Documentation Basics for Home Health

Updated on October 31, 2016

It is easy to become complacent about documentation. As nurses, we must always be trying to raise the bar on ourselves and on each other to stay professional and above all, to show that we are using best practice and evidence based techniques in every aspect of our career.

However, in home health, it is very easy to succumb to the least amount of charting; to live by the “chart by exception” rule and not give ourselves the credit we deserve as professional nurses. What happens then? We come off looking as if we do not care, we do not know enough to write even the basic nursing care and as if we are not willing to raise the bar on ourselves, just to get away with the least amount of work effort.

That is embarrassing and an affront to your nursing profession. Medicare rules and regulations changed drastically in 2000 and have continued to change since that time. Our documentation must reflect the changes and the growth of knowledge expected by Medicare for all our home health patients. We should not have to be told by Medicare to change; it should be our desire to change, to flourish as nurses and to learn at every opportunity.

However, as it is with many things, sometimes a reminder of the expectations and direction are all that is needed to get the ball of change rolling. That is what we will be talking about today.
The Outcome and Assessment Information Set

In home health, the Oasis (Outcome and Assessment Information Set) is done on admit, resume care, recertification’s, significant changes and on discharge. From the admit and the recert OASIS is created the physicians Plan of Care called the 485. This is the tool that must be used at every home health visit when completing your nurse’s note. This is your physician order for care delivered in the home. Your documentation must show that you are aware of the physician orders, are following the physician orders and that you are updating the physician, the patient and the family on all changes related to the patient that are not on the physician orders.

Without the 485, you are going blind into a patient’s home and delivering care without any idea of what the physician is expecting you to do and to know. That is not the way you want to deliver your professional care! In order for the office staff to generate that hard copy of your physician order, the 485, you must get the OASIS, especially the admit but all types of this tool, completed and turned into your office within a timely fashion. Every home health office has different expectations, however, most are expecting that OASIS to be returned to the office within a 24 hour window.
Seven Day Window

The reason for this is that the information must be inserted into the computer and locked and sent to Medicare, or the HMO or private insurance company, within a seven-day window. It does not mean seven working days. It means seven days from the start of care. This is not unreasonable. If you were working in a hospital and had an admission, all your paperwork for that admission must be completed by the end of your shift. Home health gives a 24-hour window for completion.

All parts of the OASIS must be thoroughly scrutinized by an objective set of eyes. Usually this means a clinical supervisor or case manager who goes over all the information from the referral and the OASIS with a fine toothcomb. The result of this, many times, is that you receive your work back with enough yellow stickey’s on it, for it to take wings and fly. None of the corrections is meant to insult your intelligence or degrade you as a nurse. It is meant for you to take a better look at the information you have provided and give a succinct picture of that patient and that patients needs for home health.

Every bit of information, sometimes redundant, must be completed on the OASIS or Medicare or the HMO or the private insurance company could send it back without a word of explanation except that it is incomplete. A refusal of payment is not out of the question either; especially if the forthcoming information is so sketchy and vague, that it does not show good reason for our services.
Your Daily Visit Notes

The following documentation, your everyday nurse visit notes, must then reflect the physician orders found on the OASIS. The 485 will tell you what to write in fact it will write your nurses note for you if you use it as the tool it is intended to be. Every nurse note in home health must stand-alone. Every nurse note must reflect the assessment, the performance, the instruction, the goals and the progress toward goals for your patient. That means you must have that 485 in your hand in order to see your patient, carry out the physician orders, do all the assessments expected by the physician and instruct your patient on what you are doing in order to give them the best possible care.

Is this not what we, as professional nurses, want for our patient’s?

Are we not proud of the fact that with our extensive skills base, we can go into any patients home and deliver the most competent care in an autonomous fashion, make critical care decisions that reflect our nursing knowledge and help the lives of our patients in a way no other nursing field is able to do? We should be proud enough, then, to deliver the most up to date documentation to reflect that care.

