Finding the home care provider best suited for your needs requires research, but is time well spent.  Important factors include the quality of care, availability of needed services, personnel training and expertise, and coverage provided by the payor.  Before starting a search, it is important to determine which types of services you need.  You may wish to consult with your physician, a hospital discharge planner, or a social service organization (such as an Area Agency on Aging) for assistance in evaluating your needs.  Once you've completed this assessment, you will be able to identify the type of home care provider most appropriate to assist you.

When choosing a home health care agency, you should thoroughly check out the agency before signing any contract or agreement.  You should ask the following questions:

• What counties does the agency provide services in?
• Does the agency offer specialized services?
• Is the agency licensed by the Pennsylvania Department of Health?
• Have any complaints been confirmed against the agency in the past two (2) years?
• Can the agency receive payments from Medicare or Medical Assistance?
• What is the agency's compliance history with state and federal regulations?

Medicare, Medicaid, and most private insurance plans may pay for services that licensed home health agencies deliver.  Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria.  Individuals may opt to pay out-of-pocket for services that are not covered by other sources.  Some agencies receive special funding from state and local governments and community organizations to cover the costs of care when other options are not available.

As soon as you think you have a problem, you should immediately talk to the staff to see if they can help.  If you are not satisfied with any response you may receive, make sure you talk to the administrator.  It is the administrator's responsibility to assure that your concerns are dealt with efficiently and effectively.  The administrator should always report back to you about their efforts to deal with your concerns.

You can make a complaint about a home health agency to the Department of Health, Division of Home Health.  Complaints can be made by letter, telephone or fax.  Our toll-free hotline can be called 24 hours a day, 7 days a week.  The hotline number is 1-800-222-0989 .  Our mailing address is Division of Home Health, 132 Kline Plaza, Suite A, Harrisburg, PA 17104-1579.  Our fax number is (717) 772-0232.

A Department of Health, Division of Home Health surveyor will investigate your complaint.  These surveyors are registered nurses who have been trained and are knowledgeable about federal and state regulations for home health agencies.

The person taking the complaint information from you will ask if you wish to remain anonymous.  When we investigate an anonymous complaint, we will select a group of patients (including the one you are concerned about) who share similar characteristics.  In this way, the home health agency will not know which patient is the subject of the investigation.  Department of Health staff maintain strict confidentiality with patient information, including complaint investigations; while we cannot guarantee that the home health agency will not figure out the identity of the patient in question, Department staff will not inform them nor confirm their suspicions.

Yes, that is why it is important that you provide us with your name, address and phone number (including area code).  You will receive confirmation that the complaint was received, and you will also receive notification afterward telling you the results of the investigation.

If the surveyor was able to find sufficient evidence, the complaint will be considered substantiated.  If a complaint is substantiated, there are two (2) further determinations that can be made regarding the problems at the home health agency.  The first determination that can be made is "substantiated with deficiencies cited."  The Department will issue a statement of deficiencies or a list of problems to the agency.  The agency must submit a written plan of correction to the Department.  The plan tells us how the home health agency intends to prevent a recurrence of the problems in the future.  A second determination that can be made is "substantiated with no deficiencies cited."  This means that the allegation was true but did not violate any of the state or federal regulations.  We are only permitted to issue deficiencies according to the state and federal regulations that we monitor and enforce.

 

It is not always possible to substantiate allegations due to the passage of time or lack of documentation or observation to support a finding of substantiation.  This does not mean that the complaint was not true, it simply means we could not find enough evidence to substantiate it at the time of the investigation.  Please be assured that we will continue to review all complaint issues when we visit the home health agency in the future.

For every deficiency identified, the surveyor must decide how serious the problem is for the patients.  The surveyor writes a description of the problem(s), which is then called a "statement of deficiencies," and submits it to the home health agency.  The home health agency must respond in writing with their proposed solution to the problem(s).  This is called a "plan of correction (POC)."  You can ask to see a copy of this report from any home health agency.  You can also review these reports on the Department of Health's website by clicking here and choosing the county where the agency is located.

 

Depending on the seriousness of the deficiencies, different consequences may be given to the home health agency.  If the problem(s) is/are very severe, the Department may revoke the home health agency's license to prevent them from providing care to patients.  If the problem(s) is/are less severe, the Department may issue a statement of deficiencies and request a plan of correction which allows the home health agency to continue to operate while the Department monitors areas in which improvements must be made to ensure the health and safety of the patients. 

 

Another action that can be taken is to have the home health agency lose its ability to participate in the federal Medicare or state Medicaid programs.  The home health agency would lose funding from these programs if the agency's services do not meet the minimum state and federal regulations.