1. What is the difference between a certified and non-certified agency?
A certified agency is able to bill your Medicare, Medicaid or insurance company for services ordered by your physician for a specific skill such as a nurse for wound therapy or a physical therapist for walking after a disabling stroke. Clients who are eligible for service from a certified agency are usually discharged from a hospital or rehabilitation unit with a diagnosis such as stroke, COPD, Cancer, an open wound that needs dressing changes, diabetic teaching, physical therapy or occupational therapy.  A nurse, physical therapist, occupational therapist or speech therapist can visit several times a week while the patient needs these certified skills. Once the patient has reached their maximum potential the certified agency will immediately discharge the patient to self-care or care of immediate family members.  Sometimes a certified agency may send in a home health aide to assist the patient in personal care while they are managing the patient, but often this is inconsistent.  The certified agency will authorize a home health aid once to three times per week at their convenience.  Once the certified agency discharges the patient, they no longer send in a home health aide.

This is where a non-certified agency is most helpful.
A non-certified agency such as Apex Healthcare Services contracts directly with the patient to provide personal care, housekeeping, grocery shopping, transportation to appointments or social meetings, meal prep, medication set up and reminders. Services are available from one hour to 24 hours per day to assist the patient and the family to stay in the home safely. A non-certified agency can work in conjunction with a certified agency to promote a safe environment while the patient is recuperating and continuous service after the certified agency has discharged the patient.  Apex Healthcare Services is often hired by a family during hospice to supplement the hours not serviced by the certified agency. Apex can bill the patient directly, activate a long-term care insurance plan, bill the veterans administration or sometimes bill a state program if the patient meets certain guidelines.

2. What it the difference between a Home Care Agency vs. Independent Provider?
Determining what type of home care worker to hire depends on your needs, preferences, and financial resources.  It is important to assess your needs and your loved level of care.  Once this has been established, you will want to consider whether to hire someone from a home care agency or independently by private contract.  This decision will have implications in terms of training, cost, type of individual you employ and other factors.  Use this information to weigh the pros and cons of each option to see what is best for you.  Determining what type of home care worker to hire depends on your needs, preferences, and financial resources.  It is important to assess your needs and your loved one’s level of care.

Home care services cover a wide range of health and social services for individuals recovering from surgery or an injury, those with disabilities and chronic conditions, or people with terminal illnesses. Services can range considerably in scope and often can be tailored to meet your needs. Keep in mind that Medicare does not cover 24-hour home care, personal care, homemaker or chore services (or any services not “medically-necessary” but considered to be “custodial care”). If you are considering home health care, use this guide to help you decide which option is best for you.

Home Care Agency
According to the National Association for Home Care, there are over 20,000 home care agencies in the U.S. that provide care to about eight million people. Home care agencies offer consumers convenience. Agencies differ though; some are more medically oriented, while others provide exclusively non-medical care. Nearly half are Medicare certified.



Trained and licensed staff generally are available. Cost is typically higher due to agency administrative overhead.
Back-up” people available in case the usual home care worker is absent. Higher costs may mean using fewer hours of care overall.
Able to furnish references or other assurances of the worker’s competence. There may be less flexibility in the type of tasks each category of home care worker is permitted to do.
Responsible for the worker’s HR benefits. You may not be able to choose the individual, only the worker type.
Responsible for Worker’s Compensation Insurance, Social Security, State and Federal Taxes, Professional Liability and Bonding.
Supervises and trains the worker. If you don’t like the person, the agency will handle dismissal.
Development and ongoing supervision of care plan by a registered nurse.
Assumes full liability for all care and scheduling.
Generally easier to find help on short notice.

Independent Provider
Independent providers are people you hire individually to provide home care services. Some are listed in attendant registries at local community-based programs; others are located through advertising or word-of-mouth. Hiring someone independently maximizes consumer choice and control. Training, skill and fees for independent providers vary greatly. You may wish to contact a local council on aging to ask about average rates in your community.



Choose who to hire according to your best judgment (even friends, neighbors or relatives). Additional work and time to locate and interview applicants and check references.
Consumer control to direct the care and related tasks to meet your own needs (e.g., no restrictions for driving or other duties mutually agreed upon). No guarantee of a nursing credential or clinical training.
Cost is typically lower than an agency. Background checks are up to you.
More hours can be purchased for fewer dollars Usually no back-up should your independent provider be unable to work.
Expand care and defer some costs by offering room and board as partial payment for live in care. Liability for care is not covered by an agency.
Additional responsibilities as the employer (e.g., paperwork for social security, taxes, employee benefits). It is advisable to consult with a tax specialist regarding employer and employee withholdings. Alternatively, check out the IRS household employers tax guide.
Care plan and worker training responsibility of family.
Family responsibility for scheduling and coverage.

Making Your Choice
Whether you choose the agency path or the independent provider route, you can increase your confidence by asking about your home care worker’s prior experience, training, credentials and by checking references.  When hiring someone independently, you can also conduct a personal background check by getting written authorization from a prospective employee for criminal background, medical records, driving record, and credit.  For a fee, some private companies will conduct a background check for you.

Think through your care-giving situation.  Is it more important to get the “biggest bang for your buck,” or do you value convenience — perhaps paperwork and employer responsibilities seem daunting?  Assessing your preferences will help you choose the right home care worker to make life easier for your loved one and provide you, the caregiver, with both practical support and peace of mind.

3. What should I ask before being discharged home from a hospital or rehabilitation facility?

Look at how the patient has been coping at home prior to this admission and assess if they will need more assistance after discharge.

Upon discharge ask for info on an agency that can support you in your home environment for a length of time.

Find out if you are eligible to activate your Long Term Care Insurance or are eligible for a state assistance program.

Let family and friends know options available to help care for the loved one alone.

Let doctors and discharge planners suggest support in the home during a trying recovery.

Go over with a discharge planner how you perform activities of daily living and review changes due to diagnosis.

Use our web site for suggestions with daily care and activities assistance.

Keep in mind that an appropriate discharge reduces returning to the hospital.

Use an agency with nurses for the best outcome of recovery at home.

Use an agency that will service 1 hour per day if that is all that is required.

Keep costs down by having a professional come in and assess your situation.

Sometimes grocery shopping, transportation or meal prep and laundry is all that is needed to help.

For younger people like Mom’s and Dad’s who are sick, minimal hours with meal prep and laundry keeps the house running smoothly and helps with their recovery time.