How to choose the right health care agency for your loved one

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1 1 CONSUMER AWARENESS GUIDE How to choose the right health care agency for your loved one HOSPICE (Page 2) HOME HEALTH CARE (Page 9) PERSONAL CARE (Page 12) There are hundreds of home health agencies in Utah. This guide will help you choose the one that s best for you. If you have any questions about this information, call

2 HOSPICE 2 How to find the right hospice care provider Remember that the terminally ill patient has a right to choose the course of his/her care. This means that if the terminally ill person or the family is unhappy with the hospice team or hospice facility, they have a right to request different care providers. Questions to ask To choose hospice care, the terminally ill person and family or caregivers should discuss the following: Is the patient more comfortable with home hospice care or facility hospice care? Is the facility and hospice team licensed, bonded, and certified? What is the response time of the hospice team? What is the patient-to-caregiver ratio? How often will the hospice team arrive at the home? Finding a hospice program To find a hospice care team and facility: - Ask the hospital, doctor, and nurses - Call your state hospice organization - Contact Senior Services, social workers, and counselors - Ask family and friends - Go online - Look in the Yellow Pages. Many small, comfortable hospice providers will be listed in the Yellow Pages but not online, depending on their size.

3 Make sure they are Medicare-approved. 3 The hospice program you choose must be Medicare-approved to get Medicare payment. For more information: 1. Call National Hospice Associations, or visit their Web sites. National Hospice & Palliative Care Organization (NHPCO) nhpco.org 1731 King Street Suite 100 Alexandria, Virginia Hospice Association of America nahc.org/haa 228 7th Street, SE Washington, DC Visit Medicare.gov. 3. Call MEDICARE ( ). TTY users should call Note: At the time of printing, these phone numbers and websites were correct. This information sometimes changes. To get the most updated phone numbers and websites, visit Medicare.gov/contacts or call MEDICARE.

4 4 Hospice Checklist Use this checklist when choosing a hospice. If you have questions, call QUESTION YES NO COMMENTS Does the hospice honor the patient s wishes? Are caregivers trained to care for the patient at home? Is relief for the caregiver available? Are bereavement services available? Is the nurse-to-patient ratio low? Are there volunteers who come into the home? Are the nurses screened? Are they trained to keep the patient out of the hospital? Is the first choice for hospice the home? Does the hospice offer nursing home alternatives? Does the hospice staff regularly evaluate the plan? Including pain control and symptom management? Does the staff respond quickly to needs? Are spiritual and emotional services available? Is there after-hours care? Does the hospice respond immediately to all needs?

5 QUESTION YES NO COMMENTS 5 Is there a social work available after-hours? Has the hospice earned national awards for care? Does the hospice adhere to NHPCO standards? Does the hospice have special credentials? Is the hospice program certified and licensed? Do they have other kinds of accreditation? Are all hospice costs covered by insurance? Are there any out-of-pocket charges?

6 HOME HEALTH CARE 6 How often is it covered? This information was provided by Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you. Medicare doesn t pay for: 24-hour-a-day care at home Meals delivered to your home Homemaker services Personal care Who s eligible? All people with Medicare who meet all of these conditions are covered: You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor. You must need, and a doctor must certify that you need, one or more of these: - Intermittent skilled nursing care (other than just drawing blood) - Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or

7 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. 7 - The home health agency caring for you must be Medicare-certified. - Your must be home bound, and a doctor must certify that you re home bound. - You re not eligible for the home health benefit if you need more than part-time or intermittent skilled nursing care. - You may leave home for medical treatment or short, infrequent absences for nonmedical reasons, like attending religious services. You can still get home health care if you attend adult day care. Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs. Your costs in Original Medicare $0 for home health care services. 20% of the Medicare-approved amount for durable medical equipment. Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren t covered by Medicare, and how much you ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Home Health Advance Beneficiary Notice (HHABN) before giving you services and supplies that Medicare doesn t cover. Note: Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn t cover. If this happens, you may have to pay some or all of the costs.

