Types of Home Care Providers | Home Care Services

Understanding Your Florida Home Care Options

• Hire a person off the street or some internet website – very risky!
• Home companion service (HCS ######) – only registered with state, no RN supervision of caregivers, no personal care or skilled care, no standards of care, and are not accredited. Insurance is not required by AHCA regulations.  A homemaker and companion service (HCS) is prohibited by Florida law from providing any hands-on personal care under the registration number (not a license) issued by AHCA. 
• Nurse Registry (NR######): licensed but not accredited and all caregivers are contractors (The following link defines contractors IRS p15a) that are sent to your home that you must manage, often they call it a “Consumer Directed Model”.  Nurse registries are only an employment service for  independent contractors looking for work, and the client may be responsible for the caregiver’s unemployment insurance, payroll taxes and workers compensation insurance.  They often list their license as just 6 numbers without the Nurse Registry or NR designation to appear as a Home Health Agency (HHA). The registry model transfers the cost of government mandated taxes and insurances to you.  The contractors are not managed by a RN, you manage them. The registry looks less expensive until you compare apples to apples. You get what you pay for in life.
• Home Health Agencies (HHA299993568), like Partners in Healthcare, are licensed and accredited and insured for all levels of personal and skilled nursing services. Home Health Agencies may be Medicare certified for acute care nursing and therapy services, or personal care focused as is Partners in Healthcare.

Partners in Healthcare is a home health agency and manages the following items so you don’t have to:

• RN Managed Services

  Home Health Agency – Companion, Personal, Skilled Nursing

• Caregiver training
• Caregiver payroll taxes
• Social Security payments
• Unemployment coverage
• Professional Liability Insurance
• Workers’ Compensation Insurance

These tax, liabilities and insurance costs, if not handled properly, may create legal or economic liabilities for you or your estate. If you utilize independent contractors or self-employed individuals, you may still be held as the responsible party for the liabilities listed.

Once you’ve chosen the type of provider that best meets your needs, it’s important to evaluate the providers in that category. A few common considerations are as follows:

• Is there a minimum number of hours per shift?
• Are caregivers employees or contractors?
• Are periodic RN visits made to the home, cost?
• Do caregivers receive orientation prior to working in the home?
• Are transportation services available?
• What level of RN support is available if you are a long distant caregiver?

The key is to stay involved with the health care team. The best results occur when you work with the provider as part of the care team to ensure the highest quality of life possible.

The following AHCA chart is summation of key differences in regulated and non-regulated home health care providers as defined by the Florida Agency for Health Care Administration (AHCA)

Types of Provider ®  Regulation	Home Health Agency (HHA)	Medicare or Medicaid Certified Home Health Agency (HHA)	Nurse Registry (NR)	Homemaker  or Companion Organization (HCS)	Hiring an Independent Caregiver
What services can be legally provided?	Homemaker CompanionHome health aide Certified nursing assistant (CNA)Nursing (LPN, RN) Therapy: Physical (PT),Speech (ST), Occupational (OT)Home Medical EquipmentSocial Work Dietetics & Nutrition	Homemaker CompanionHome health aide Certified nursing assistant (CNA)Nursing (LPN, RN) Therapy: Physical (PT),Speech (ST), Occupational (OT)Home Medical EquipmentSocial Work Dietetics & Nutrition	Homemaker CompanionHome health aideCertified nursing Assistant (CNA)Nursing (LPN, RN)	Homemaker Companion Organizations cannot provide hands on personal care.	A licensed health care professional may provide services within the scope of his or her professional license.
Are there standards for patient services?	Yes – Accredited	Yes – Accredited	Not accredited	No	No
Is insurance coverage required?	Yes. Liability and malpractice insurance is required up to $250,000 per claim	Yes. Liability and malpractice insurance is required up to $250,000 per claim	No – Nurse Registries only have independent contractors.	No	No
How are services provided?	The patient contracts with the home health agency for services. The home health agency provides services through its own employees or contracted personnel.	The patient contracts with the home health agency for services. The home health agency provides services through its own employees or contracted personnel.	The patient contacts nurse registry for a referral. The patient contracts directly with the worker and pays fees as an independent contractor. The worker pays a referral fee to the nurse registry.	The client contracts with homemaker or companion organization for services. The organization provides services through its own employees or contracted personnel.	The patient or family contracts and makes individual arrangements with the worker.
What are the primary funding sources?	Private insurance and personal funds	Medicare, Medicaid, Private insurance, and personal funds	Personal funds	Personal funds	Personal funds
Is nursing supervision required?	No. RN supervisory visits are not required, but may be provided.PHC provides RN Managed Care	Yes. Supervisory visits by an RN are required. The RN must visit every 2 weeks if receiving skilled care, or every 60 days if receiving personal care.	No, but if a home health aide or CNA is referred the nurse registry must advise that an RN is available to make visits to the patient’s home for an additional cost.	No	No
Does the provider pay federal payroll fees?	Yes	Yes	No, Nurse Registries only have independent contractors.	Yes, if employees, No if independent contractors.	No

Once one chooses the type provider that best meets their needs, they must evaluate the providers in that category.  A few common considerations are as follows:

• What is the minimum shift?
• Are caregivers employees or contractors?
• Are periodic RN visits made to the home, cost?
• Do caregivers receive orientation prior to working in the home?
• Is transportation available?
• What level of RN management is available if you are a long distant caregiver?

The key is to stay involved with the health care team.  The best results occur when you work with the provider as part of the care team to ensure the highest quality of life possible.

Click the following link to view a document that describes the different Orlando home care services available. Not all homecare is equal

Planning for Long Term Senior Care

Most people prefer to live in the safety and comfort of their home as they age. Home Healthcare Agencies can help loved ones stay in their home, but how do you know which type of home care provider best matches your loved one’s needs? The key to choosing the right provider is planning.

1. Step one: Financial planning for your loved one’s care will help ensure that you have the money needed to maintain the quality of life and level of care required.
2. Step two: Consider health care needs over time. This planning step may involve home modifications, in-home health monitoring, and Personal Emergency Response System (PERS) to help prevent falls or accidents.
3. Step three: Planning for transportation. As your loved one ages, he or she may eventually need to stop driving due to health or safety concerns. However, it is still vital for your loved one to have an active social life. Home care agencies, like Partners in Healthcare, can provide transportation to meet friends, doctor visits, hobbies, attend religious services and more.

Armed with a plan, one must understand the types of central Florida home care services and providers available. The laws and regulations that govern home care in Florida are designed to protect the patient and family. Families may choose to hire an individual licensed or non-licensed contractors, an independent contracting business (Nurse Registry), or an accredited Home Health Agency. It is important to understand the risks including elder abuse, fraud, and insurance and tax liabilities that go along with independent contractors.

When it comes to home care for a loved one, you must understand what level of care is needed. Does your parent need personal care or homemaker/companion assistance? Is assistance needed all day or all night, or just in the morning and/or evening? Do you need help for your parent when a family member or friend is not there? Assistance may also be planned for occasional respite care, or around holidays or vacations when family caregivers are not available.