I’ve always believed in the importance of education. Too many people fall victim to a variety of scams simply because they don’t always know what they don’t know. One area where lack of information can be costly is in the field of Home Health Care. It’s often the case that home health care decisions have to be made at a times of high emotion or vulnerability. In those situations, prior knowledge really can be power. Knowing the difference between home health, home service and home placement helps families needing the services to truly understand what is being offered by each, and what it means for them.

Let’s start with Home Health Agencies. Home health services are ordered by a physician; usually for extended care after discharge from a hospital, skilled nursing care and or rehabilitation facility. Home Health may also be referred from a physician’s office. These skilled Services are paid for by Medicare if the patient meets the home health requirements. Home Health benefit covers Physical Therapy, Occupational Therapy, skilled nursing, medical social workers, and Home Health aides. This service is short term, intermittent, and is delivered in the home setting. Home Health services are not a continuous 24 x7 type of service.

Some patients leaving hospital don’t require that type of specific health service but may not be permitted to go home alone because they require assistance on a regular, continuous or intermittent basis dependent on their personal circumstances.

At this point Home Services will be recommended by the hospital discharge planner or case manager.

In that situation, every hospital and rehabilitation facility in Illinois is required to give you a list of providers. That seems helpful, except that what this list contains and how it’s organized is not standardized and can be a bit misleading. Some lists are alphabetical, some are not. Some are short, while others can be a long as 17 pages. However the list is presented, what you’ll find on that list are names and contact information for Home Health Agencies; Hospice Agencies; Home Care Agencies and Home Placement Agencies. With no explanation of the services or the differences. But you, as the consumer/patient, have the right to choose who you would like to provide your care.

My advice is to choose carefully. Interview several agencies before making a final decision because, despite all of them being on the hospital lists and all having the word ‘Agency’ in their title, they are NOT all the same, and some may not be official agencies. Several hospitals have not yet brought their lists current to the new regulation. See below.

A full service Private Duty Home Care Agency, employs all the caregivers sent out by that agency. For you, this means that the agency is 100% responsible for the caregivers who are employees of the agency. They are not your employee nor are they subcontractors. Agencies in fact, cannot by law, employ subcontractors/1099 staff.

An Agency therefore takes care of everything; hiring and firing; paying wages and reporting taxes; insuring; training; scheduling and supervising every caregiver.

Illinois law requires every agency to carry out mandatory background and fingerprint checks and many also do regular drug testing.

Drug testing, however, is not mandated for Home service ,Home placement licensure, making finding out about an agency’s drug testing policies another good reason to interview several.

The Home Care Agency’s responsibilities are essentially the same as the hospital employee so I like to call this option the, ‘one-stop shop’, relieving you and your family of the additional burden of managing what would essentially be an in-house employee.

Home Placement Agencies are also licensed by the State of Illinois. They too will appear on the list you will be given at discharge. Placement agencies are also required to carry out background checks on the candidates they place, and provide an annual training for all the caregiver’s they place in homes.

And that’s where the similarity ends.

A home placement agency does just what the title suggests it ‘places’. Taking this option means you will pay the agency for a caregiver who will also be paying a fee to their agent from the same placement agency.  

Then the agency is done! 

A placement agency, by law, cannot supervise or follow the care in your home. Caregivers placed by home placement agencies are not employed by the placement agency but by you. Meaning you take full responsibility for managing the caregiver, and making you responsible for all local, state and federal taxes, insurances, and the supervision and scheduling of that worker. It can be a good option or a heavy additional burden.

Before January 2018, ‘the lists’ provided by hospitals could have contained the names of several unlicensed agencies as well. Requiring additional research on your part to make sure you were trusting your care to a responsible agency. The Home Care Association of America, Illinois Chapter, was instrumental in getting new legislation introduced stopping hospitals or healthcare providers who receive state funding, from referring patients to an in-home care service agency who are NOT licensed under the Home Health, Home Services, and Home Nursing Agency Act, a giant step forward in ensuring patient quality and safety. If your hospital is not covered by the law make sure you take especial care in your decision making.

For further information visit http://www.ilga.gov/leglisation/publicacts/fulltext.asp?name?100-0099

Take away: Ask to see a copy of the Agencies licensure and current insurance and ALWAYS verify the agency is on the IDPH website and currently licensed. If they aren’t on the Illinois departments of public health website, be safe, don’t hire them. This new regulation effective January 1, 2018 applies to hospitals licensed under the Illinois hospital licensing act, hospitals operated under the university of Illinois hospital act, nursing homes operated under the nursing home care act and all health care provider’s licensed under and act of state in Illinois. If you have any further questions, please call the IDPH at 217-782-7412.