8 8 Home Health Agency Checklist Use this checklist when choosing a home health agency. Source: If you have questions, call QUESTION YES NO COMMENTS 1. Medicare-certified? 2. Medicaid-certified (if you have both Medicare and Medicaid)? 3. Offers the specific health care services I need (like skilled nursing services or physical therapy)? 4. Meets my special needs (like language or cultural preferences)? 5. Offers the personal care services I need (like help bathing, dressing, and using the bathroom)? 6. Offers the support services I need, or can help me arrange for additional services, like Meals on Wheels, that I may need? 7. Has staff that can provide the type and hours of care my doctor ordered and start when I need them? 8. Is recommended by my hospital discharge planner, doctor, or social worker? 9. Has staff available at night and on weekends for emergencies? 10. Explained what my insurance will cover and what I must pay out-of-pocket? 11. Does background checks on all staff? 12. Has letters from satisfied patients, family members, and doctors that testify to the home health agency providing good care?

9 PERSONAL CARE 9 If you no not require in-home health care, but could use assistance with household chores and personal care, you may need a home care aide. They are also called a homemaker or a personal care aide. There is no certification required for this position. What does Medicare cover? Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you. Medicare doesn t pay for: 24-hour-a-day care at home Meals delivered to your home Homemaking services include shopping cleaning and laundry when this is the only care you need and when these services aren t related to your plan of care. Personal care is care given by home health aides like bathing dressing and using the bathroom when this is the only care you need. How Do I Select the Right Home Care Provider? The following is provided from the National Association for Home Care & Hospice. Once you acquire the names of several providers, you will want to learn more about their services and reputations. Following is a checklist of questions to ask providers and other individuals who may know about the provider s track record. Their insight will help you determine which provider is best for you or your loved one. How long has this provider been serving the community? Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish patients with a detailed Patient Bill of Rights that outlines the

10 10 rights and responsibilities of the providers, patients, and caregivers alike. An annual report and other educational materials also can provide helpful information about the provider. How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance? Are nurses or therapists required to evaluate the patient s home care needs? If so, what does this entail? Do they consult the patient s physicians and family members? Does this provider include the patient and his or her family members in developing the plan of care? Are they involved in making care plan changes? Is the patient s course of treatment documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan, and do the caregivers update it as changes occur? Does this provider take time to educate family members on the care being administered to the patient? Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? If so, how often do these individuals make visits? Who can the patient and his or her family members call with questions or complaints? How does the agency follow up on and resolve problems? What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care? What procedures does this provider have in place to handle emergencies? Are its caregivers available 24 hours a day, seven days a week? How does this provider ensure patient confidentiality?

11 Ask for references 11 In addition, ask the home care provider to supply you with a list of references, such as doctors, discharge planners, patients or their family members, and community leaders who are familiar with the provider s quality of service. Contact each reference and ask: Do you frequently refer clients to this provider? Do you have a contractual relationship with this provider? If so, do you require the provider to meet special standards for quality care? What sort of feedback have you gotten from patients receiving care from this provider, either on an informal basis or through a formal satisfaction survey? Do you know of any clients this provider has treated whose cases are similar to mine or my loved one s? If so, can you put me in touch with these individuals?

12 12 Personal Care Checklist Use this checklist when choosing a home health agency. If you have questions, call QUESTION YES NO COMMENTS 1. Will you do light housekeeping? 2. Will you wash and put away my laundry? 3. Will you make my bed? 4. Will you provide companionship? 5. Will you stay as long as I need? 6. Do you check my vital signs? 7. Will you provide transfers? 8. Do you prepare meals? 9. Do you assist me when I eat? 10. Do you do personal grooming? 11. Do you give me baths? 12. Do you remind me to take my medications? There are hundreds of home health agencies in Utah. This guide will help you choose the one that s best for you. If you have any questions about this information, call Provided as a public service from Aspire Home Health and Hospice Atherton Drive, Suite 201, Taylorsville, Utah Phone: Fax: Utah County: Fax:

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