Home care is a popular option for long-term care. Most seniors want to age in place at home, which contributes to familiarity and comfort, yet in order to keep a loved one safe at home, it requires planning and evaluation. This guide gives you a detailed understanding of in-home care options, what needs to happen to create a dramatic, positive impact on you and your entire family.
If you’re a family caregiver, in search of additional senior care, you are among 70 million people who deliver care for a loved one at home. Research concludes by 2050, over one million centenarians – individuals over the age of 100 will live in North America.
With recent advent of Accountable Care (informally known as ObamaCare), in-home care is a critical post-hospitalization piece to the care transition.
Today, discharged patients go directly home. Even hospice care is at home. If you or an aging loved one has a terminal illness and depleted other treatment options, consider hospice care at home.
It gives a loved one and family members comfort and support. Recent studies, like the Archives of Physical Medicine and Rehabilitation (May 2011) concluded that after certain hospital-based operations, joint replacement, home is an effective strategy over discharge to a rehabilitation facility.

Receiving care at home Home care is an option allowing older adults the choice to age in place at home with a specified level of care they need for safety, comfort and independence. Simply described, home care means help with activities of daily living and household tasks. It includes meaningful companionship for older adults. In-home care is the oldest form of healthcare. Today, home care serves as a comprehensive alternative to institutional living. Home care is commonly presented as a service to assist aging seniors, it’s a valuable resource when a person at any age has an injury, accident or surgery – or is suffering from a chronic illness.

Types of Home Care Non-Medical Home Care Trained caregivers give support to individuals with basic activities and functions needs:

  • Activities of Daily Living and Instrumental Activities of Daily Living. Activities of Daily Living –
    Measures the Overall Wellness
  • Bathing
  • Dressing
  • Toileting
  • Transferring
  • Continence
  • Feeding

When hiring home health care help for older adults, it’s critical to understand the ratings an agency receives by the state and federal agencies. But knowing the ratings is not enough; you need to learn exactly what the factors mean and how each affects your loved one’s quality of care.
The Centers for Medicare and Medicaid Services clearly understands the ratings’ significance, so much so, that they’ve created the Five-Star Quality Rating System to guide consumers, their families, and caregivers to compare home health care agencies; to identify areas about which you may want to ask questions. Non-medical Home Care providers, in most but not all states, are licensed and certified. Home Health Care is state certified and must follow Medicare and/or Medicaid applicable laws, regulations, and compliance concerns. Being a consumer, it’s imperative that the research and due diligence is thorough before choosing and hiring help for care at home. Be a smart home care shopper. Follow the same requirements and ask the questions that CMS designed in the Five-Star Quality Rating Systems to better identify the best home care for you or your loved one.

Choosing Home Care
The CMS quality rating system uses the following sources for rating home health care agencies. We adapt and display those ratings in our home care directory. The information in Home Health Compare should be looked at carefully when seeking home care help. Use it with the other information you gather. Talk to your doctor or other health care providers for references, questions to ask, what to look for, and how to choose a home care provider. They know best the type of care an aging adult needs to age in place safely and remain independent. Recovering from surgery or need long-term care for a chronic illness, faced with another situation, an individual may need home care services. Home care services range from skilled care provided by nurses or therapists to household support, such as cleaning, cooking and running errands.

Medicare Quality Ratings for Home Health Care Agencies
When calculating a rating for the overall quality of care, each question weighs equally for the questions where complete data is available. Questions without complete data are ignored. When calculating overall ratings, both the patient survey and quality of care information are weighed, if both are available. In the case that only one is available, the remaining rating is used.
Remember: Ratings are only available for Medicare-certified agencies. Ratings may also not be available for all agencies due to a lack of sufficient data to accurately rate the agency.

Quality of Care Data
Quality of Care includes Process Measures and Outcome Measures. Process Measures tell you how often a home health care agency gave the recommended care such as checking patients for depression at the beginning of an episode of care. A rate of 90% means that the home care agency provided the recommended process 90% of their episodes of care. Patient Surveys The patient survey data is collected by Medicare through the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) program. The data’s collected from patients, their families, and their friends on a nationwide since the fall of 2009.
The Care Data Measured by Medicare Professional Care

  • There were no problems with the home health care
  • Providers were always gentle
  • Providers were always respectful
  • Providers were always up-to-date about the patient’s treatment


  • Explained services before giving them
  •  Gave advice promptly
  • Always said when staff would arrive
  • Always explained things clearly
  • Always listened carefully

Hiring a Home Health Aide

The Joint Commission, an independent, not-for-profit organization, accredit and certifies more than 20,000 health care organizations and programs in the United States.

