Home care services are provided by numerous organizations including home health agencies; hospices; homemaker and home care aide agencies; staffing/private-duty agencies; and companies specializing in medical equipment and supplies, pharmaceuticals, and drug infusion therapy. There are also independent providers and registries. Several types of home care organizations may merge to provide a wide variety of services through an integrated system.

The choice of a home care service is an important one for the patient, family and physician. To help ensure that you have made the best choice, we have provided a few definitions and guidelines. Be assured, there are many excellent home care services available.

Home health agencies: There are more than 20,000 home health care agencies in the United States. Individuals requiring skilled home care services usually receive their care from a home health agency. Some home health agencies are Medicare certified. A Medicare-certified agency has met federal minimum requirements for patient care and management and therefore can provide Medicare and Medicaid home health services. Due to regulatory requirements, services provided by these agencies are highly supervised and controlled. Some agencies deliver a variety of home care services through physicians, nurses, therapists, social workers, homemakers and home care aides, durable medical equipment and supply dealers, and volunteers. Other home health agencies limit their services to nursing and one or two other specialties. For cases in which care is needed from more than one specialist, home health agencies coordinate a care giving team to administer services that are comprehensive and efficient. Personnel are assigned according to the needs of each patient. Home health agencies recruit and supervise their personnel; as a result, they assume liability for all care. Home care services generally are available 24 hours a day, seven days a week.

Hospice care: This care involves a core team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for terminally ill patients and support for families. Trained hospice professionals are available 24 hours a day to assist the family in caring for the patient, ensure that the patient's wishes are honored, and keep the patient comfortable and free from pain. It is based primarily at home enabling families to participate in the patient's care. Many hospice programs are Medicare certified and licensed according to state requirements.

Homemaker and home care aide agencies: These agencies help individuals by providing meal preparation, bathing, dressing, housekeeping, and companionship. Some states require that these agencies be licensed and meet minimum standards of care.

Pharmaceutical and infusion therapy companies: These companies specialize in the delivery of drugs, equipment, and professional services for individuals receiving intravenous or nutritional therapies through specially placed tubes. Nurses are used to teach self-administration of medicines or nutritional feedings in patients' homes. Some pharmaceutical and infusion therapy companies are home health agencies, certified by Medicare.

Durable medical equipment and supply dealers: These companies provide products ranging from respirators, wheelchairs, and walkers, to catheter and wound care supplies. Companies employ staff who deliver and, when necessary, install these products as well as instruct patients on their proper in-home use. These companies usually do not provide physical care for patients, but there are a few exceptions. Some offer pharmacy and infusion services, providing a nurse who administers medication and nutritional formulas to patients and teaches them the proper techniques for self-administration. Some provide respiratory therapy services to help individuals use breathing equipment. Those that bill Medicare are required to meet federal minimum standards. Some states require that these companies be licensed.

Staffing registries/private-duty agencies: The private duty agencies provide individuals with nursing, homemaker, home care aide, and companion services. Generally, these agencies are not licensed or regulated by the government. Registries serve as employment agencies for home care nurses and aides by matching the provider with the patient and collecting a finder's fee.

Independent providers: These are nurses, therapists, aides, homemakers, and companions who are privately employed by those who need their services. The responsibility for recruiting, hiring and supervising rests with the patient. Patients pay the provider directly.