How long a person or couple can live an independent, safe and fulfilling life in his or her later years depends on many factors, especially the support of family, friends and neighbors.

But, as we all know, many people do not have those support networks, and sometimes have to depend upon the kindness of strangers. As the independent living for elders movement has grown, so has the range and depth of community fee-based services that can fill the gaps, from Meals on Wheels to home health care.

Dozens of companies in the Tristate provide a large menu of support services, from housekeeping to skilled nursing. How does one go about evaluating these companies and entrusting them with your life, or the lives of loved ones?

First, always ask for referrals or recommendations from physicians. Next, ask the healthcare provider for references from customers. Then request more than just a menu of services, fees and schedules. Find out if the company has a mission statement.
Comprehensive Health Care in Sharonville, for example, promotes these mission goals in the services it provides:
• Promote independence, enabling individuals to stay in their own comfortable and secure environment.
• Ease pressures on the family..
• Provide one-on-one care and support, individualized to each older adult served, and coordinated with his or her physician.
• Offer compassion, respect and dignity, with sensitivity to each client’s habits, likes, dislikes, fears and concerns.
• Smooth the transition from hospital to returning home.
AARP offers a wealth of information to help you make good, informed choices. Here are some tips from AARP’s guide to selecting home healthcare worker or service.

Who provides home health care? Home health care services may be provided by home care organizations, which include home health agencies, hospices, homemaker and home care aide agencies, and staffing and private-duty agencies. Independent providers may also provide home care.

What is a home health agency? The term “home health agency” often means that a home care provider is Medicare-certified. A Medicare certified agency has met federal minimum requirements for patient care and therefore Medicare and/or Medicaid will pay for covered home health services. People who need skilled nursing home care services usually receive their care from a home health agency. Skilled nursing includes services such as wound care, giving injections and other care that cannot be performed by a non-medical person. If a person needs care from more than one specialist, a home health agency can coordinate a team of caregivers to provide services. If you use a home health agency, the agency will hire and supervise the workers that come into your home. The agency assumes full liability for all care. Also, the workers are employees of the agency, and the agency is responsible for all employee taxes and benefits.

What are homemaker and home care agencies? These agencies hire homemakers or chore workers, home care aides, and companions to help patients with meal preparation, bathing, dressing, and housekeeping. Some states require these agencies to be licensed and meet minimum standards established by the state. Most homemaker and home care aide agencies hire, train, and supervise their employees and are responsible for the care their employees provide. They are also responsible for all employee benefits and taxes.

What are staffing and private-duty agencies? Staffing and private-duty agencies generally are nursing agencies that provide individuals with nursing, homemaker, home care aide, and companion services. Most states do not require these agencies to be licensed or meet regulatory requirements. These agencies recruit their own employees and responsibility for the employee and patient care rests with each agency.

What are registries and independent providers? “Registries” are basically employment agencies for home care nurses and aides. They match home care workers with patients and collect finder’s fees. These organizations are not usually licensed or regulated. In many states, registries are not required to screen or do background-checks on the home care workers. “Independent providers” are nurses, therapists, aides, homemakers, chore workers, and companions who are privately hired and employed by patients. Aides, homemakers, chore workers, and companions are generally not required to be licensed or to meet government standards. If you hire a worker referred by a registry or hire someone on your own, the responsibility for hiring and supervising the worker rests with you.

Who pays for home care services? Home care services can be paid for directly by the patient and his or her family members or through a variety of public and private sources. The two primary public payors are the Medicare and Medicaid programs.
How do I qualify for home health coverage under Medicare? To qualify for Medicare home health coverage, you must meet all four of the following conditions:
• Your doctor must have determined that you need medical care in your home, and the doctor must prepare a plan for your care at home. Your doctor and home health agency personnel must review your plan every 60 days or more; and
• You must need at least one of the following: intermittent (not full-time) skilled nursing care, or physical therapy or speech language pathology services, or continue to need occupational therapy; and
• You must be homebound. Your home can be a house or apartment, a relative’s home or even a home for the aged. But a hospital or other facility that mainly provides skilled nursing or rehabilitation services does not qualify as a home. You may be considered homebound if you leave home only with considerable effort. Absences from home must be infrequent, or of short duration, to get medical care or to attend religious services.
• The home health agency caring for you must be approved by Medicare.
How can I find an approved agency? You can find a Medicare-approved agency by asking your doctor or hospital discharge planner, senior community referral service, or other community agencies involved with your health care.