Joint Commission accreditation and certification recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. The Private Duty Home care Association (PDHCA) established by the National Association for Home Care & Hospice (NAHC), is a trade association of home care providers dedicated to helping the ill and disabled remain at home. When hiring a home care agency, consider if they’re accredited and certified by either the Joint Commission or the Private Duty Home Care Association. Both recognized nationwide as a symbol of quality that reflects commitment to certain performance standards. These standards imply that home care organizations directly employ home care aide staff, been in operation for at least one year, and handled a minimum of 25 cases at the time of application. All home care aide services in an organization must apply for accreditation at the same time. The home care organization must have qualified professionals on staff to give assessment, care planning, and supervision and maintain compliance with the standards and procedures and pay accreditation fees annually.

Core Standards for Accreditation of Home Care Aide Services: 

  • Ensures that the organization is legitimate, accountable and can deliver safeguards to consumers, if something go wrong.
  • Assures consumers that the organization complies with employment laws and regulations.
  • Makes certain the consumer is dealing a fiscally sound organization.
  • Assures that employees are prepared and capable before entering the home and able to perform the needed tasks and level of care.
  • Declares the service meets the needs of the consumer, is appropriate, and that the consumer remains informed and treated fairly.
  • Ensures that the service delivered is safe, that problems resolve quickly, employees supported, and service meets the changing needs of the recipient
  • Assures that the home care agency strives to give quality of care, deliver more effective service and maintain positive service outcomes.
  • Ensures that the organization has capacity to deliver services promised.
  • Inform the consumer of the rights and responsibilities they have as recipients of home care services.
  • Makes certain the consumer understands the risks in home care, to ensure the safety of the recipient and employee, to minimize accidents and improve the delivery of service.
  • Assures that the organization complies with the law and program regulations and that the organization maintains a high level of integrity.

Read more on the Joint Commission’s Standards and the Private Duty Home care Standards.

Home Health Care and Caregiver Aide Education and Training
Home health aides and professional caregivers help people with a disability, chronically ill, or cognitively impaired. They assist older adults who need help, at home or in another care setting. In a few states, home health aides give patients medication or check their vital signs under with direction from a nurse or another health care practitioner. It’s important that aides receive training and skills that apply to the job.
Orientation Topics include:

  • Care setting Certified and Trained
  • Job responsibilities
  • Care plan and care team
  • Client rights
  • Documentation and reporting
  • Mandatory reporting

Basic communication methods and techniques Safety Topics include:

  • Body mechanics
  • Employee safety
  • Accident prevention
  • Emergency, disaster, and evacuation preparedness
  • Hand washing and gloves
  • Infection control and standard precautions
  • Fire safety prevention
  • Fall prevention Other Training
  • Housekeeping tasks
  • ADLs: Bathing, toileting, transferring, medication reminders, dressing
  • Nutrition and special diets
  • Checking vital signs
  • Administering prescribed medication at scheduled times

Home Health Aide Duties:

  • Help clients in their daily personal tasks, such as bathing or dressing
  • Provide basic health-related services – check vital signs or administer prescribed medication at scheduled times
  • Do light housekeeping, such as laundry, washing dishes, and vacuuming in a client’s home
  • Organize a client’s schedule and plan appointments
  • Arrange transportation to doctors’ offices or for other kinds of outings
  • Shop for groceries and prepare meals to a client’s dietary specifications
  • Provide companionship


