Home Health Care

Cancer survivors may face challenges during or after treatment that require ongoing assistance with health care. Medical advances are making it increasingly possible to safely provide health care at home instead of in a medical facility. If you or a loved one have concerns about these types of challenges during or after treatment, home health care may make it possible to continue to live at home without giving up the benefits of specialized health care.

Home Health Care: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources.

Home health care is a term that includes a wide range of medical, psychosocial, personal and rehabilitation services that can be provided to individuals in their own homes. With medical advances, more and more care can safely be given at home instead of in a medical facility such as a hospital, clinic or doctor's office. An important goal of home health care agencies is to enhance the well-being of everyone involved without taking over or replacing the role of your family and other caregivers.

Depending on need, home health care services may be provided on a temporary, short-term basis or on a long-term basis. For example, home health care can be used by people who are in the process of recovery such as those recently discharged from the hospital. These services may also be appropriate when there is a long-term need for assistance such as for a newly disabled person or someone who is chronically or terminally ill.

Some cancer survivors face physical challenges during or after treatment that require ongoing assistance with health care. If this is something you or a loved one are facing, keep in mind that home health care may make it possible to continue to live at home without giving up the benefits of specialized health care. Many people find the home health care option preferable to an extended stay in a hospital or a move into an assisted living or nursing home facility.

This document provides an overview of the process of finding home health care services that best meet your needs including:

• When home health care services should be considered
• The types of home health care services that are available
• The types of care providers that are associated with home health care
• When a survivor should talk with a doctor about home health care
• How a survivor can get home health care services
• How a survivor can pay for home health care
• What to do if you have concerns about the home health care services provided
• How a survivor can find and select private home health care workers

When should home health care services be considered?

Home health care is usually considered when you cannot live comfortably and safely without support services. It may also be appropriate if you require a specific medical skilled service such as intravenous (IV) medications or physical therapy that can be done at home instead of traveling to a medical center if this has become hard to do. This type of care may be suggested by a doctor or another member of a health care team. In addition to the emotional comfort that the home environment may provide, home health care is usually less expensive than care provided in a medical facility. Access to hospitals or other health care facilities remains available as needed.

If there comes a time when these services are needed, be sure to research and compare a number of licensed home health care agencies. You can also consider the possibility of hiring your own caregivers. There are major differences in how home health care agencies and individual caregivers operate. You may find that one method meets your needs better than the other.

What types of home health care services are available?

Home health care falls into two broad categories based on length of care:

1. Short-term (or acute) care: This type of care provides assistance following an illness or injury. The goal of short-term care is to provide the necessary health care services to help you get better, regain your ability to function, care for yourself, and become as independent as possible.
2. Long-term care: This type of care is for people who are chronically ill or more seriously or permanently disabled. The goal of long-term care is to help you maintain your highest level of function or health and to help you learn to adjust to and manage the changes resulting from your illness or disability.

Within these two categories there are different levels of care:

Custodial care (non-skilled care) is care that helps with activities of daily living like dressing, bathing and toileting. This type of care is often not covered by government-sponsored programs like Medicare.

Skilled care is a level of care that requires the caregiver have special training and skills. This type of care must be provided by a licensed professional and prescribed by a doctor. Government-sponsored programs may pay for medically necessary skilled care.

There are generally two types of skilled care services:

• Intermediate care services include nursing and rehabilitative care that is provided at a level between intensive and basic care. These services are ordered by a doctor and supervised by skilled medical personnel.
• Intermittent services are usually defined as skilled health care services that are needed or provided fewer than seven days each week or less than eight hours per day over a period of 21 days.

What types of care providers are associated with home health care?

Certified home health care agencies employ a variety of care providers to deliver services. In addition to nursing care and home health aide services, agencies can provide or arrange for specialized services such as with social workers or physical, occupational or speech therapists. Home health care agencies can also assist with arrangements for medical supplies and equipment as well as nutrition programs like home-delivered meals.

