid Services.

2. Managed Long-Term Care Plans
Managed long-term care plans provide long-term care services (like home health and nursing home care) and ancillary and ambulatory services (including dentistry, pharmacy, medical supplies and equipment), and receive Medicaid payment. Members get services from their primary care physicians and inpatient hospital services using their Medicaid and/or Medicare cards. Members must be eligible for nursing home admission. While several plans in New York State enroll younger members, most managed long-term care plan enrollees must be at least age 65.

Who Pays for Home Care Services?
Self-pay
Home care services that fail to meet the criteria of third-party payors must be paid for "out of pocket" by the patient or other party. The patient and home care provider negotiate the fees

Medicare
Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency. Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational, and speech therapies; medical social work; 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 for reimbursement.

A Note About Hospice Services
Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit. The physician also must re-certify the individual at the beginning of each six-month benefit period. In turn, the patient is required to sign a statement indicating that he or she understands the nature of the illness and of hospice care. By signing this statement, the patient surrenders his or her rights to other Medicare benefits related to terminal illness.

Medicaid
Administered by the states, Medicaid is a joint federal-state medical assistance program for low-income individuals. Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals 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, yet otherwise are ineligible for AFDC, also qualify as categorically needy. Under federal 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 also may cover audiology; physical, occupational, and speech therapies; and medical social services. Hospice is a Medicaid-covered benefit in 38 states. 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 and 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 primarily was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. However, as the public 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 (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. Medicare beneficiaries who are enrolled with an MCO may elect their hospice benefit from the hospice of their choice. These organizations only pay for services that are pre-approved.

Tips on choosing a good home care agency
(by Sue Ellen Wagner, Manager, Home and Community-Based Services, Health Care Association of New York State)

What's the first thing I should look for when choosing a private home care agency?
Licensing by the New York State Department of Health is an absolute must. It's your loved one's best protection against disreputable, inexperienced service providers. Licensing is also your guarantee that proper background and medical screening of all home care aides is being performed, and that aides have been trained in accordance with Health Department regulations.

What if the home care aide and my family member don't get along? What happens when the aide goes on vacation?
By selecting an experienced and resourceful home care agency, as we are, you're assuring yourself and your loved one of a large pool of trained aides to choose from. We're better at making appropriate matches from the start, and we can replace aides to make everybody happy. That same large pool of trained, qualified home care aides ensures coverage for vacations or illness. And the registered nurse assigned to your family member makes sure every aide is properly oriented to the plan of care.

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?
A service plan organized on the team model, as our private home care is, provides for both initial and on-going multi-disciplinary assessment. Our procedure is that a Selfhelp registered nurse performs the initial in-home assessment and consultation with your loved one's physician prior to the commencement of services, and then continues on-going supervision and daily involvement with the plan of care. The nurse also supervises the home health aide and coordinates with the gerontological social worker. These continual assessments ensure that hours and services are appropriately adjusted as circumstances change.

My family member has special needs. Can you provide special services?
Our specially trained and licensed personnel are adept 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. Bilingual aides are also available.