When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patientneeds help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.

Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services). In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

• Illnesses/injuries, and signs of an emergency medical situation
• Likes and dislikes
• Medications, and how and when they should be taken
• Need for dentures, eyeglasses, canes, walkers, etc.
• Possible behavior problems and how best to deal with them
• Problems getting around (in or out of a wheelchair, for example, or trouble walking)
• Special diets or nutritional needs
• Therapeutic exercises.

In addition, you should give the home health care provider more information about:

• Clothing the senior may need (if/when it gets too hot or too cold)
• How you can be contacted (and who else should be contacted in an emergency)
• How to find and use medical supplies and medications
• When to lock up the apartment/house and where to find the keys
• Where to find food, cooking utensils, and serving items
• Where to find cleaning supplies
• Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure)
• Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).

Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home healthcare funding include Medicare, Medicaid, the Older Americans Act, the Veterans' Administration, and private insurance. Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:

• The patient must be homebound and under a doctor’s care;
• The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)
• The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient
• The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”
• The home health care agency providing the services must be certified by the Medicare program.

Taken from publication by U.S. Department of Health and Human Services Administration on Aging