Help at Home There is no place like home to provide a healing, relaxing environment when recovering from an illness, injury or surgical procedure. Could it be right for someone in your family? It’s no surprise that close to 90% of seniors living in the U.S. want to age in place – at home. Now more than ever, medical experts confirm that aging in place is the best choice. It’s healthier. It’s more flexible. In fact, we typically think of senior citizens as the primary clients for non-medical home care. While seniors are the primary consumer, there are many others with mental and physical needs requiring home care help too. Home Care for Seniors • A history of falls • Weight loss, diminished appetite or willingness to prepare meals, spoiled food in the refrigerator • Problems with walking or balance, getting up or down, or transferring in and out of bed • Lessened driving skills or recent car accidents • Changes in personal grooming or hygiene such as uncombed hair, body odor, infrequent bathing or shaving, or wearing unclean or stained clothing • Not remembering to take medication or get prescriptions refilled, difficulty managing multiple prescriptions • The home has become cluttered or unclean • Paperwork is piling up or bills are not paid • A loss of interest in socializing or in activities that were once enjoyed • Confusion, memory loss, difficulty concentrating and changes in personality which are signs of dementia or Alzheimer’s disease Home Care for Chronic Illness and Surgical Recovery Returning home from a hospital or rehab requires planning. A needs assessment is necessary to create a realistic and sustainable plan for the care steps post discharge. Family caregivers need awareness on the healing process in order to help a loved one heal. Family Caregiver Assessment • What is the primary family caregiver’s background: age, education, employment, other family responsibilities, living arrangements? • What is the primary caregiver’s perception of the care recipient’s health and functional status? • Length of time giving care and experience: is this a new event, what are the concerns in providing care? • What are the primary caregiver’s preferences about caregiving: do it all myself, have trouble with needles or incontinence? • What is the caregiver’s health status? • What’s the impact of caregiving: emotionally, financially, and relationships with other family members? • What are the skills and abilities to perform caregiving tasks? • Are they familiar with caregiving resources? Additional Things a Family Caregiver Needs to Know • Do you know how to move your loved one from bed to chair so that you don’t hurt yourself or her? • Can you do it? • Has anyone explained the medications the family member will take? Do you understand them? • Can you show other family members what to do, if you are not available? • Do you know how to feed the loved one? • Can you transfer a loved one safety? Home care providers improve transitions for patients upon discharge from the hospital or for individuals living at home with chronic illness. Care providers engage and partner with family members the assistance needed for older adults who are home bound due to a major operation or chronic illness. Home care staff helps with basic needs and recovery, but also provides support for housekeeping, meal preparation, laundry and bathing until the patient is able to perform them again. The Mayo Clinic suggests that if someone of any age who is basically home bound has several of these indications, home care is an effective solution: • Recurrent Hospitalizations • Infusion Therapy • Wound Care • Ostomy Care • Catheter Tube Care • Joint Replacement • New Medications • Diabetic Management • Changes in Function • New Diagnosis Home Care for Prenatal or Postpartum Moms Women having difficult pregnancies and on bed rest may need the services of non-medical home care to help around the house and provide basic assistance, including aiding in and monitoring overall health. Home care agencies provide postpartum care for women, particularly in case of a cesarean, and can provide newborn care as well. Home Care for Hospice Clients Regardless of age, clients who face end of life wish to die at home. Many home care agencies offer hospice services, which is a specialized form of care that designed to give comfort and support for those who faced with a life-limiting illness. Home Care for Medically Fragile Children Medically fragile children are often eligible for home health care services. Children who are ventilator dependent, have cardio-pulmonary conditions, genetic syndromes, or prematurity complications are all among those served by home health care services. Services may include home oxygen management, administering medication, infusion therapy, respite care, and patient/family education. Home Care for Disabled Adults and Children Adults and children who are either severely developmentally or physically disabled may qualify for home health care services. Typically, they would have to meet the requirements for admission in a nursing facility if they are seeking government payment for such care. Those with emotional or mental health issues may qualify as well. What to Ask Private Hire Caregivers or Home Care Agencies? When paying for home care, whether it’s privately or using insurance, ask these questions: Questions to Ask • What types of services provided? • List the tasks they perform. • Are you trained? • Do you train your aides? How often? On what topics? • What kind of testing is given to aides? • Do aides have special training to deal with medical conditions like dementia, paralysis, or stroke? • What kind of supervision do your aides receive? How often does the supervisor come and observe the aide’s work? • What hours do they work? • Do you screen aides before you hire them? • Do you conduct a background check? • What exactly does that background check include? Is the criminal background check for this state only, or is it nationwide? • Are the aides tested for drugs? How often? • Are aides insured and bonded with your agency? • What type of medical insurance do you accept? • How much do you charge per hour? • How often do I pay you? • Do you take credit cards? • Can your agency arrange for medical equipment when needed? • How do you handle complaints? • Do you provide 24 – hour access in case of emergencies?

Here’s a checklist of questions to ask providers. Plan to ask family, friends, and your medical health staff for references.

Choose Right Home Care:

  • How long has the home care or home health care agency been in business?
  • Did they give literature on the services, eligibility requirements, fees, and funding sources?
  • Did you receive a copy of the Patient Bill of Rights; the rights and responsibilities of the providers, patients, and caregivers?
  • How do they select and train the employees? Do they offer benefits packages and have malpractice insurance?
  • Do nurses evaluate and assess patient’s home care needs?
  • Will they consult the your physician and include family members in the care planning?
  • Who’s included in developing the care plan of patient? Are they also involved in making care plan changes?
  •  Is the patient’s treatment documented, detailing the specific tasks needed by the home health aide or professional caregiver?
  • Will the family receive education on the care given by them?
  • Are home health care aides supervised? How often do the supervisors make visits?
  • Who does the family or patient contact, if there’s a question, concern, or complaint?
  • How do they follow-up and resolve issues, concerns or problems? •
  • How do they bill? Will you receive statements explaining costs and payment plan options?
  • How do they handle emergencies?
  • Are its caregivers available 24 hours a day, seven days a week?
  • Do they actively follow a patient confidentiality procedure?

Ask for References Get a list of references from the provider:

  • Doctors
  • Discharge planners
  • Current and former patients and their family members
  • Community health care leaders and professionals

Contact references 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?
  • Do you know of any clients similar to your care needs? If so, can you put me in touch with these individuals?

Need help? Call our award-winning support team 24/7 at +1 703-347-9650

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1st Family Home Care is a family owned company founded by a nurse and operated by trained and licensed health care professionals.

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