This brochure provides information for consumers about health care available in the home. You are encouraged to use all available resources to help you find the health care services you need. Resources can include your physician, your insurance company, and the contacts listed in the Resource Directory at the back of this brochure.

• Some of the topics included in this brochure include:
• Services that are offered.
• Providers that offer these services.
• A description of quality standards.
• Guidelines for selecting a health care provider.
• Sources of assistance.

There are many aspects to health care services in the home and this brochure can help you be informed should you or someone you know need these services.

Health care services offered in the home may include:

• Nursing care;
• Physical, occupational, respiratory, or speech therapy;
• Home health aide services;
• Medical social services;
• Nutritional counseling;
• Medical equipment and supplies; and
• Homemaker and companion services.

Home Health Agencies
Home health agencies provide nursing care; physical, speech, occupational, respiratory and IV therapy; home health aide services; homemaker and companion; home medical equipment, nutritional guidance, and medical social services in the patient's home or place of residence.

Nurse Registries
Nurse registries arrange for nurses, certified nursing assistants (CNAs), home health aides, homemakers, or companions to provide services to patients in their homes.

Hospices
Hospices provide nursing, physician, social work, and pastoral services; nutritional counseling; and bereavement counseling (dealing with the grief of death and dying) for terminally ill patients and their families. Additional services may include: physical, occupational, speech, and massage therapy; home health aide and homemaker services; home medical equipment and supplies; and respite services. The staff is specially trained to assist the patient and family members who are dealing with death and dying. These services are provided in the patient's place of residence, a hospital, or a hospice facility.

Home Medical Equipment Providers
Home medical equipment providers sell or rent home medical equipment and services. Equipment includes, though is not limited to, oxygen, respiratory equipment, and customized wheelchairs. Services include delivery, set up, instruction, and maintenance of equipment. A home health agency or hospice can also provide this service.

Homemaker and Companion Services
Companies providing only homemaker and companion services must be registered with AHCA. Services include housekeeping, meals, shopping, and trips outside the home. These services can also be offered by a home health agency, nurse registry, or hospice.

If you employ an independent practitioner, you should ask them who will be responsible to pay household employment taxes, income withholding taxes, and unemployment taxes. If the independent practitioner does not pay these taxes, you may be required to pay them.

• If a patient is receiving skilled services the patient's physician must sign a treatment order, indicating the services needed. Skilled services are those services provided by a nurse or by a physical, speech, occupational, or respiratory therapist. A plan of care must then be developed, giving details of how the care will be given (sometimes a plan of care is called a POC or a plan of treatment). A plan of care is not required for clients receiving home health aide services without a treatment order or for clients receiving only homemaker or companion services.
  
  
• A patient has the right to participate in the planning of his or her care and to receive, upon request, a copy of the plan of care.
  
  
• For patients receiving skilled services, a health care professional licensed to perform these services must do an assessment of the patient's condition.
  
  
• The plan of care must be reviewed at certain times by the physician, and the care must be coordinated and supervised by the provider. These requirements vary depending on the provider offering the services, so ask the provider and your physician what to expect.

• You may want to talk with two or more providers until you find one that meets your needs. You may also want to discuss the choice with your physician. However, you are not required to use a provider recommended by your physician or hospital.
  
  
• If you need nursing care, therapy, home health aide services, or home medical equipment, discuss this with your physician. The physician might write a treatment order for your care. If you have a treatment order the cost might be paid by your private insurance or, if you and the home health care provider are eligible, by Medicare or Medicaid (See the "Medicare and Medicaid" section of this brochure).
  
  
• If you need help getting a bath or other types of personal care, but you do not need any other medical care, you may want to discuss this with your physician, or you can arrange these services yourself. A home health aide or CNA would provide these services (But not if they are employed or contracted with a homemaker and companion service). Most often these services would be paid with your own money. For possible assistance, check with your insurance company, Medicaid, your local office of the Florida Department of Children and Families, or call the Elder Helpline (through the Florida Department of Elder Affairs) about their local programs. If there is a program in your area, there may be a waiting list.
  
  
• If you need someone to help you with shopping, meal preparation, household chores, or driving, these services can be provided by a homemaker or companion. Most often these services would be paid with your own money. For possible assistance, check with your insurance company, your local office of the Florida Department of Children and Families, or the Elder Helpline.
  
  
• To find out about Medicare eligibility, contact Medicare. For Medicaid eligibility contact your local office of the Florida Department of Children and Families. Further information about these programs is listed under the "Medicare and Medicaid" section of this brochure.

• You can ask the health care company to show you their current Florida license or registration. Independent licensed practitioners can show you their professional license. Home health aides and CNAs can show you a training certificate. Independent homemakers and companions are not required to have a training certificate.
  
  
• Ask what health care services will be provided.
  
  
• Ask for a written description of fees. The provider should explain what you will pay and what your insurer will cover. If you are covered by Medicare or Medicaid, ask if the provider is eligible to bill one or both of them.
  
  
• Ask for proof of current liability insurance. (Homemakers and companions are not required to carry liability insurance.)
  
  
• If you are receiving skilled services or are on life-support equipment, the provider is required to be on-call 24-hours a day, 7 days a week. Be sure the provider gives you their 24-hour phone number.
  
  
• If you are receiving only non-skilled services or equipment that is not life supporting, the provider should give you the phone number where you can call during regular service hours.
  
  
• Ask about procedures for handling complaints. The provider might have a procedure to handle complaints within their company. You also have the right to file a complaint with the Agency for Health Care Administration.
  
  
• The local offices of the Florida Division of Emergency Management maintain a Special Needs Registry for patients who will need assistance with evacuation and sheltering during a disaster, like a hurricane. This assistance is for special needs patients who have a physical or mental condition that requires medical oversight during evacuations. If this describes your situation, ask the provider to help you register with the Special Needs Registry.
  
  
• Ask for references.

• To qualify for Medicare you must be 65 years or older or disabled or with end-stage renal disease.
  
  
• To qualify for Medicaid you must be low-income, aged, blind or disabled. Applicants must meet certain eligibility requirements.
  
  
• The health care provider must have a Medicare or Medicaid provider number. All hospices serve Medicare and Medicaid patients.
  
  
• Home health agencies and home medical equipment providers may or may not have a Medicare and/or Medicaid provider number, so if you are eligible for Medicare or Medicaid you should ask the company if they are eligible too
  
  
• Nurse registries and homemaker and companion services are not eligible for Medicare or Medicaid.
  
  
• For Medicare you must be under the care of a physician, be homebound, need skilled nursing care, physical therapy, speech therapy, or have a continuing need for occupational therapy.
  
  
• "Home" can be a house, apartment, assisted living facility, or adult family-care home. When you leave home, it is for infrequent or short time periods, such as for a doctor's appointment.
  
  
• For information on Medicaid standards, contact your local Medicaid office.
  
  
• Services must be on a part-time basis (not 24 hours).
  
  
• Your physician must sign a treatment order for you to receive care. Some of the Medicaid waiver programs do not require a physician's treatment order.

Medicaid Waiver Programs
In addition to the regular Medicaid program there are a variety of Medicaid waiver programs that target certain populations, including disabled adults, elderly, brain and spinal cord injured, developmentally disabled, and AIDS patients, among others. For eligibility requirements contact your local office of the Florida Department of Children and Families.

What Is Not Covered by Medicare

• Help getting a bath and other types of personal care unless skilled services are also ordered;
  
  
• 24-hour care at home;
  
  
• Meals delivered to your home; and
  
  
• Homemaker or companion services.