With a doctor's order, the following caregivers may
be arranged through home health care agencies:

• Licensed care providers including:
  
  
  • Registered nurses (RNs) and licensed practical nurses (LPNs) cangive medication, change bandages, administer treatments, monitor pain or other symptoms and check vital signs (temperature, blood pressure, heart rate, breathing rate).
  • Occupational Therapists (OTs), Registered Physical Therapists (RPTs), Nutritionists and Social Workers (MSWs) can provide home health care services prescribed by a doctor in their professional area of specialty.
• Attendant caregivers such as:
  
  
  • Certified nursing assistants (CNAs) must complete a state-approved training program and competency test. CNAs perform routine tasks under the supervision of licensed nursing and medical staff. Tasks may include doing wound and skin care, checking vital signs, helping with transfers (moving from one place to another), assisting clients with ambulation (walking) and prescribed exercises.
    
    CNAs can also provide assistance with activities of daily living (ADLs). ADLs are those activities that are necessary for people to be able to live independently including bathing, toileting, eating, and moving around the home.
  • Home health aides may assist with personal services and ADLs such as bathing, toileting, eating, ambulation and transfers.
  • Personal care attendants (PCAs), homemakers or companions can only assist with tasks such as cleaning, cooking, laundry and other household chores. They may also provide help with shopping, accompany clients to appointments or do other errands.
• Respite caregivers
  
  Respite care services offer the usual caregiver a temporary break from the day-to-day demands of taking care of another person on a full-time basis. Respite care is typically needed by the primary caregiver of someone who is severely or chronically disabled. Services may also include housekeeping, home health assistance, nursing and child care.
• Hospice caregivers
  
  Hospice is a specialized service that provides a compassionate, supportive network of professionals and volunteers to help manage the physical, emotional, practical and spiritual challenges that often occur at the end of life.
  
  Services may include skilled and unskilled nursing care, emotional support, pain management, and assistance getting personal and legal affairs in order. Hospice workers might be nurses, social workers, home health aides, volunteers, therapists and pastoral counselors. Services can be provided at home or in a hospital or other care facility such as a nursing home.

When should a survivor talk with a doctor about home health care?

If you think you may have a need for home-based health care services, discuss your needs with your health care team. The doctor must prescribe (order) skilled home health care services in order for insurance to pay. Tell your doctor about any problems you are having with daily activities. Discuss the types of health care services that might be helpful to you at home.

Be certain to include the following in your discussion with your doctor:

• Your concerns about being home alone
• How often a caregiver might be required
• Types of assistance that are needed such as cooking, cleaning or help with other ADLs
• The barriers that exist to getting around your home (including stairs and physical challenges such as walking the distance to the bathroom, kitchen or bedroom)

Write down any concerns and questions before meeting with the doctor to discuss your needs. This discussion will help define how much and what type of home health care services might be needed (such as skilled or intermittent care).

How can a survivor get home health care services?

There are generally two main types of home health care services. The services are generally provided through a licensed home health care agency or by hiring a caregiver on your own (private pay).

• Using a home health care agency

Home health care agencies coordinate and supervise the provision of skilled services (such as wound care, injections and other medical care) in the home. These services are provided according to the needs of the patient and as ordered by the doctor. Home health care agencies are licensed. If the agency has also met federal and state minimum requirements for patient care, it can be Medicare-certified. This qualifies the agency for Medicare and/or Medicaid payments for home health services.

If you have a doctor's order or prescription and work with a licensed and certified agency, costs for services may be covered through an employer-sponsored, private, or government-sponsored insurance plan. Frequently, only part-time or temporary home health care services are covered. Ask your insurance provider about your specific plan. Find out what is covered and what the plan requires for services to be covered.

Local and national cancer organizations and agencies for the aging may be able to suggest home health care providers. Generally, you have the right to choose the home health care provider that you want. However, certain insurance plans limit coverage to the agencies that are listed in the policy. Your insurance company may have a relationship with certain home health care agencies and direct you to a specific service provider.

If home health care is needed following a hospitalization, a hospital social worker will usually initiate contact with a home health care agency and coordinate services with the doctor, you, and your family. A home health agency has the right to refuse to accept any individual patient if the agency is not able to meet the patient's needs.

