Finding Quality Home Health Care

As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.

In looking for a home health care agency, the following 20 questions can be used to help guide your search:

1. How long has the agency been serving this community?

2. Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.

3. Is the agency an approved Medicare provider?

4. Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations?

5. Does the agency have a current license to practice (if required in the state where you live)?

6. Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?

7. Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary?

8. Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?

9. How closely do supervisors oversee care to ensure quality?

10. Will agency caregivers keep family members informed about the kind of care their loved one is getting?

11. Are agency staff members available around the clock, seven days a week, if necessary?

12. Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?

13. How does the agency ensure patient confidentiality?

14. How are agency caregivers hired and trained?

15. What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?

16. How does the agency handle billing?

17. Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?

18. Will the agency provide a list of references for its caregivers?

19. Who does the agency call if the home health care worker cannot come when scheduled?

20. What type of employee screening is done?

More About the Screening Process

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have.

For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first. Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem.

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

* Illnesses/injuries, and signs of an emergency medical situation
* Likes and dislikes
* Medications, and how and when they should be taken
* Need for dentures, eyeglasses, canes, walkers, etc.
* Possible behavior problems and how best to deal with them
* Problems getting around (in or out of a wheelchair, for example, or trouble walking)
* Special diets or nutritional needs
* Therapeutic exercises
* In addition, you should give the home health care provider more information about:
* Clothing the senior may need (if/when it gets too hot or too cold)
* How you can be contacted (and who else should be contacted in an emergency)
* How to find and use medical supplies and medications
* When to lock up the apartment/house and where to find the keys
* Where to find food, cooking utensils, and serving items
* Where to find cleaning supplies
* Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure)
* Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them)

A Word of Caution …

Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

How Can I Pay for Home Health Care?

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance. Medicare is the largest single payer of home care services.

For More Information

AoA recognizes the importance of making information readily available to consumers, professionals, researchers, and students. Our website provides information for and about older persons, their families, and professionals involved in aging programs and services. For more information about AoA, please contact: US Dept of Health and Human Services, Administration on Aging, Washington, DC 20201; phone (202) 619-0724; fax (202) 357-3523; Email: or contact our website at

Medicare and Home Health Care

The Medicare program will pay for home health care if all of the following conditions are met:

1. The patient must be homebound and under a doctor’s care

2. The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)

3. The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient

4. The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”

5. The home health care agency providing the services must be certified by the Medicare program.

6. To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at:

Learn more About Home Health Care

There are several national organizations that can provide additional consumer information about home health care services. These include the following:

The National Association for Home Care

The Visiting Nurse Associations of America

The Eldercare Locator

To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging at 1-800-677-1116 to help connect you to these agencies.

Source: U.S. Department of Health and Human Services Administration on Aging,

Alzheimer’s Rally for Access

CMS… Fix this mess!

Today we’ve have made progress in the fight against Alzheimer’s with new FDA-approved treatments, but an unprecedented and unjust decision by the Centers for Medicare & Medicaid Services (CMS) is blocking access to these treatments! CMS is denying access to all current and future FDA-approved treatments addressing the underlying cause of the disease. This coverage determination was the first time ever that CMS chose to not have Medicare cover an FDA-approved drug. Which is why CMS must reverse its decision! These treatments are proven to slow the progression of the disease. Leading Alzheimer’s researchers and clinicians overwhelmingly agree that patients should have access to these treatments. Access to these treatments means more time for the person living with early Alzheimer’s. They allow people more time with loved ones, more time to enjoy life, and remain independent longer.

On Friday June 16th, our local Retirement Connection team came out to share our support and our voices to reverse the devastating CMS decision denying Medicare coverage for Alzheimer’s treatment. The fight to treat Alzheimers has made progress but we need your support to make Alzheimers treatment barrier free. The event was led by our fearless leader Amy Schmidt along with Director of the Portland Alzheimers Association Tracey Morgan and, local Lake Oswego student advocate Joonseo Lee whom all spoke out about their direct involvement with the Alzheimer’s Association.

“We are officially in the era of treatment, but Medicare is treating Alzheimer’s differently than any other disease! This is disease discrimination, plain and simple. Every day without access to FDA-approved drugs, more than 2,000 people transition to a more advanced stage of Alzheimer’s where they are no longer eligible for treatment. We need CMS to step up, to listen to the community, to listen to the science and to stop blocking access to these treatments! Let’s tell them why we need Access NOW! ” says Amy Schmidt.

Together, let’s fight for more time, more memories, and a brighter future. We would like to give a big PURPLE thank you to the Portland Alzheimers Association for hosting the Rally For Access. #AccessNow #Rally4access

“The Alzheimer’s Association welcomes and celebrates this action by the FDA Advisory Committee to support traditional approval of Leqembi for people with early Alzheimer’s,” said Joanne Pike, DrPH, Alzheimer’s Association president and CEO. “With this action we are one step closer to more people living with Alzheimer’s having more time with more of their capabilities intact — to do the things they want to do and love to do best.”

Read more:

Pride Month: June 2023

Celebrate Pride, Without Exception

The month of June is celebrated as LGBTQ Pride Month to honor the 1969 Stonewall Uprising in Manhattan, an event that became essential to the Gay Liberation Movement in the U.S. Initially, the last Sunday in June was celebrated as “Gay Pride Day”, but the one day quickly grew into a month-long series of celebrations including parades, festivals, concerts, workshops, and other events that attract millions from around the world. The purpose of these events are to honor the impact that lesbian, gay, bisexual, and transgender individuals have had on history.