Many times, it is simply a matter of not giving ourselves the credit we deserve. We walk into a patents home, we are talking and assessing, and teaching the entire time but we never put down on our nurse note all that came out of our mouths. Well, what is that old saying? Oh, I know, “If it was not documented, it was not done.” If your nurse note, all by itself, were to be held up in a court of law, say in a decade, would you be able to tell, from that one note, exactly what you accomplished on that one visit?
Your Boss Looking At Your Work

That is the problem with home health notes. They are often held up one at a time for scrutiny and found lacking. The first scrutiny comes from your clinical supervisor who is looking at your daily nurse’s note. That nurse is looking at the 485 on the screen in front of her or from the patient chart. First, it is given a quick scan, just looking for any holes, things that were missed because you were in a hurry. Then every piece of that note is looked at to be sure it shows your awareness of the 485, the patient and that you accomplished everything in that visit that was expected by the physician.
Parts of the 485

The 485 has different fields on it that correspond to everything that is pertinent about that patient. It contains the demographics, the insurance, the supplies, the homebound status, the functional limitations, the assessments, skills, and instructions the nurse will be providing and the goals we want that patient to accomplish within a 60-day period. Fields 18, 21 and 22 are the ones we use the most to deliver care and to write every nurses note. Field 18 deals with homebound status and functional limitations. These must match on your nurse’s note or you need to document how they have changed. Perhaps therapy has progressed the patient from a walker to a cane. Your nurse note needs to reflect that change and you must write every time that therapy has progressed patient. The 485 you carry around from visit to visit should be so dog-eared by the time of discharge you can barely read it. It should have all the new and changed orders stapled to it. You should be able to put your hands on it without a second’s hesitation and see your patient in your mind’s eye. Your clinical supervisor should be able to pick up any one of your daily visit notes and also see your patient in their minds eye.

Field 21 is what you are to do, every visit, for that patient. Of course, if for example there is wound care you need the most current physician order related to that wound care and it must be verbatim. You must deliver the wound care or any skill precisely the way the physician has ordered it by signing the 485. Otherwise, we are delivering care without a physician order. Even if all you change is kling instead of kerlix, that is an error. Where it gets really dicey is with complicated patients, with wounds, IV therapy, post op, therapy, polypharmacy, and therapy. Without that 485 in your hands you are not delivering safe care with best practice standards.
Discrepancies Found in Daily Nurse’s Note’s

If the 485 has a diet of low sodium and you write cardiac, it will come back to you. If you write taught on disease process without any supporting documentation, it will come back to you. If you do not write a measurable progress of goals taken from field 22 on your 485, it will come back o you. If you said you drew labs and did not spell out every step, it will come back to you. If you gave a cyancobalamine injection and did not write down the lot number and the expiration date, it will come back to you. If one portion states patient had a pulse oximetry taken and the 485 does not give a physician order for pulse oximetry, it will come back to you. If you forget to remark on how much recall the patient had from previous visits, it will come back to you. If you write that you instructed patient on IV therapy without stating every step you taught, it will come back o you. If you state return demonstration received without writing what was demonstrated, yes it will come back to you. Of course, if you write about sending the patient to the physician office or to the hospital emergency room, that will be scrutinized closely to make sure you used best practice, called the physician, notified the emergency room nurse of patient coming to them, called the caregiver, and completed all forms that go with notifying all other disciplines of your actions.
But WHY?

The reason for this extremely meticulous documentation is, of course, that every nurse note must stand-alone. It must be able to be picked up years, months, or days from now and see exactly what and how something was done in that patients home. Most of all, what is being looked for in every nurse’s note is your knowledge of that 485 and the physician expectations for home health care.

What is being done in every home health agency is not being made up to make the field staff lives miserable. Home health agencies are being held responsible by Medicare, the HMO, or the private insurance company accountable for delivering exceptional care. You clinical supervisor is being held accountable for their job description and they, in turn, are holding you, as field staff, accountable for the care you are delivering. If you are being paid by the visit, by the hour or by salary, the expectations remain the same. Provide the care to the patient that the physician ordered and be responsible for everything that you do.