• Researching home health care agencies

Begin your research by asking health care team members (such as your doctor, nurse or therapist) to help you with recommendations and contact information for home health care agencies. A hospital social worker, Oncology Social Worker, nonprofit cancer organization, or your Health and Human Services office may also be able to direct you to local resources that are available.

• Comparing the quality of care provided by home health care agencies

Home health care agencies are certified to make certain they meet federal health and safety requirements. You can get information about home health agencies and the results of their quality measures from a Medicare agency. In some cases, a local ombudsman, who can be contacted through your local agency on aging, may have information on quality care measures of home health agencies in your area.

You will have a say about which home health care agency you use, but your choices may be limited by agency availability or a factor such as Medicare rules. Some hospitals have their own home health care agency, but this does not mean you have to choose the hospital's agency.

Quality care means doing the right thing, at the right time and in the right way to obtain the best possible results for the patient. Quality care measures give you information about how well home health agencies provide care for patients. Patients are monitored for quality measures in areas such as:

• Improvement in mobility (ability to move around the home)
• Patient medical emergencies
• Improvement in mental health
• Ability to perform ADLs such as bathing, dressing, and eating
• Infection control

• Developing a patient care plan

You and your loved ones have a right to participate in planning care and discussing treatment options. Patient care plansaredeveloped for individuals as part of the case management process. These written plans are based on the doctor's orders and outline all of the services and caregiving arrangements that are needed. A multi-disciplinary team (that may include family members, nurses, dieticians, doctors, therapists, activities and social services professionals) defines timeframes and specific care services to be provided.

Your care plan is periodically reviewed by the home care team and adjustments are made to the care plan as needed to reflect your current needs. Home health care staff cannot make changes to the care plan your doctor has ordered without the doctor's knowledge and permission.

Using private home health care workers

Private home health care workersare individuals hired directly by you or your family. They may be found a number of ways including through a friend or by using a classified ad or a similar "help wanted" posting. These caregivers typically provide companionship and help with ADLs such as housecleaning and meal preparation.

If you plan to hire and pay an unlicensed personal care attendant for home health care services on your own, you do not need a doctor's order. However, licensed nursing services that are provided by a RN or LPN do require a doctor's order.

If you do decide to find your own home health care worker, be aware that you will be required to take responsibility for certain things. Carefully consider these responsibilities including:

• The need to withhold taxes as an employer for the worker

• The need to have a written contract (including a job description) with the home health care worker, particularly if he or she is going to live in your home. If the caregiver is going to live with you, it must be clear in the contract that their right to stay in your home continues only as long as that person works for you.

• The need to be certain that the home health care worker is covered by personal liability or worker's compensation insurance so that you are covered in case there is a liability claim such as an injury in your home.

• The need to do background check to make certain that the health care worker you hire has no record of criminal activity or abuse. Some states have registries (many are available online) for personal care attendants and home health aides that make it easier for you to do the background check.

• The need to have a back-up plan for care in case the worker becomes ill or unavailable at short notice.

Interview potential health care workers in your home where there is an opportunity for the caregiver to become acquainted with you and any family members. The interview and selection process should be a time for an open and honest discussion between the patient, family, and the health care provider. This is the time to ask questions and to cover all topics that are of concern to you. Ask the caregiver how he or she would respond in specific situations and request that they provide examples from past experience that show how they solve problems.

Make it clear to the home health care provider that you will not tolerate abuse, neglect, chronic tardiness, absenteeism or failure to perform assigned duties. Discussing a set of rules and job requirements is important before signing an employment agreement.

Home health care registries are independent contractors that provide services at prices that are usually lower than home health care agencies. They operate somewhat like an employment agency in that they screen, interview and do reference checks on home health care workers that are referred. Be sure that any agency you select can provide the type of caregivers you need.

Some states and counties offer home health care services to people who are disabled or to family caregivers. An application for assistance is reviewed and evaluated by need. If you qualify for program services, home health care aides may be provided.

Finally, some families elect to set up formal caregiver contracts (also called personal service or personal-care agreements) to hire a family member to provide care services. These legal contracts name the specific services to be performed, the rate of pay to be provided the caregiver and when it will be paid, such as in one lump sum or in regular payments. Talk with an attorney who specializes in this area to receive guidance if you decide to set up such a contract. There is also information on caregiving contracts and related matters available online, such as through the National Academy of Elder Law Attorneys.