This year, the Human Rights Campaign is celebrating Pride, without exception. Together we can rise up and fight until we have freedom without exception, liberation without exception, joy without exception and pride without exception.

Other notable celebrations in the month of June include…

-Father’s Day, June 19

-Juneteenth, June 19

-The Longest Day, June 21

June is named after the Roman goddess Juno – the god of marriage and childbirth, and the wife of Jupiter, king of the gods.

Learn more about the history of previous months here.

10 Benefits of Agency-Based Home Care

When trying to decide the best home care solution for your aging loved one, it helps to explore all your options. The information provided can help you explore the benefits of agency-based home care, answer some of your commonly asked questions, and help you understand what to ask when deciding on an agency for your care needs.

10 advantages of agency-based home care

  1. Caregiver background checks, reference checks and ongoing drug screening
  2. Liability insurance for accidents and wrongdoing, workers compensation insurance for caregiver injuries
  3. Backup caregivers allow for continuity of care, no breaks in service, and having family/friend to manage
  4. Access to RN’s, Case Managers, & schedulers
  5. Continuing education and training of your caregivers on latest industry techniques
  6. Industry and Department of Human Services oversight on best practices,
  7. Quality assurance programs to ensure the standard of care
  8. Access to long-term care insurance for those with policy in place
  9. Access and assistance with obtaining Veterans Aid and; Attendance pension for home care
  10. Peace of mind

Cost of agency-based home care versus private home care

If cost is a consideration for you, then you should know that agency-based home care does tend to have a higher average cost at about $38/hr while private home care may only cost, on average, $22/hr.

Commonly asked questions about agency-based care

Are “Home Health” and “In-Home Care” the same thing?
Home Health is a medical service for people who are homebound which includes skilled nursing, at-home physical therapy, pain and prescription management, and wound care. Home Care is classified as non-medical assistance with daily activities including personal care, meal preparation, light housekeeping, ambulatory assistance, medication administration, and nurse delegated care. Although agencies can manage medications and some minor wound care, they are limited in their medical services.

Will my Medicare or Health Insurance pay for my services?
No, both are medical insurances. The entire home care industry is non-medical. The only insurance that ensures a benefit for home care is Long Term Care insurance.

What questions should you ask an agency when deciding on care and why

Do you pay your caregivers as employees or as contract employees?
It is a State law that all agencies must employ their caregivers as employees.

Will I have the same caregiver every shift?
Any case that is 5 or fewer days per week and less than 8 hours and one shift per day, should be scheduled with one caregiver. Caregiver availability is a rising challenge so you may need a second caregiver, but you should see the same caregiver(s) on a weekly basis.

If I am unsatisfied with my caregiver what can I do?
You should have the ultimate choice in your caregiver. It is wise to try and work out issues, as caregivers want to please you and are willing to adapt, but if you don’t have a choice, look elsewhere.

Top 10 Estate Planning Issues

As an Elder Law attorney, I am often asked “What is the biggest estate planning problem?”.  My answer, “Failing to start”.  The following is a list of issues to think about when preparing your estate plans.  Almost all issues can be taken care of with a little thoughtful consideration, but the same issue can also create major problems if not dealt with in advance.

1. Probate – Court supervised administration of your estate is never a pleasant journey. Despite the helpful court personnel, there are still filing fees, lack of privacy issues, and long waiting periods before distribution. And that’s if all goes well.

2. Asset Protection – Many people do not take advantage of the asset protection opportunities that can be achieved with relatively basic estate planning. Creating trusts for spouses and children with the right provisions means your assets can be protected from claims of creditors and predators for years to come. While we hope that our children would not fall victim to divorce, this is one asset protection conversation that must be planned for.

3. Tax Planning – This is never an easy issue as the various tax systems don’t always line up with each other. Consider the tension between gift planning, (giving away some of your assets) to shelter appreciation by moving them outside of your estate, and loss of basis for capital gains purposes. While not easy, this issue can really cost you money if not properly handled.

4. Family Disharmony – Estate planning is a way for you to say you care about your loved ones. But selection of your personal representative or trustee can also stir the pot and create issue issues for those not chosen. Sometimes it is best to name a non-family member to be in charge of your estate. Giving thought to how to help resolve these conflicts or at least, not make them worse, can help to avoid family conflicts.

5. Attorney’s Fees – The best way to control legal fees is to incur them while you are alive and able to oversee the planning process. Failure to plan is likely to increase the total amount of fees paid. Especially if family members decide that fighting is the best way to resolve disputes after you’re gone.

6. Successor Fiduciaries – Make sure that you name back up personal representatives and trustees, or provide the beneficiaries with a way to fill a vacant role, so that a court proceeding is not required.

7. Contingent Beneficiaries – Make plans for your estate in the event that your immediate family members die and are unable to inherit your estate. Pick a charity or a group of more distant relatives or close friends.

8. Updating Beneficiary Designations – Life insurance and retirement accounts are controlled by the beneficiary designations you make when you purchase the life insurance or open a retirement account. They are most notably the small boxes you checked at the end of your application. Make sure these stay updated. We have seen more than once a policy which still names a client’s first wife or husband many years after a divorce and remarriage.

9. Joint Accounts – Often used as a convenience during life and a will substitute at death. Because these accounts go to the survivor, make sure that this lines up with your overall plan of passing assets to your heirs. Leaving money in a joint account for one child with the idea that they will spread the wealth around after your death can be a recipe for disaster.

10. Failing to start – Procrastination is probably the leading cause of problems in estate planning. Once a disability or death occurs, planning becomes very difficult and lots more expensive, if possible at all.