Guide to Searching for and Selecting a Home Health Aide

January 30, 1998 [Updated March 31, 2009]

The following is a Guide on Selecting a Home Health Aide. A caregiver of a person with disabilities in the Milwaukee County, Wisconsin area recently tried to find a home health aide for their loved one and found it to be a complex and frustrating project. As there are many people and caregivers facing this problem, we are including this guide in the hope it will benefit our readers.

The purpose of this guide is to provide information for people with disabilities who are 18 to 59 years of age, and does not necessarily offer information for the elderly.

New Horizons Un-limited assumes no responsibility in guaranteeing the services, programs or conditions as described. If you are interested in a resource listed below call or contact the resource to verify the current situation. Evaluate information and make your own decisions when using the guide.

Acquiring a reliable home health aide can be a formidable task. Home care may be less expensive than nursing home care, however can one receive quality care at home from a private duty nurse or home aide, managed care provider or home health service?

One usually does not begin to look for something until one is at need. It is important however, to consider and investigate your options for any type of long term care before you need this type of care. Many wish they had started planning years in advance, or at the least, began to consider their options well in advance. Being informed may assist you in taking an active role in selecting your care and making decisions for yourself.

Have you considered all the options for long term care that may be available to you or better meet your needs? Is a Home Health Aide what you need, or would a group home, day care, assisted living, or nursing home be better for you?

Begin by assessing your situation:

  • Checking your insurance coverage and assessing your ability to pay will assist you in what options are available; whether you will need to look for an home health aide through an agency, service or whether finding an aide privately will best fill your needs.

  • If you are seeking financial assistance from the government or your insurance company, check that the care you need is covered. Apply as soon as you can to the government financial assistance program and check whether you will ever actually be served by the assistance for which you apply, or you may end up for many years on a government financial assistance program waiting list.

Identify your needs:

  • What kind of care do you need?
  • What special care needs do you have?
  • Consult your doctor to determine your medical needs.
  • Consider your abilities and disabilities.
  • To what extent are you able to care for yourself (personal hygiene, dressing, feeding yourself, etc.)?
  • What areas do you need help (do you need ambulatory care, help with medication, meal preparation, cleaning or shopping, companion care, etc.)?
  • Weekly hours of help (day, evening, live-in).
  • What is your financial or insurance situation?

Once you have determined that home health care will meet your needs:

Determine what level of caregiver you require:

  • a skilled nurse,
  • certified nursing assist,
  • home health aide
  • homemaker companion or personal care worker
  • home care: shopping, meals, cleaning, transportation

Identify your resources:

Identify your resources and begin to gather information from these resources.

  • Contact friends, neighbors, and family
  • Doctor, hospital
  • State and county health programs
  • Insurance or financial resources
  • Area agencies on aging
  • Local library
  • Yellow pages either online or local telephone book
  • Disability organizations
  • Clergy or religious organizations

Contact friends, neighbors, family:

  • Or people you know who are dealing with the same problems. You may be able to get the most reliable information on a quality care, home health aide, how they selected their aide, insurance issues, etc. from people you know.

Consult your doctor and/or the hospital from which you will be or you have been released:

  • Hospital discharge social workers that deal with the needs of the patients being released may be able to recommend a local, quality care home health service. If you need to receive financial assistance from the government or your insurance company, check that the home health service you require will be covered. If you will be unable to get assistance for this care, you may need to ask the hospital or medical social worker to help you evaluate other options for your care; such as nursing home care, respite care etc.

  • Be aware that hospitals will recommend affiliated services. The hospital may be part of a corporation of health services. Through this affiliation, they may be able to offer you the service you need. If they cannot or you do not like the affiliated service, you do have the right to choose another service.

Insurance or financial assistance:

Do you need to seek insurance coverage or government financial assistance for a home health aide?

  • If you have skilled nurse needs you should check with Medicare and Medicaid for coverage of a home health aide. You can view information from Medicare on the internet. See the Medicare and Home Health Care guide. If you have questions, you will need to be as informed as you can before you call. Be sure to write down all of your questions so you do not miss any while you have a representative on the phone. The Medicare hotline is 1-800-638-4227. If you use a TTY/TDD, call 1-800-820-1202. If you call this number, you will be asked to leave a message. Ask your question in detail and leave your name, address and telephone number.

