These agencies can be considered "full service" home care agencies, although historically these organizations have focused almost exclusively on providing licensed health professionals (e.g. Registered Nurses) and relying on Medicare reimbursement. Agencies of this type can elect to be Medicare certified or not. Medicare certified agencies are authorized to accept Medicare payments, non-certified agencies are not. Quality does not differ between certified and non-certified agencies.
Services from a skilled agency are always ordered by a physician and are considered "skilled" in that they almost exclusively provide licensed health care professionals such as RN’s, LVN’s, Physical Therapists, Occupational Therapists, Speech Therapists, and Medical Social Workers. An example of the type of care provided to a client of a skilled agency is an open wound that requires dressing changes; another is the administration of IV antibiotics.
Services are typically provided on a short-term basis, with the number of visits dictated by the diagnosis and what Medicare/Insurance allows for those diagnoses. The average number of visits is 10-15 per episode.
Families can hire licensed staff privately in the home, if so desired. The cost of licensed caregivers from skilled agencies is related to wage rates for licensed staff in the particular geographic area where the services are provided. Costs usually start at $40 per hour. This usually needs to occur if aggressive skilled care is being done in the home that is no longer being covered by Medicare or insurance.
The number of skilled agencies has currently been decreasing as the Medicare program has cut back its home health benefits, under what is called the Perspective Payment System (PPS).
There are a number of different types of organizations that provide caregivers to people in their homes. Each type of organization has a slightly different perspective and orientation.
Home Care Aide Agencies
These organizations provide unlicensed caregivers to clients in people's homes.
Services provided by home care aides include assistance with what are called the Activities of Daily Living including: meal preparation, light housekeeping, transportation, companionship medication reminders, bathing, assistance with ambulation and incontinent care.
A Home Care Aide agencies goal is to provide caregivers who allow an individual to remain in his or her home with safety and dignity. If the condition of the client permits, it is possible that home care aides can allow an individual who is dying to remain at home until the end.
The employees that provide this type of service are companions, nurse’s aides, or personal care attendants. Most reliable Home Care Aide agencies provide training to their caregivers to insure their competence and reliability in the home environment.
Home Care Aide agencies base their rates on the costs of compensating; training and supervising home care aides. Rates typically start at $16 per hour in California.
The Medicare program does not cover Home Care Aide agencies, due to the fact that Activities of Daily Living (ADL’s) are considered custodial care. Clients or their families pay directly for services not covered by insurance.
Amdal In-Home Care is a Home Care Aide agency.
Hospice
Hospice care is specialized care designed for the terminal stages of illness. Most hospice programs offer supportive services planned by RN’s, social workers, home health aides, clergy, and volunteers. The Hospice philosophy regards death as a normal phase of life.
The goals of hospice care are to:
- Help the dying individual remain as free of pain as possible, but also allow the individual to be alert and conscious.
- Give the dying client and family as much control as possible over the process of dying.
- Provide the highest quality of life.
- Assist family and loved ones through the emotions that are associated with losing someone you love.
Hospice care requires an order from a physician. Unfortunately the dying process is not discussed as much as it should be. Referrals to Hospice agencies usually happen very late in the dying process many times in the last few weeks of life. This limits the support that can be given to the client and the family.
