Selecting a Home Health Agency (HHA) for yourself or a loved one is a significant decision. An HHA provides professional, medically necessary services for individuals recovering from an illness, injury, or managing a chronic condition in their residence. These services focus on skilled care that must be delivered or overseen by licensed medical professionals, distinguishing them from general non-medical assistance. Making an informed choice ensures the patient receives high-quality, targeted care that supports recovery.
Defining Home Health Agency Services and Eligibility
A Home Health Agency provides skilled medical care requiring the specialized knowledge of licensed staff. This care includes services such as skilled nursing, physical therapy, occupational therapy, and medical social work, which are medically directed and goal-oriented. These services are intermittent, meaning they are part-time and not continuous, focusing on recovery or managing a stable chronic condition. Non-medical custodial care, such as assistance with bathing or housekeeping, is distinct because it can be safely provided by non-licensed personnel.
To be eligible for HHA services, particularly those covered by Medicare, the patient must meet specific criteria. The patient must be under the care of a physician who orders the services. They must also be considered “homebound,” meaning leaving the home requires a considerable effort due to their condition. The care provided must be reasonable and necessary for treating an illness or injury, and the entire plan must be overseen and regularly reviewed by the patient’s doctor.
Identifying Potential Agencies and Checking Credentials
The initial step in selecting an HHA involves compiling a list of potential providers from reliable sources familiar with the patient’s medical needs. These sources often include the discharging hospital social worker, the referring physician’s office, or state licensing boards. Securing a referral from a physician is required, as the doctor must certify the patient’s need for the services.
A baseline requirement is verifying the agency’s legal standing and certification status. The most significant is certification by the Centers for Medicare & Medicaid Services (CMS), which is necessary for the agency to bill Medicare or Medicaid. CMS certification confirms the agency meets federal health and safety standards. Additionally, checking a state’s Department of Health website confirms the agency holds a current state operating license, a mandatory regulatory requirement.
Evaluating Agency Performance and Care Quality
After confirming licensing and CMS certification, evaluate the quality of care using the federal government’s Care Compare website. This platform publicly reports objective data on Medicare-certified HHAs and provides star ratings, which synthesize performance across several metrics to offer a quick, comparative assessment of overall quality.
Care Compare data includes outcome measures, tracking how well patients improve in areas like mobility, pain management, and the ability to perform daily activities. Another metric is the rate of unplanned hospitalizations (readmission rates), which indicates the agency’s success in managing the patient’s condition. Patient satisfaction scores, collected through the HHCAHPS Survey, measure patient experience in areas like communication and willingness to recommend the agency.
In addition to reviewing public data, families should prepare specific questions to ask prospective agencies directly. Inquire about emergency protocols, such as how they handle after-hours calls and whether a registered nurse is available 24/7. Also, ask about staff training and consistency, including the staff turnover rate and how often the same clinician is assigned to a patient, as continuity of care is important.
Confirming Coverage and Initiating the Care Plan
Before services begin, confirming financial coverage is necessary to protect the patient from unexpected costs. Medicare, Medicaid, and private insurance plans have distinct criteria and limitations for HHA coverage, requiring verification of eligibility with the specific plan. The agency’s intake process includes verifying insurance coverage and obtaining any required pre-authorizations from the payer.
The initial visit, typically conducted by a registered nurse, serves as a comprehensive assessment of the patient’s medical status and home environment. This assessment collects clinical data (OASIS), used for care planning and quality reporting to CMS. The agency then develops the personalized Plan of Care (PoC), outlining specific skilled services, frequency, and measurable goals. The PoC must be signed and approved by the patient’s attending physician before services can officially begin.