How might home health care services be paid for?

Home health care services can be costly. Some services may be partially covered by private medical and disability insurance policies. However, home health care on a long-term basis may have to be financed through personal funds and state and federal medical assistance programs.

If your insurance policy or a government program will not normally cover those needs, your doctor or a home health care company may be able to negotiate for you with the insurance carrier. Specifically, if it can be shown that it is less expensive to deliver the needed services to you at home rather than in a hospital, they might consider covering costs for a time.

• Medicaid is a government assistance program for people who meet certain low income requirements. It is jointly funded by the federal and state governments and operates under national and individual state guidelines. Eligibility for Medicaid varies from state to state. Some states have "medically needy" options to cover the cost of medical care for persons who would qualify for Medicaid on the basis of the services they require, but have too much income to qualify for the program and too little to pay for the needed medical services.
• Medicare is a national health insurance program that pays for acute medical care services for people age 65 or older or those who have qualified for government disability benefits.
  
  In most cases you need to meet all of the following conditions to be eligible for insurance or Medicare-covered home health care benefits:
  
  
  • Your doctor must determine that you need medical care, and write a prescription referring you to home health care services.
  • You must need at least one of the following care services: intermittent skilled nursing care or physical therapy, speech-language therapy, or ongoing occupational therapy.
  • You may need to choose a home health agency that is certified or approved by the insurance company or assistance program. For example, the agency may need to be Medicare-certified.
  • You must meet certain requirements such as not being able to leave home unassisted or being confined to home by illness. Leaving home for medical treatment, adult day services or short, infrequent trips is allowed.
• Private insurance may cover some home health care services. Check your policy to find out if your home health care needs will be covered. If so, find out the length of time services will be covered.
  
  In some cases, it may be possible to use a long-term care insurance policy to pay family members who provide the caregiving services. Some government benefit programs provide funding to pay family members for "consumer-directed care." Local agencies on aging or departments of social services may be able to provide more information on government funding.

Costs

Rates for home health care are based on the level of service, individual agency rates, and the rates typically charged in the area in which the services are provided. Contact several agencies to compare services offered and rates charged before deciding to contract for services.

There may be limits on the number of hours per day and days per week that you can get skilled nursing or home health aide services. Contact your insurance company to find out specifically what home health care services are covered. If you have Medicare or Medicaid, the Centers for Medicare and Medicaid Services can provide you with information.

If you are eligible for home health care, services ordered by a doctor such as the following are likely to be covered:

• Skilled nursing performed by a registered nurse or a licensed practical nurse on a part-time or intermittent basis
• Home health aide services on a part-time or intermittent basis
• Physical therapy, speech-language therapy and occupational therapy for as long as the doctor says you need it
• Medical social work services to help you with social and emotional concerns related to your illness such as counseling
• Certain medical supplies, but not prescription drugs
• Rental or purchase of medical equipment such as a hospital bed, wheelchair or walker

  If your insurance company will not automatically pay for needed home health care equipment, try taking the following steps:

  • Compare and discuss the costs of obtaining the treatment at home to the cost of getting the care at a medical facility.
  • Check to see if it is possible to borrow the equipment.
  • An area agency on aging or another community service group may be able to assist you to find a supplier from which you can borrow the equipment.
  • Compare costs to see if it is cheaper for you to rent the equipment or buy it.
  • When comparing the costs of renting or purchasing medical equipment, include the cost of servicing the equipment. If you rent, equipment maintenance may be free.

What if you have concerns about the quality of home health care services?

If you have concerns about the home health care services, start by speaking directly with the care provider to let him or her know your concerns. If that does not improve the situation, speak with the provider's supervisor or the agency owner. If there is still no improvement in the work, ask for a new health care worker. Be sure to let your doctor know of any unresolved concerns or problems with the agency.

