One of the hurdles I discovered in arranging for caregiving services for my father was the discrepancy between home health and personal care. Home health services are medical in nature and may also be referred to as skilled nursing care. Home health services can include physical therapy, occupational therapy, nursing, and medically regulated services such as speech and language pathology and medical social services. These services may also include providing necessary medical equipment. In contrast, personal care services are non-medical. These services aid in activities of daily living such as bathing, grooming, using the restroom, escorting to and from appointments, light housekeeping, and cooking as well as shopping and running errands. Companionship can also be provided with personal care services.
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Due to the nature of medical care licensing, a home health agency must be licensed from the state and have accreditation through Community Health Accreditation Partner (CHAP) and/or the Joint Commission on Hospital Administration (JAYCO), etc. This is also a requirement for the home health agency to be able to bill through Medicare. Requirements exist for standards of minimum care, and a licensed RN and MD must serve on the agency’s board of directors. (Care options. AHI Group (April 18, 2018). Retrieved from https://www.ahi-group.com/). However, that being said, the home health aides providing services may or may not be certified, which includes a specified number of hours of training. The requirement for certification varies by state if it is required at all. Personal care agencies (non-medical care) do not have to meet these requirements. According to AGI Group, “half of the states in the nation do not require a license from the Department of Public Health to provide non-medical services in their state.” Most caregivers employed by personal care agencies are not certified as CNAs. Most private independent caregivers, employed directly by family, are not medically trained or licensed as well.
The difference in these two types of agencies goes beyond this, however. In order to qualify for home health services, you must be under the care of a physician who writes your care plan and regularly reviews it. The physician must certify the need for skilled services and the patient must be homebound (although one can still attend religious services and adult day care.) (Your Medicare coverage: Home health services, July 6, 2018. Retrieved from www.medicare.gov/coverage/home-health-services.html) The home health agency typically coordinates these services and, in some states, is required to tell you how much Medicare will pay if you are eligible for services and how much you will be required to pay out-of-pocket if you are deemed ineligible.
Medicare will not pay for personal care services but may cover a home health aide that can assist with bathing and grooming in instances when it is determined to be medically necessary. These services must follow the guidelines above. Currently in most states, including Texas, the only way to avoid paying for personal care services out of pocket is to have long term care insurance (E. Parker, personal communication, June 18, 2018).
There are both advantages and disadvantages to using a home care/personal care agency vs. a private independent caregiver. A different caregiver can be requested from the agency if there is not a good match between caregiver and client or if a caregiver cannot do an assigned shift. There is no back up for an independent caregiver if a shift cannot be done due to illness, emergency, appointments, etc. With an agency, your agreement is with the agency itself, not an individual. All locating, hiring, interviewing, and training of a private caregiver is done by the family. Most private caregivers do not have professional liability insurance and your homeowners’ policy may not cover injuries, accidents, or theft. An agency pays withholdings, social security, payroll taxes, liability insurance, etc., which are included in the hourly fee. Since the IRS has determined that private caregivers must be hired as employees rather than independent contractors, all payroll taxes and withholdings must be done by the family. A third-party service can be hired to manage payroll logistics and assist with how to ensure payments are tax deductible. The IRS may require a physician certification of chronic illness (a dementia diagnosis suffices here) in order for services to be tax deductible, and a percentage of the costs of caregiving –and even supplies --may be claimed. This is well worth the time and energy to investigate on the IRS website and is a little-known avenue to getting some costs covered.