There are a number of questions you might ask when considering a home care service.
Accreditation: Is the agency accredited by a nationally recognized accrediting body, such as the JCAHO? The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs that volunteer for this review. Accreditation is an important measure in selecting quality health care services.
Certification: Is This Home Care Program Medicare-certified? Medicare-certified programs have met federal minimum requirements for patient care and management. Because of regulatory requirements, services provided by these agencies are closely supervised and controlled. Medicare certifies only agencies with skilled nursing care.
Licensure: Most states require licensing of home health agencies. If it is required in your state, is the provider licensed?
Consumer Information: Does the agency have written statements outlining services (including cancer care services), eligibility criteria, costs and payment procedures, employee job descriptions, and malpractice and liability insurance? Request that they send you any brochures or other available information about their services.
References: How many years has the agency been serving your community? Can the agency provide references from cancer care professionals, such as an oncologist, oncology nurse, cancer center, or an oncology social worker, who have used this agency? Ask for specific names and telephone numbers. A good agency will provide these on request. Talk to these people about their experiences. Also check with your local Better Business Bureau, your local Consumer Bureau, or the State Attorney General's office.
Admissions: How flexible is this agency in applying its policies to each patient or negotiating over differences? If the agency imposes up-front conditions that do not feel comfortable, that may be a sign that it is not a good fit for you.
If you are not certain whether you or your family member qualifies for Medicare-covered home care, or whether you even want it, is the agency willing to make an assessment to help you clarify these issues?
Plan of Care Does the agency create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family, or is it based solely on your own view of the situation and request for services? Is the plan of care written out and copies given to all involved? Check to see if it lists specific duties, work hours/days, and the name and telephone number of the supervisor in charge. Is the plan of care updated as the patient's needs change? Ask if you can review a sample plan of care.
Preliminary Evaluation: Does a nurse or social worker conduct a preliminary evaluation of the types of services needed in the patient's home? Is it conducted in the home rather than over the telephone? Does it highlight what the patient can do for him or herself? Does it include consultation with oncology professionals, family physicians, and/or other professionals already providing the patient with health and social services? Are other members of the family consulted?
Personnel: If you are dealing with an agency, are references on file? Ask how many references the agency requires (two or more should be required). Does the agency train, supervise, and monitor its caregivers? Ask how often the agency sends a supervisor to the patient's home to review the care being given to the patient. Ask whether the caregivers are licensed and bonded. Whom can you call with questions or complaints? What is the procedure for resolving issues?
Family Caregiver: Does the agency require a family primary caregiver as a condition of admission? How much responsibility is expected of the family caregiver? What help can the home care agency offer in coordinating and supplementing the family's efforts or filling in around job schedules, travel plans, or other responsibilities? If the patient lives alone, what alternatives can the agency suggest?
Confidentiality: Can the agency ensure patient confidentiality? How?
Costs: How does the agency handle payment and billing? Get all financial arrangements such as costs, payment procedures, and billing in writing. Read the agreement carefully before signing. Be sure to keep a copy. What resources does the agency provide to help you find financial assistance if it is needed? Are standard payment plan options available?
Equipment: If equipment such as a respirator, oxygen machine, or dialysis machine is used, does the agency teach the patient or responsible family member how to use and care for the equipment at home?
Quality of Care: Does the agency have a 24-hour telephone number you can call when you have questions or complaints? How does the agency respond to your very first call? Do telephone staff show an attitude of caring, patience, and competence from the first contact, even if they need to return the patient's call? Do they speak in simple language, or do they use a lot of jargon? What is the procedure for receiving and resolving complaints? How an agency responds to that first call for help may be a good indicator of the kind of care to expect.
Emergency: Does the agency have an emergency plan in place in case a power failure or natural disaster occurs? Ask to see a copy of the plan. In case of an emergency, you need to know if the agency can still deliver its services to the home.
Services: How quickly can the agency initiate services? What are its geographic service boundaries? Does the agency offer specialized services by rehabilitation therapists, pharmacists, dietitians, family counselors, or art therapists when these could improve the patient's comfort? Does the agency offer to lend used medical equipment or other items that might also enhance the patient's quality of life?
Inpatient Care: What are the agency's policies regarding inpatient care? Where is such care provided? What are the requirements for an inpatient admission and how long can a patient stay? What happens if the patient no longer needs inpatient care but cannot return home? Can you tour the inpatient unit or residential facility? Which hospitals contract with the agency for inpatient care? What kind of follow-up does the agency provide for those patients? Do nursing homes contract with the agency? Does the agency provide as much nursing, social work, and aide care for each patient in the nursing home as it does in the home setting?
Patient's Rights and Responsibilities: Does the agency explain these? Ask to see a copy of the agency's patient's rights and responsibilities information.
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