As home health nurses, we are the eyes for the physician. We must use our mouths to keep the physician updated on what is happening with the patient. We must deliver the quality of care the patient deserves. We must continue to learn every day and to grow as nurses every day in order to meet the needs of our patients. It is our pleasure to do so. We are service-oriented people who want only the best for our patients and we want to be proud of the care we deliver in the home health setting.

How to Become a Home Health Aide – Jobs Without a High School Diploma

Nanohanakan Community Center for Seniors
Nanohanakan Community Center for Seniors | Source
Work and Rewards

The work of a Home Health Aide (HHA, near the top of the list on the Top 10 Hot Careers to 2020) requires physical labor and the ability to interact well with clients that are elderly, physically and/or mentally challenged, or ill with chronic conditions.

HHAs and home companions also help care for individuals that are at home recovering after surgery and do not require the more intensive services of a nursing home or rehabilitation center. Probably the most important role of the HHA is to help an elderly person stay in their own home rather than to enter an assisted living facility.

A friend of over 20 years became an HHA after a few years in other careers. She worked for a home health services agencies, gathering skills and experience. She found the work time consuming, physically tiring, but rewarding, One of her clients hired her full-time until his death. At that time, she inherited his condominium, new car, savings, and other items.

This is not the usual outcome of full-time positions as an HHA, home companion or Certified Nursing/Nurse’s Aide, but is an occasional occurrence. Otherwise, the starting pay is at the lower end of the Healthcare Industry pay scale, increasing over time. HHAs that go on to open their own home health businesses make larger salaries. One of my students began as the HHA and progressed to LPN after earning a GED, with plans to further her studies through tuition reimbursement offered on the job.
Sports clinic in the German Alps. Techs and Aides work in such places as well.
Sports clinic in the German Alps. Techs and Aides work in such places as well. | Source
Sample Job Descriptions

Home health aides and personal care aides (Number 4 the Top 10 List below in links) have similar duties and training. Home health aides work in clients’ homes, hospitals, clinics, hospices, nursing homes and rehabilitation centers, and adult day care centers.

These aides often have a high school diploma, but also a demonstrated 10th grade level of reading and writing, and mathematics knowledge of at least 9th grade level, which includes pre-algebra. Some US States do not require the high school diploma for licensure.

Home Health Aide Certification is available through short training programs in high schools, vocational schools,and independently-owned schools. From time to time, county and city funds are available to furnish free HHA training through a list of approved training providers. Basic PC skills and good interpersonal relations are also required. The personal and home care aides do not require licensure, but do similar work.

Some Tasks Are Less Glamorous Duties

Some job duties of the Home Health Aide can be very physically challenging and tiring, even boring at times. Others can be enjoyable. Any or all of these duties appear in job descriptions:

doing laundry,
changing bed linens,
grocery shopping,
planning menus and cooking,
helping clients in and out of bed, and assisting with prosthetics, helping client walk,
bathing, toileting, dressing, and grooming clients,
taking vital signs,
providing massage and skin care,
providing range-of-motion and other exercises,
providing transportation to doctors’ appointments, physical therapy, etc.
running errands,
providing client education on nutrition, personal care, and household tasks,
keeping accurate records of services performed and client progress,
working as a member of a treatment or social services team,
taking direction from a Registered Nurse (RN) or other licenses healthcare professional.


Driver’s License
HHA Certificate
CPR and Basic Life Saving Certification
Pre- employment physician’s Health Clearance: negative TB skin test and/or CXR and other state-mandated tests.


Some companies provide any or all of the following benefits for full-time HHA work:

Employee and Family Health Coverage
Employer-contributed Pension Plan
Scheduled time off, Vacations and Sick Time
Tuition Reimbursement
403(b) or other Retirement Plan

5 Creative Ways to Make More Money as a Home Health Aide

Home Health Aide Training Program listing information for those looking to start a career as a Certified Home Health Aide. The service is FREE and you receive Programs in your area.

