Service Providers

There are several types of agencies that provide home care services. They come in the non-profit and for-profit varieties and a newer public-sector model.

Home health agencies

A "home health agency" generally refers to an agency that is Medicare certified. This means it has met minimum federal requirements for client care in order for services to be reimbursable by Medicare (as well as by Medicaid). These agencies focus on medical services and employ professional trained caregivers, such as registered nurses, licensed practical nurses, and physical therapists.

Individuals who require "skilled" care usually receive that care from a home health agency. If the client needs more than one service, the agency can put together a team that might include several health professionals, along with a certified nurse assistant.

Homemaker and home care agencies

These agencies provide non-medical services—employing homemakers, chore workers, home care aides and similar types of caregivers. Generally, these caregivers do not work under the supervision of a medical professional and their services are not reimbursable by Medicare. Some states require these agencies to be licensed and meet minimum standards.

Staffing and private duty agencies

These are nursing agencies that provide and coordinate the services of professional nurses, homemakers and home care aides. States rarely require such an agency to be licensed or meet regulatory requirements.

Social service agencies

Sometimes home care is available through non-profit social service agencies, including some that have a religious affiliation. Services often follow a preliminary assessment by a nurse or social worker, who may also be assigned to coordinate the client’s care plan.

Public authorities

"Public Authorities (PAs)" for home care services are sponsored by state or county governments. They are the "employers of record" for home care workers in a geographic area and serve as a clearinghouse for available aides. These home care workers have the status of public employees.

Acting as "employers of record," the Public Authorities are responsible for issuing paychecks, complying with state and federal health and safety laws, and for witholding and forwarding taxes from the worker’s pay (including Social Security payroll taxes). They also perform background checks and take on all liability for the worker. Responsibilities such as these might be very difficult for frail elderly clients to assume on their own.

Public Authorities are a relatively new concept in home care and operate primarily in western states, such as California and Oregon. But the concept is moving eastward and may be coming to your area one day soon.

Independent home care workers

Individuals seeking home care can arrange for their own caregiver by advertising in the newspaper or hiring someone they’ve heard about or already know. In these cases, the client is the employer and must comply with all the legal requirements of an official employer.

In addition to paying the worker and witholding taxes, the client is responsible for training and supervising the worker. The client is also responsible for meeting all official health and safety regulations and assumes all liability for whatever might occur in the home during working hours.