  • If your doctor can stipulate that a skilled nurse is required, you may be able to qualify for medicare or Medicaid coverage of a home health aide.

  • If you are on Title 19, Medicaid may cover home health aide.

State and County health programs:

If you are over 18 and under 59 you may qualify for coverage through government financial assistance programs. Contact your state and county health departments for these programs. Ask if any of the information is on the internet. Details of the programs may be available through your local library.

  • At present in the Milwaukee area there are long waiting lists to acquire a home health aide through government financial assistance programs. In Milwaukee County, contact the Milwaukee County Department of Human Services, Disability Services Division phone: (414) 289-6660; TTY/TTD: (414) 289-8559 to apply for financial assistance for home health care.

  • The Milwaukee County Department of Human Services, Disability Services Division brochure states: “Both the COPWaiver (COP-W and The Community Integration Program II (CIP II) provide funding for individuals over the age of 18 who are chronically physically disabled. The specialized funding will allow individuals to live or remain in the community rather than entering a nursing home. These federally funded programs purchase services (contract area home health services) tailored to the needs of the individual that help with attendant care, chore services, day care, transportation, home delivered meals, adaptive equipment and home modifications. Following an assessment of the individual's service needs, a case plan is developed and implemented. A case manager is assigned to monitor and coordinate the services to ensure that they continue to meet the needs of the individual.”

    You can find the documents of the Wisconsin Legislative Fiscal Bureau Informational Papers- 2009 on-line. The Medical Assistance Program, Badger Care Plus, Senior Care, and related programs (Paper 44), Supplemental Security Income Program (Paper 48), Community and Children and Family Aids (Paper 49), the Services for Persons with Developmental Disabilities (Paper 50), and the Services for Persons with Mental Illness (paper 51) are among the informational reports and budget papers of the Wisconsin state financial assistance programs available at this site. You can also find these documents through your local Library or contact the Wisconsin Legislative Fiscal Bureau, One East Main, Suite 301, Madison, WI 53703.

Area agencies on aging:

Though these agencies will not be specifically geared toward the services of people who are not elderly, but those who have disabilities, they may have information or guides that can be helpful or may be able to address the concerns of people with disabilities depending on the governmental agencies in your state. If you are elderly, then you should contact these agencies.

Non-profit organizations:

Contact disability organizations, or other non-profit organizations, churches etc. that offer home health service. If you require state or county financial assistance you may still be required to go through the state or county health service department. If you intend to pay privately, you may find this service more understanding of disability concerns, more caring, or less expensive.

Volunteer Organizations:

Contact area churches, community centers, volunteer services, disability organizations, schools and universities for volunteer programs. You may be able to acquire some limited, short-term care for yourself or respite for your caregiver.

Private Resources:

If you do not wish to go through a service, or you have been unable to acquire a home health aide through any other program and have the financial means to private pay even though it may be on a limited basis, you may want to hire a nurse, nurse assist. nurse student, homemaker companion, personal care worker on your own.

Consider some of the advantages and disadvantages of searching and selecting an aide on your own, as opposed to going through a service or program:

  • Finding a private pay care person can be a formidable task.

  • The burden of securing quality care becomes entirely your responsibility, posting position notices, screening possible caregivers, checking references and experience, etc.

  • The question of liability becomes a personal issue either for you or your caregiver.

  • Depending on your insurance coverage, you may be able to still qualify for financial assistance.

  • In the Milwaukee area, if you are on Title 19 your caregiver can earn a certification to entitle them to qualify for payment through Title 19 for your care. Interfaith (414) 289-6874 offers a 16 hour course for this certification through their Supportive Home Care program. Other services offer this certification as well.

Home Health Service

Whether you are recommended a home health service, through the doctor, hospital, state or county health department program, or other program or you must seek a home health service, on your own:

  • check the yellow pages of your local telephone book under the listings for “Home health Services” or “Nurses,” you will still want to evaluate whether the service will meet your needs.