If you find that you do not feel comfortable with the home health care you receive, you can change home health care providers. A close friend or family member can speak on your behalf if you do not want to personally deal with the problem. Keep in mind that because of federal laws about health privacy, the home health care agency will need written permission to speak with someone other than you about your care.

If a problem with the health care provider cannot be resolved to your satisfaction, you will likely want to change agencies and/or health care workers. The following are basic guidelines for changing your home health care provider:

• You may choose to end your relationship with one home health care agency and choose another at any time.
• If you need to change agencies, contact your doctor to get a referral to a new home health care agency. You must notify both the agency you are leaving and the new agency of the date that the change will take effect.
• Before you make any arrangements to change home health care agencies, be certain that the change is pre-approved by your insurance provider(s).
• Keep in mind that you can only get care from one home health agency at a time. However, it is common for people to receive skilled services through one agency and homemaker services through another.

  Most home health care agencies and their staff are honest and use accurate billing information. Unfortunately, fraud (cheating), waste or abuse can occur.

  Watch for possible signs that something is wrong such as:

  • Home health visits that your doctor ordered, but you never received
  • Visits by home health staff that are not needed
  • Bills for services and equipment you never got
  • Forging of your signature or your doctor's signature
  • Pressure to accept items and services that you do not need

Home health care should be overseen by you, loved ones, and your health care team. If necessary, changes can be requested. Patients of home health agencies have rights. A Medicare-approved facility must provide you with a written copy of your rights.

The ultimate goal of home health care is to make it possible to remain in the home in a safe and comfortable environment while enjoying a better quality of life. Although there may be a period of adjustment to a new care routine, it is important that you feel safe and satisfied that you are receiving a high standard of care.

This document was produced in collaboration with:

David S. Landay, Esq., author of Be Prepared: The Complete Financial, Legal and Practical Guide for Living with Cancer, HIV and Other Life-Challenging Conditions.

Works cited:

"Accessing Home Health Care." Leukemia-Lymphoma.org. The Leukemia & Lymphoma Society. White Plains, NY. 9 February 2005.
www.leukemia-lymphoma.org

"Guide to Interviewing a Caregiver, Tips for Hiring a Caregiver and A Home Healthcare Planner." Respite Match.com, Home Healthcare Solutions. >Rex, GA.< 8 August 2006.
www.respitematch.com

Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New YorkSt. Martin<'s Press, 1998.

McFarlane, Rodger, and Philip Bashe. The Complete Bedside Companion. New York: Simon and Schuster, 1998.

Silverman, Rachel Emma. "Who Will Mind Mom? Check Her Contract: Seniors Turn to Written Agreements to Compensate Relatives as Caregivers; Reducing Estate Size." The Wall Street Journal, 7 September 2006: D1-D2.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Publication 10969: Medicare and Home Health Care and Home Health Compare. Baltimore, MD. August 2004.

Home Health Care: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

The rights for a home health care patient include:

• The right to choose your home health agency
• The right to have your property treated with respect
• The right to have your family or guardian act on your behalf
• The right to file a complaint about your treatment or care if it is not provided appropriately or if the staff shows disrespect for you or your property
• The right to be given a copy of your plan of care that documents the types and frequency of services
• The right to know about the staff that the home health agency will provide

When considering whether you need home health care:

• Make a list of the advantages and disadvantages of using home health care if you are not sure whether you want to continue to live on your own after treatment. Discuss your concerns with your family, friends, health care team or social worker if you would like their help in making this decision.
• Talk to your health care team or social worker about home health care services that might help you to continue to live in your current home.

If you plan to hire a caregiver through a home health care agency:

• Contact your health insurance company to find out exactly what home health care services are covered by your policy.
• Contact a local, state or national organization that oversees home health care agencies and workers to find out more about home health care providers:
  • The National Association for Home Health Care (NAHC)
  • State and local health departments may also have a registry of licensed home health care agencies in your community
  • Department of Veteran Affairs
  • State Health Insurance Assistance Program (SHIP)

Consider the following questions if you are in the process of selecting a home health care agency:

• Is the agency certified by Medicare or Medicaid?
• Does the agency offer the specific health care services you need?
• Does the agency meet any special needs, such as language or cultural preference?
• Are personal care services you need offered, such as help bathing, dressing and toileting?
• Are needed support services offered, such as help with laundry, cooking, shopping or housekeeping?
• Is there staff available to provide the type and hours of care your doctor ordered?
• Can the agency start services when you need them?
• Is the agency recommended by your hospital discharge planner, doctor or social worker?
• Is someone available at night and on weekends for emergencies?
• Has someone explained what services will be covered by insurance, and how much you must pay on your own?
• Have background checks been done on all staff?
• Are there positive written references about the staff and care from satisfied patients, family members and doctors?

