Working for a Home Health Agency

There are two kinds of agencies that provide care to home patients. The first is a home health agency. This is an agency that accepts funds from Medicare, Medicaid, and other types of insurance to provide temporary, intermittent skilled care. The second type is known as a private duty agency. Private duty agencies are usually compensated with private funds, and occasionally the state’s Medicaid program. They provide home health aides who perform custodial care, such as staying with a confused client around the clock or helping someone with heavy care needs.

Here we will look at working for the first type of agency described, home health agencies.

Medicare Home Health Eligibility Requirements

In order to qualify for Medicare home health, the patient must meet several requirements. First, he or she must be homebound. This means that the doctor has advised the patient not to leave the home, and that the patient cannot leave the home without difficulty.

The second eligibility requirement is that the patient must be under the care of a physician who has reviewed and approved the home health plan of care.

Finally, the patient must have a documented need for some type of skilled service such as intermittent nursing care, physical therapy, occupational therapy, or speech therapy. The need for a home health aide alone does not justify Medicare coverage.

Patients usually receive care from home health agencies for a few weeks or months. At the end of that time, several things may happen:

• The patient may recover completely.
• The patient may need to hire a private duty agency or go to a nursing facility or assisted living facility to meet his or her care needs.
• The patient may transfer to hospice care.

Implications for Home Health Aides

Working for an agency that is bound by Medicare guidelines has several implications for the home health aides employed by the agency. First, it means that they will need to meet the criteria for federal certification, since they work for an agency that receives federal funds.

Second, it means they will work under the direction of a nurse case manager who coordinates the patient’s care with other disciplines and with the patient’s physician.

As far as workload goes, aides employed by homecare agencies can expect to see several clients every day to provide personal care and light housekeeping services. Their visits to each patient usually last no longer than an hour. In most cases, they will visit each individual patient two to three times per week. If the nurse case manager is planning to discharge the patient, home health aide visits may be reduced to one time per week or eliminated entirely to give the patient practice functioning independently.

Working for a home health agency also means a high turnover rate among patients. Larger agencies may have several admissions and several discharges in a single day.

Benefits of Working for Home Health Agencies

A 2007 study conducted by the CDC of over 160,000 home health aides revealed that the average pay for a home health aide was $10.88 per hour, although this amount varied depending on the aide’s experience and the location of the agency.

The vast majority of full-time aides (75%) reported being offered some form of health insurance through their company.

Other homecare agencies offered additional benefits including the use of a company cell phone or a cell phone stipend, vacation time and sick leave, short and long-term disability plans, retirement plans—some matched by the company, some not, and reimbursement of tuition for continuing education.

Another benefit that many home health aides reported was that the agency was responsible for administrative tasks such as advertising to get new patients, managing employee taxes, and maintaining a worker’s compensation program.

Drawbacks of Working for Home Health Agencies

Homecare agencies usually have strict rules governing the interaction between employees and patients. Most of the time, for instance, employees are not allowed to accept gifts or tips from patients, eat a patient’s food, or socialize with the patient outside of working hours. Although these rules exist to reinforce professional boundaries, some aides find them stifling.

Another drawback of agency work, as explained by Helene Alison writing for the New York Times website, is that a home health aide may be assigned by the agency to work with a client whom she or he would not have selected if given the choice.

The high patient turnover can also be emotionally difficult for some aides, especially those who connect deeply with their patients.

A final drawback is that there is not much chance for a home health aide to advance within a home health agency. Usually the best chance of advancement is for the home health aide to return to school to get his or her nursing degree. Some employers are willing to pay for this.

A home health aide who enjoys fast-paced work and doesn’t mind a high client turnover will probably thrive in the home health agency environment. Someone who wants the freedom to spend several hours a day with a single client, or who isn’t comfortable with change, may be better suited to work for a private duty company.