- Home Care
- A wide range of services that can be provided in a patient's home for an illness or injury. Home care is typically less expensive and more convenient than facility care, and can be just as effective as care offered in a hospital or skilled nursing facility (SNF).
- Skilled vs Non-Skilled Care
- Skilled care requires a licensed nurse or therapist. Non-skilled care, such as personal care or companion care, does not.
- Skilled Services
Skilled services are typically provided by medical professionals and licensed practitioners, such as registered nurses and physical therapists.
Examples of skilled nursing care include injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient's condition, management and evaluation of a patient's care plan, and wound care.
- Companion Care
- Non-hands-on support such as supervision, socialization, light housekeeping, and errands.
- Long-Term Care (LTC)
Long-term care (LTC) consists of services that meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Although LTC can apply to people of any age, it is more commonly needed by older adults.
LTC includes non-skilled care (such as help with daily tasks like dressing and using the bathroom) as well as skilled care from licensed practitioners who address the multiple chronic conditions common in older populations. LTC can be provided at home, in the community, in assisted living facilities, or in nursing homes.
- Hospice
- A specialized type of care for those facing a life-limiting illness, chronic and/or terminal, along with their families and caregivers. Hospice care addresses the patient's physical, emotional, social, and spiritual needs, and also supports the patient's family caregivers.
- Homecare Management Software
- Home care management software, like Pearl OS, connects providers, state Medicaid programs, managed care organizations (MCOs), and caregivers. It automates tasks such as caregiver scheduling, billing, and record-keeping, and can help track patient progress and identify potential problems.
- Electronic Visit Verification (EVV)
- Electronic Visit Verification (EVV) is a technology solution in which home care services are captured and verified through a vendor system. With the passing of the 21st Century Cures Act, Medicaid home care providers are required to implement EVV. Under the Act, visits must be electronically verified for the type, date, and location of the service performed, the individual receiving the service, the caregiver performing the service, and the time the service begins and ends.
- Plan of Care (POC)
- A personalized document outlining the specific healthcare services, treatments, and goals for a patient receiving home care. It serves as a guide for care providers.
- Clinical Documentation
- A record of medical treatments, trials, or tests. Clinical documentation is used to facilitate provider communication, allow evidence-based healthcare systems to automate decisions, provide evidence for legal records, and create patient registry functions so public health agencies can manage and research large patient populations more efficiently.
- Supervisory Visit
- A periodic visit by a registered nurse to observe care, reassess the client, and confirm the caregiver is following the plan. Often required every 60 or 90 days.
- Reassessment
- A scheduled re-evaluation of a client's needs that keeps services and authorizations current.
- Compliance
- Compliance in home care refers to adhering to laws, regulations, and industry standards to ensure the delivery of safe, high-quality care while also meeting documentation and reporting requirements.
- Survey
- A state inspection of an agency's records and practices to verify compliance with licensing rules.
- Survey-Ready
- Having documentation complete and current so an agency can pass a survey at any time without scrambling.
- In-Service
- An in-service program is a professional training or staff development effort in which professionals are trained and discuss their work with peers. It is a key component of continuing education for caregivers, and refers to any form of on-the-job training, such as the in-service training of a caregiver.
- Tuberculosis Test (TB / PPD)
PPD, TB Screen, and QuantiFERON tests are used to check whether someone is infected with tuberculosis (TB). PPD and TB Screen are interchangeable terms for the same type of test, while QuantiFERON is a more expensive and more accurate test. If test results are:
- Negative — the caregiver is able to work with the patient; a yearly TB screening is required thereafter.
- Positive — the caregiver is out of compliance and unable to work with patients.
All U.S. health care personnel should be screened for TB upon hire at an agency. The local health department should be notified immediately if TB disease is suspected. Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission.
- Health Insurance Portability and Accountability Act (HIPAA)
- Signed into law in 1996, HIPAA provides security and data-privacy provisions to keep patients' medical information safe. Its Privacy and Security Rules, enforced by the HHS Office for Civil Rights, set national standards for protecting electronic Protected Health Information (PHI); the Breach Notification Rule requires covered entities and business associates to give notice after a breach of unsecured PHI; and the Patient Safety Rule protects identifiable information used to analyze and improve patient safety.
- Authorization
- The payer determines the services or treatment to be provided to a patient, along with the frequency and time frame. Service providers must abide by the authorization terms to be reimbursed for their invoices. Non-authorized services may not be covered, and the payer may deny reimbursement accordingly.
- Prior Authorization
- Approval a payer requires before certain services will be covered.
- Claim
- A request for payment that a patient or health care provider submits to a payer for items or services rendered.
- Service Units
- The measured amount of a service, often in 15-minute increments, that a payer approves.
- Durable Medical Equipment (DME)
- Reusable medical equipment, such as wheelchairs or hospital beds, used in the home.
- Private Pay
- Private pay in the home care industry refers to patients or their families directly paying for home care services out of pocket, without relying on insurance or government programs.
- Medicare
- The national social insurance program in the United States, administered by the U.S. federal government since 1966. Medicare provides health insurance for Americans aged 65 or older who have paid into the system, regardless of income, and to younger people with disabilities, end-stage renal disease, or amyotrophic lateral sclerosis (ALS).
- Medicare vs Medicaid
- Medicare is federal insurance based on age or disability and covers limited home care. Medicaid is need-based and funds most long-term home care.
- Veterans Administration (VA)
- The Veterans Administration (VA) is a U.S. government agency responsible for providing healthcare services, including home care, to eligible veterans. VA home care services can include home health, palliative care, and long-term care.
- Referral
- When a case manager, hospital, or physician sends a new client to an agency to begin services.