Consider the following questions about your satisfaction with your home health care agency:

• Does the agency staff treat you and your loved ones with respect?
• Does the agency staff allow you and your loved ones to participate in creating the plan of care?
• Does the agency staff let you know about changes in the plan of care?
• Are the agency staff trained and licensed to perform the type of health care you need?
• Has the agency explained what to do if you have a problem with the staff or the care you are getting?
• Does the agency respond quickly to your needs and requests?
• Does the staff check your physical and emotional status at each visit?
• Does the staff respond quickly to changes in your health or behavior?
• Is the staff concerned about your special needs and changes that should be made in your home to better meet your needs?
• Has the staff told you what to do if you have an emergency?
• Is your privacy protected?
• Do you feel safe and comfortable with the care you are receiving?

Ask yourself the following questions if you suspect fraud, waste or abuse in the way home health care services are being provided:

• Are there home health care services that your doctor ordered, but you never received?
• Are there visits by home health staff that are not needed?
• Are there bills for services and equipment you never got?
• Have you noticed the forging of your signature or your doctor's signature?
• Has there been pressure to accept items and services that you do not need?
• Are items listed on your invoices that you do not think you received?
• Are you confident about the skills and abilities of your health care workers?
• Are you concerned about your safety and well-being?
• Have you noticed any items or personal belongings missing from your home?

If there is a need to change home health care agencies, you should:

• Contact your doctor to get a referral to a new home health care agency.
• Notify both the agency you are leaving and the new agency of the date that the change will take effect.
• Be certain that a change in home health care agencies is pre-approved by your insurance provider before you make any arrangements to proceed with the change. Keep in mind that you can only get care from one home health agency at a time.

If you plan to hire home health care workers on your own, understand the legal requirements you may have as an employer including:

• Insurance: Verify that your homeowner's or renter's insurance policy covers household employees in case of an accident. If your policy does not cover workers in your home, look into purchasing a worker's compensation policy to cover your employees.
• Taxes: Be fully informed about any legal responsibility to pay taxes for household employees, including reporting the worker's wages and tax liabilities on his or her yearly 1040 form.
  • Social Security Tax: An employer is required to withhold Social Security taxes and file them with the Internal Revenue Service (IRS) every year.
  • W-2 or W-3 form: The appropriate form must be filed with the IRS at the end of each year and a copy must be sent to the employee.
  • Employment eligibility verification form I-9: Each employee must complete this form, and a record must be kept on file with the employer to prove that the employee has the right to work in the United States.

Develop a job description before interviewing prospective home health care providers on your own. The job description that you write can be used as a work contract that is signed by both you and the home health care provider.

Include information such as:

• Names of the responsible people including the employer (you) and the caregivers
• Wages, benefits, mileage, meals to be paid
• How and when payments will be made
• Work schedule including hours, days off, holidays
• Caregiver's social security number
• Job duties
• Specific behaviors that are not allowed such as smoking, consuming alcohol or other substances
• Reasons for termination without notice
• Requirements for giving notice to quit the job
• Signatures and date the document is signed

Ask questions such as the following when interviewing prospective private home health care workers:

• What is your experience in the health care field and where did you previously work?
• What specific skills and training do you have?
• How do you handle difficult situations?
• Do you have transportation?
• Are you physically able to transfer someone from one place to another?
• Are there any tasks listed in the job description that you are uncomfortable performing?
• Can you provide personal and work-related references?

