The goal of home health care is to provide treatment for an illness or injury. It helps you regain your independence and become as self-sufficient as possible. If you have long-term health problems, the goal of home health care is to maintain your highest level of ability or health, and help you learn to live with your illness or disability.

Home health care includes part-time or intermittent skilled nursing care, as well as other skilled care services such as physical and occupational therapy, and speech-language pathology (therapy) services. Services may also include medical social services, and assistance from a home health aide (when needed, if you are also getting skilled care). In order for Medicare to pay for these services, you must meet certain eligibility criteria, and the services must be reasonable and necessary for the treatment of your illness or injury. Many health care treatments that used to be done only in a hospital can now be done in your home. Usually, a specific home health care agency coordinates the services your doctor orders for you.

This guide will provide you and your family members with some needed information to assist you in selecting a home health agency near you.

In the state of Georgia, home health agencies, under Georgia Law, 290-5-38, Rules and Regulations for Home Health Agencies, are required to obtain a license from the Office of Regulatory Services. Additionally, agencies who wish to accept Medicare and/or Medicaid patients must be certified by the Centers for Medicare & Medicaid Services (CMS). For more information related to licensure and compliance history, please visit ors.dhr.georgia.gov.

Health care given in the home is usually less expensive, more convenient and just as effective as the care you receive in a hospital or skilled nursing facility. If you are eligible, Medicare pays for certain health care services in your home. This is known as the Medicare home health benefit.

When you speak to someone at the home health agency find out exactly what you will be billed for and if you will be billed monthly. Find out if there is a charge for overtime (time needed to provide care beyond the allotted time), and whether or not you will be billed even if the services are not performed. Some agencies have a minimum hourly charge for their services.

The agency should provide you with a clear and detailed written account of all of its charges, as well as a breakdown of what insurance will cover and your individual financial responsibility. Remember, Medicare only pays for home care if you meet certain conditions. For more information, you can view the Medicare and Home Health Care booklet on medicare.gov. Home care costs can vary depending on where you live, the type of care you need and how often you need care. Per visit charges for common services can be found on the georgiahealthinfo.gov Web site.

Your home health team may include the following:

• Home Health Aides: Are responsible for assisting you with the daily activities such as bathing, getting dressed, getting to and from the toilet, and preparing meals. Home health aids are required to complete all approved training programs and a competency evaluation.
• Occupational Therapists: Assist the residents in becoming more independent by working with them to perform daily activities such as bathing and getting dressed on their own. An occupational therapist must be a graduate of an accredited occupational therapy program or have two years of relevant work experience and have passed a proficiency exam.
• Physical Therapists: Are responsible for treating illness or injuries through exercise or massage. They also provide treatments to improve physical abilities, lessen pain and prevent injury. They must be licensed by the state, and have graduated from an approved physical therapy program.
• Physicians: Are responsible for diagnosing the patient’s illnesses, assess injuries, and prescribe the appropriate care treatment. They must be licensed and legally authorized to practice medicine and surgery by the state.
• Licensed Practical or Vocational Nurses: A Licensed Practical Nurse, also referred to as an LPN, is usually responsible for completing the initial evaluation of the patient and determining the patient’s medical needs. LPNs must be licensed as a practical nurse by the state.
• Registered Nurses: The Registered Nurse, also referred to as an RN, treats the patients, monitors and administers care. They are also responsible for supervising other caregivers on occasion. RNs must have graduated from an approved school of professional nursing and be licensed by the state.
• Social Workers: Help patients and family members cope with the emotional and psychological stressors of an illness. They must have a master’s degree from an accredited school of social work and have one year of experience in a health care setting.
• Speech Language Therapist: Help strengthen speech and communication skills. They must be certified by the American Speech-Language-Hearing Association and be licensed by the state.

Federal law requires that all individuals receiving home health care services be informed of their rights as a patient. The following is a patient bill of rights developed by the National Association for Home Care. These patient rights are currently enforced by law.

Home Health Care patients have the right to:

• Be fully informed of all his or her rights and responsibilities by the home care agency
• Choose care providers
• Appropriate and professional care in accordance with physician orders
• Receive a timely response from the agency to his or her request for service
• Be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed
• Receive reasonable continuity of care
• Receive information necessary to give informed consent prior to the start of any treatment or procedure
• Be advised of any change in the plan of care, before the change is made
• Refuse treatment within the confines of the law and to be informed of the consequences of his or her action
• Be informed of his or her rights under state law to formulate advanced directives
• Have health care providers comply with advance directives in accordance with state law requirements
• Be informed within reasonable time of anticipated termination of service or plans for transfer to another agency
• Be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements
• Be referred elsewhere, if denied service solely on his or her inability to pay
• Voice grievances and suggest changes in service or staff without fear of restraint or discrimination
• A fair hearing for any individual to whom any service has been denied, reduced, or terminated, or who is otherwise aggrieved by agency action. The fair hearing procedure shall be set forth by each agency as appropriate to the unique patient situation (i.e., funding source, level of care, diagnosis)
• Be informed of what to do in the event of an emergency
• Be advised of the telephone number and hours of operation of the state’s home health hot line, which receives questions and complaints about Medicare-certified and state-licensed home care agencies