  • Use the Yahoo! Yellow Pages - to find the home health care providers nearest you.

Be sure to consult your resources of family, friends etc. to assist you in evaluating the service and making a decision for yourself Asking the right questions of the home health service, will get the answers you need.
  • If you require insurance coverage, is the service certified by Medicare? Contact Medicare for a report on the particular service. Certification by medicare means the service meets federal requirements for patient care and financial management.

  • If the service is not certified by Medicare, you may want to ask why to determine the quality of care.

  • Is the service licensed by the state? Contact your State Health department to review a report on the particular service.

  • Wisconsin residents can call the Home Health Care Hotline (800) 642-6552, at DHFS, Division of Health Services, Division of Quality Assurance, P.O. Box 2969, Madison,WI 53701-2969. The Home Health Care Hotline provides information about local home health care agencies; certifies agencies for Medicare and /or the Medical Assistance Program; has the results of state inspections and provides information about complaints against an agency which have been confirmed within the last two years.

  • Or in Wisconsin, direct your inquiries to the Wisconsin Department of Health, Home Health Agencies Statistics, for the Wisconsin Home Health Agency Directory and fact book. Check your local Wisconsin library reference section for a copy of this directory and fact book. The directory presents detailed information about individual home health services in Wisconsin. Data in the directory is obtained from the survey questionnaire attached to the annual licensure application for home health services so it is information provided by the home health services.

  • There are home health services that are not licensed, this may or may not be a disadvantage. Ask the service why and be sure to ask for references.

  • How many years has the service been in business of health care?

  • Is the service bonded and insured?

  • What are the credentials of the nursing, nursing assistance, personal care staff? What certifications are required at each level?

  • Ask for a list and description of services and rates of the services.

  • What procedures does the service have for emergencies or do they provide on-the-spot service?

  • How does the service protect client confidentiality?

  • Ask for references of the service, former patients that have used the service.

  • Ask for a written care plan that will detail the services to be provided you, and financial arrangements before service begins.
The home health service will ask you:
  • Initially, what is your situation and what are care needs?

  • They will want to call your doctor to get medical history, medication requirements, requirements for skilled care if ordered, such as nurses, physical therapy, medical education, medical social work etc.

  • Home health service will want to do an in your home assessment. Assessing your skilled nurse needs as well as personal care, house care needs.

  • For what insurance do you qualify?

  • Where your home is located, are you near a bus line for easy access for the health aide?

  • How many hours do you need care (i.e. part-time, full time, evening, live-in)?
Advantages of going through a service, if they are able to do the following well:
  • You might be able to rely on the fact that the service will be doing all the screening, background checks on the people that will be caring for you and you might find that some what reassuring that you will receive quality care.

  • If the Home health service is licensed by the state or meets federal requirements for patient care, they are required to meet certain standards to ensure quality care.

  • If you qualify for nurse skilled care, a nurse may supervise the home health aides care concerning you.

  • If your caregiver assigned to you is unable to care for you at any moment, the service may be able to find someone else to cover.

  • If your needs change, the service may be able to find the caregiver that will provide you the level of care you need
Disadvantages of going through a service
  • You may still want to ask for the option of evaluating each caregiver that is sent to care for you.

  • A home health aide, non-nurse skilled will be unable to monitor medication, although there are ways of dealing with this disadvantage, this may not meet your needs.

  • The service might switch caregivers when you do not wish it.

Home Care Service

If you do not require nurse skilled care, another option may be a home care or personal care service:

  • These services are not licensed for health care but may provide many other care needs, such as companion care, meal preparation, shopping, housecleaning, etc.

  • If you are able to fund home care privately, this may be an option.

  • Asking for references of the service may help you determine quality of care.

  • Some non-profit or county services offer this care, you may prefer this option to the commercial home care service.

Sources: "How to Choose Home Health Care That's Right for You," The Source Volume 11. No. 9 Wisconsin, Northern Illinois Edition - September 1997, via: the Mayo Clinic Health Letter via The Hopeline, newsletter of ALS of SE Wisconsin Aug/Sep 1997

Milwaukee County Department of Human Services, Disability Services Division Internet links:

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