Define your rules for employment and clearly discuss important matters with the health care worker, such as:

• How much notice you and the caregiver must give before ending your employment agreement
• When you have the right to end the employment agreement
• What behaviors are unacceptable to you, such as tardiness, poor attitude, personal problems interfering with the job performance and borrowing money
• When you expect the caregiver to work including the days per week, number of hours, the schedule with start and end times, length and frequency of breaks

Seek legal help if you are interested in setting up a formal caregiver contract to hire a family member. Seek legal guidance from an attorney or professional organization, such as the National Academy of Elder Law Attorneys (naela.com), about how to correctly set up the arrangement.

Look into the possibility that some government programs (such as a state Medicaid consumer-directed program) may be able to provide funding to pay family members for care. Local agencies on aging or departments of Social Services may be able to provide more information on government funding.

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Home Health Care: Additional Resources

The resources listed below provide more detailed information and support services to help you with home health care. Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG Navigation Services
LIVESTRONG.org/Get-Help

Online: Complete an intake form through the LIVESTRONG website.
Phone: 1.855.220.7777 (English and Spanish)
Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about fertility risks and preservation options, treatment choices, health literacy and matching to clinical trials. Emotional support services, peer-to-peer matching and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG has partnered with several organizations including Imerman Angels, Navigate Cancer Foundation, Patient Advocate Foundation and EmergingMed.

Eldercare Locator: Connecting You to Community Services
www.eldercare.gov

Email:	eldercarelocator@spherix.com
Phone:	1-800-677-1116
	Calls are answered by Information Specialists from Monday-Friday, 9:00 a.m. to 8:00 p.m. EST. Voicemail is available after hours. Translators are available for 150 languages.

The Eldercare Locator is a free national service of the U.S. Administration on Aging of the U.S. Department of Health and Human Services. It provides a connection to resources that can help seniors live independently in their communities. The website lists phone numbers for state and local Area Agencies on Aging that serve older adults and their caregivers. People of all ages can use this resource to find in-home care.

Legal Services Corporation
www.lsc.gov

Email:	Send email through the website.
Phone:	1-202-295-1500

The Legal Services Corporation is a nonprofit organization that helps low-income individuals and families find free or affordable legal services. The website provides contact information and eligibility rules for legal aid services in your county or state. Some of the state websites also include information about a variety of legal topics. The information includes wills and estates, employment or housing discrimination, family law, public benefits, elder law, health care and disability rights.

U.S. Department of Health and Human Services - Medicare.gov
www.medicare.gov

Phone:	1-800-MEDICARE (1-800-633-4273)
	Calls are answered 24 hours a day, seven days a week. Spanish-speaking customer service representatives are available.

Medicare.gov is a program offered through the U.S. Department of Health and Human Services. This program provides free information about Medicare eligibility and benefits. It also offers publications about choosing a nursing or assisted living home, long-term care planning, home health care, alternatives to nursing homes, and more. A search tool allows you to find nursing homes as well as home health care and physical therapy services in your area. In addition, there are links to state resources for home health care and nursing home or assisted living information. Some information on the website is available in Spanish.

National Association of Professional Geriatric Care Managers, Inc.
www.caremanager.org

Phone:	1-520-881-8008
	Calls are answered Monday through Friday, from 8:00 a.m. to 4:30 p.m. (MST). Voice mail allows you to leave messages 24 hours a day, seven days a week.

The National Association of Professional Geriatric Care Managers is an organization of nurses, social workers, gerontologists, psychologists and other professionals who specialize in the field of elder care. Through this website, you can find a private geriatric care manager in your area, learn more about the services a geriatric care manager can provide, and find additional care management resources, such as government agencies, national organizations and community services. You can also order brochures and books related to caregiving issues.

Quality Check
www.qualitycheck.org

Email:	Send email through the website
Phone:	1-630-792-5800

Through this website, you can check the Quality Reports on nearly 15,000 long-term care facilities, home care agencies, hospitals and other organizations across the nation that are accredited by the Joint Commission on Accreditation of Healthcare Organizations. You can search by facility name, zip code or city and state. These reports include the organization's accreditation decision, information about the facility's services, and compliance with the Joint Commission's National Patient Safety Goals. The site also has information about how to read these reports and understand what qualities are being rated.

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