Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net
In order to be appropriate for home care services of all types, patients must be able to care for themselves or have primary caregivers who can meet patients’ needs in between visits from professional staff from home care providers. This requirement is necessary in order to meet the eligibility of many payors, to avoid risk of legal liability and to help ensure quality of care.
Patients’ family members or others may be willing to serve as primary caregivers on a voluntary basis. If not, providers should offer patients and/or their family members the option to pay privately for primary caregivers. These services may be referred to as private duty or non-medical services.
The option to pay for private duty home care services should be offered to all patients who cannot care for themselves and who have no voluntary primary caregivers. Patients who can care for themselves or have voluntary primary caregivers may also wish to contract for additional assistance, so providers should offer this option to all patients who may benefit from these services.
Specifically, this means that:
- Hospital discharge planners/case managers should offer private duty services to all patients who may benefit from them and assist patients to arrange for such services post-discharge as part of the discharge planning process.
- Other types of institutional providers; such as skilled nursing facilities (SNFs), Long Term Acute Care Hospitals (LTACHs), and independent rehabilitation facilities (IRFs); should also offer patients who are being discharged the option to arrange for assistance from private duty agencies and should arrange for such services post-discharge.
- Assisted living facilities (ALFs) should offer private duty services to all of their patients who may benefit from such services.
- Home health agencies should offer patients the option to private pay for services if primary caregivers are no longer available to provide assistance and if patients no longer meet the eligibility requirements of payor sources.
- Home health agencies, hospices and home medical equipment (HME) companies should educate patients about private duty services even though patients may have voluntary caregivers and help patients and their families arrange for these services.
Providers may be reluctant to offer these services to patients and their families because of their cost. They may also erroneously conclude that patients and their families cannot afford them. Providers should not jump to conclusions about who can afford these services. Instead, private duty home care services should be offered to all patients and their family members who may benefit from them.
A home health agency, for example, decided that a patient no longer met the eligibility requirements of the Medicare Program. The staff of the agency was reluctant to offer the patient the option to private pay for additional services prior to discharge because the patient lived in a “shack” and drove an old, beat-up truck. They did so anyway. To the staff’s surprise, upon receipt of the offer, the patient got out of bed, extracted a wad of cash from under the mattress and told the staff that there was plenty more money to pay for private duty services!
Private duty care has a very important role to play in the provision of home care services. This type of care should be offered to all patients whenever it seems that patients may benefit from it.
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