Choosing an Agency

Before you start your search process, it’s important to clarify what type of care at home is needed and who will be providing it.  The following are some of the terms that will be discussed as you and your providers begin planning for your care.

Skilled Care:
Skilled Care is needed if you or your loved one will be discharged from a hospital or nursing home and need follow-up care, or if a physician has recommended that a nurse or rehabilitation therapist provide medical care at home.

Hospice Care:
Hospice Care is needed if the person has a life-ending illness and requires medical care and comfort at the end of life. For more information on Hospice Care, see our Hospice page, or contact our Hospice Director, Janice McDermott.

These services are a good choice for assistance at home with activities of daily living, or if family members are overwhelmed with caregiving responsibilities. You may find the Needs Assessment Worksheet from the National Caregivers Library helpful as you and your family determine what types of assistance are needed.

The State of New Hampshire requires all home care agencies to be licensed.  Agencies must comply with strict regulations regarding the types of services they offer, background checks, training and supervision of employees, and the quality of care provided.  Some agencies provide all types of health care services, while others are limited to personal care and homemaking services. Agencies that provide hospice services must also have a separate hospice license. Be sure to ask the agency what type of license it has, or check out its website. All agencies must provide clients with the Home Care Clients’ Bill of Rights.

Other Terms You May Encounter

PRIVATE DUTY: If you are planning to pay for home care services on your own, you need an agency that provides private duty services – which can range from skilled care to personal care and homemaker services. Private duty agencies provide services to clients who pay on their own or who are covered by private insurance.  Some private duty agencies may limit their services to personal care or homemaker services.

DIRECT HIRE: Some families or individuals choose to hire an individual caregiver rather than an agency.  There are pros and cons to this approach, and consumers should be very careful when doing this.  In New Hampshire, people who offer themselves for hire as “individual home care service providers” must be registered through the Department of Health and Human Services. Click here to download our PDF, “What You Need to Know about Direct Hire of Caregivers”.

HOMEBOUND: Medicare (and many private insurance companies) will help cover home health costs for beneficiaries who meet four conditions (Note: this applies ONLY to the Medicare home health benefit, not the Medicare hospice benefit, Medicaid or other programs):  You must be homebound. This means that: 1) Leaving home is a major effort, 2) You are normally unable to leave home unassisted 3) when you leave home it must be to get medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care 4) Your doctor must decide that you need medical care at home, and make a plan for your care. Your doctor must determine you need at least one of the following: intermittent skilled nursing care, or physical therapy or speech-language therapy or continue to need occupational therapy.  The home health agency caring for you must be approved by the Medicare program. More on Homebound.

MEDICARE:  If the person receiving home care services is a Medicare beneficiary and a doctor has ordered home care, then the agency you choose must be “Medicare-certified.” Ask the agency if it’s certified, or check out its website.  There you will also find a Home Care Agency Checklist, to aide you in your search.  You can also look at the federal government’s Medicare home health website to find certified agencies in your community.  For more information about Medicare and other payor sources, see our Paying for Home Care page.

MEDICAID: If the person receiving services is covered by Medicaid, look for an agency that is an enrolled Medicaid provider. If the individual is eligible for NH Medicaid’s “Choices for Independence” (CFI) program which covers long-term services for elders at home, ask the agency if it provides CFI services.  A Medicaid case manager can help coordinate services. For the application for the home and community-based waiver, link here. For more information about Medicaid and other payor sources, see our Paying for Home Care page.

Resource: PBS piece on Choosing In-Home Care

Use the Find a Home Care Agency search function on the top right side of this page for information on the agencies that deliver different types of home care in New Hampshire’s communities.