See also: Caregiver, Family caregivers, Carers rights movement, Caregiving and dementia, and Long-term care
Home care , (commonly referred to as domiciliary care ), is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is also known as skilled care) or by family and friends (also known as caregivers, primary caregiver , or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care , which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care , refers to care that is provided by licensed personnel.
Concept
"Home care", "home health care", "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning non-medical care. In the United Kingdom, "Homecare" and "domiciliary care" are the preferred expressions.
Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home Care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services.
Professional Home Health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, occupational therapy.
Life assistance services include help with daily tasks such as Meal Preparation, Medication reminders, Laundry, Light Housekeeping, Errands, Shopping, Transportation, and Companionship. Activities of daily living (ADL) refers to six activities (bathing, dressing, transferring, using the toilet, eating, and walking) that reflect the patient's capacity for self-care. The patient's need for assistance with these activities for the Study mentioned was measured by the receipt of help from agency staff at the time of the survey. Help that a patient may receive from persons that are not staff of the agency (for example, family members, friends, or individuals employed directly by the patient and not by the agency) was not included in the Study.
Instrumental activities of daily living (IADL) refers to six daily tasks (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enables the patient to live independently in the community. The patient's need for assistance with these activities was measured in the Study by the receipt of help from agency staff. Help that a patient may have received from persons who are not staff of the agency (for example, family members, friends, or individuals employed directly by the patient and not by the agency) was not included in this Study.
While there are differences in terms used in describing aspects of Home Care or Home Health Care in the United States and other areas of the world, for the most part the descriptions are very similar.
Estimates for the U.S. indicate that most home care is informal with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home health care is generally paid for by Medicaid, Long Term Insurance, or paid with the patient's own resources (including though reversed mortgage)
Aide worker qualifications
It is not a requirement that you have a GED or High School Diploma, you will need to check with your local Department of health for state requirements. Often aide workers have experience in institutional care facilities prior to a home care agency. Workers can take an examination to become a State tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.
Licensure and providers by State
California California is NOT a licensure state for non medical or custodial care services and therefore there are no barriers to entry, no consumer protection laws, no minimum standards yet and no official state oversight. In California the consumers and their families must adopt a "buyer beware" approach, do their homework and hire caregivers that are bonded and insured. This is why it is important to use a full service agency that has supervision and oversight of staff. Full service agencies also do pre employment background check (criminal)DMV checks and reference checks. Staff become the agency's employee not an independent contractor or "under the table" person. Full service agencies also train, monitor and supervise the staff that provide care to clients in their home.
There IS, however, a certification available for home care companies in California. It is administered by CAHSAH, the California Association for Health Services at Home. For more information about this, see www.cahsah.org
Florida Florida is a Licensure State which requires different levels of licensing depending upon the services provided. Companion assistance is provided by a Home Maker Companion Agency whereas Nursing Services and assistance with ADL's can be provided by a Home Health Agency or Nurse Registry. The State licensing authority is the Agency for Health Care Administration (AHCA)
Payments and Fees
Home Health Aides Caregivers traditional work for state licensed agency are billed hourly at rate of about $8 to $15 depending on state for self employed caregiver or caregivers hired directly by family. For caregivers hired though agency rates are generally 40%-70% higher, since they are employees of the agency.
Live-in Aides Live-in aides rates are between $120-$200 per day for . The rates are 20-30% higher for 2nd care recipient. Live-in aides are available only though direct hire (see External links).
Additional Fees Agencies' fees for non-medical home care are traditionally NOT reimbursed by State, Federal, or private insurance. However, private long-term care insurance will often reimburse policyholders for part of the cost of non-medical home care, depending upon the terms of the policies.
Compensation
RNs and Skilled Services In the United States, registered nurses employed in the home care field receive on average around $22.00 to $30.00 per visit. Some as much as $45-$55, and also receive 52 to 58 cents per mile tax free. Payment / reimbursement of other Skilled Services vary according to the specific discipline.
Home Health Aides Caregivers traditional work for state licensed agency are billed hourly at rate of about $11.00 to $25.00 depending on state. A Home Health Aid employed by the agency are paid between $5.85 USD (current US minimum wage) to approximately $10.00 (or more) per hour depending on location.
Direct Hire Caregivers Direct hire caregivers are aether employed by family or self employed. A direct hire home care aid is paid between $8.00 and $15.00 per hour depending on location, number of hours and experience.
Recent Supreme Court case: Coke v. Long Island Home Care
For years, home care work has been selectively classified as a “companionship service” and exempted from federal overtime and minimum wage rules under the Fair Labor Standards Act (FLSA). The Supreme Court considered arguments on the companionship exemption, which stems from a case brought by a home care worker represented by counsel provided by SEIU. The original 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne , argues that agency-employed home caregivers should be covered under overtime and minimum wage regulations.
Evelyn Coke, a home care worker employed by a home care agency that was not paying her overtime, sued the agency in 2003, alleging that the regulation construing the “companionship services” exemption to apply to agency employees and exempt them from the federal minimum wage and overtime law is inconsistent with the law. The case has wound its way through the appeals process, and in January, the Supreme Court decided to hear the case this spring.
In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for individuals . . . unable to care for themselves." 29 U. S. C. §213(a)(15). The court found that the DOL's power to administer a congressionally created program necessarily requires the making of rules to fill any 'gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding. In this case, one of the gaps was whether to include workers paid by third parties i
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