Not All Home Care Agencies are Created Equal

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14 Mar 2012

Our first experience with home care is usually during a period of enormous stress.

Added to the concern for the health of a loved one, we are faced with making rapid decisions in areas of the unknown.

This is some information that will allow you to make informed decisions:

Certified agencies are Home Health agencies whose primary business is Medicare, Medicaid, and 3rd party insurance companies. You will be using these agencies immediately following discharge from the hospital or rehab.

The services are short term and based on specific Medicare criteria. They provide the nurses, physical therapists, occupational therapists, and speech therapists. Home health aide hours are allocated during the time that the nurses and/or therapists are assigned. The certified agency contracts with licensed agencies to provide the home health aide hours. Medicaid services are also provided from these agencies, but services are hours vary greatly from state to state.

Licensed agencies are Home Health agencies whose primary business is Home Health Aides that are paid for privately (families of the agency) or long-term care insurance.  Services can be purchased by the hour or for live-in care.  The Home Health Aides are the employees of the Agency.  This means that the agency has screened the Home Health Aide, supervises him/her and pays for the Workers Compensation insurance, disability insurance and taxes.  This employer/employee relationship is very important to you and your family and provides crucial protection.  A Registered Nurse oversees the care and you have a professional with whom to discuss any issues.

Registries / Employment Agencies – There are different businesses that place workers in the home.  The screening process is not regulated like it is in licensed agencies.  Additionally, they do not assume the same liability or pay taxes for the individuals sent to your home.  They charge a little less than the licensed agencies, but are providing you with less protection. You assume full responsibility for the worker and any injuries sustained.

Home Health Aides / Nurses Aides / Companions – There are several different categories of people who provide help in the home.

Home Health Aide – In most states, this individual has completed a training program and has a state certificate.  A person with this certification has been formally trained in the care of people in the home environment.

Nurses Aides – These individuals have been formally trained in the care of people who are in the hospital.


These individuals do not have any formal training or certification. They provide non-hands-on care in the home. They are suitable for companionship (hence the name) and housekeeping. They are not trained or certified to provide personal care, i.e. bathing, dressing.

Each state has its own guidelines and regulations. New York, New Jersey, Florida, and Illinois require licensure for their home care agencies. Massachusetts, Michigan, California, and Ohio do not. These laws can change, so it is best to check on your state’s current requirements. This information is available online.

Do not be afraid to ask questions. The services are being provided to someone near and dear to you and you should expect nothing but the best.

Batsheva Schreiber is a registered nurse and Certified Care Manager who is the President/ CEO of CareManagers Inc., a national care management company.  She is a member of the National Association of Professional Geriatric Care Managers, the Society on Aging, the National Academy of Certified Care Managers, the Multiple Sclerosis Society, Guardians of the Sick of Raritan Valley, and many other communal organizations. She is frequently asked to present at community health events and is a member of the Executive Board of the United Way of Central Jersey.

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.