5 Creative Ways to Make More Money as a Home Health Aide

As a Home Care Worker you have many opportunities. The home care industry is booming and Home Health Aide’s are at the front line. Home Health Aide’s are the eyes and ears of the nurse, so why shouldn’t they make good money. According to the Bureau of Labor Statistics the annual yearly wage can be up to 29,390.

I doubt that includes overtime pay, so that is a potential for more money. Also, I must include that the basic criteria to becoming a Home Health Aide, is that you have to be 18 years old and have a basic reading level. The class can be 2-3weeks long and you can start making money.

These are 5 creative ways a Home Health Aide can make more money:

1) Upgrade your skills: Too many times Home Health Health Aides complain about not getting enough money per hour. However, they do not take the time to improve their clinical skills. A C.P.R class may get you more money or for example, a special training in handling Special Needs patients or T.B.I (Traumatic Brain Injury) patients.

Don’t forget being that you have hands on patient care. Becoming a C.N.A (Certified Nursing Assistant) maybe something you can handle. Some CNA’s make over 20.00/per hour with Shift differentials and the positions are union.

REMEMBER: It’s a small sacrifice for a lifetime of paradise.

2)Be available to Work: This may seem obvious to some, but many Home health aides have small children at home and can not take extra work from your coordinator to make more money because of the lack of child care services.

Some times that babysitter can really come in handy when you need to make the extra holiday pay.

3) Market Yourself: That may not have sounded right *smile*, but seriously you really need to get yourself out of your shell. Your an experienced specially trained healthcare professional, ACT LIKE IT!

As a Home Health Aide you know how to care for people, so market yourself to your coordinators at the agency you currently work for. So, you can get that exclusive private(V.I.P) case. They may pay more money to take care of a V.I.P client. if anything they might have perks. You never know unless you try.

A private case can also be working for yourself. Put basic information about your skills and experience on internet classified ads, like Craigslist to get customers.

Many rich people DO NOT like to spend money. So, they will gladly be happy not to pay a home care agency and pay you out of their pocket, because it’s cheaper for them.

It will be a higher wage(because you asked for more money) and the conditions might be better.

4)Work For Multiple Agencies: This can be tricky but, if the home care company does not mind, then your good. If one agency doesn’t give you what your looking for in hours call your other agency to make up the difference.

5)Think out of the BOX: Every organization needs a health care department. Think about it. People fall, trip, and injury themselves all the time on the job there are medical personnel in all of these business establishments.

My point is that, because you have the health care experience and hands on care you can work for jobs that do not necessarily say “WE NEED HOME HEALTH AIDES”. The job might say in the DESCRIPTION, “need someone with health care experience and hands on care” and might indicate that a health care certificate or degree would be preferred.

That is an opportunity waiting, right there. Many non traditional health care companies ask that many of there employees have health care experience. You have a better chance of getting that job, than someone who has business, banking, or retail experience.

Someone I know got a job working in transportation of medical patients, just because she had experience with hands on transferring of patients. She still had to get a C.D.L license, but she probably had a leg up from the competition that only worked driving the transport bus.

So, There you have it, 5 Creative ways to make more money if you have Home Health Aide Training. I hope these suggestions help, along with my examples.

Home Mortgage Rates – 4 Choices

Home mortgage rates are in a period of flux during the credit crisis going on at this time in the United States. You will still be able to find decent rates for a home mortgage, but you will need to work a little harder than you would have a few months ago. It is important to determine which if any of the mortgage types and rates are appropriate for your particular home mortgage situation. Information is available on line, or you can visit with a local lender in order to determine the best route for you to follow. Panic buying is never the answer, so you should take time to research your path in advance.

Fixed Mortgage

Perhaps the most typical of the home mortgage rates and packages until fairly recently, chronologically speaking, is that of the fixed mortgage. If you hold a mortgage with an eight percent rate and a thirty year term with twenty percent down, it probably is an older mortgage. Today, the fixed mortgages still are often 30 year mortgages, but they may also be 12 years terms, 15 year terms, 20 year terms, or other negotiated packages. The rate of interest will vary according to the term and the credit worthiness, but it does not change over the term of the loan.

Variable Mortgage

In recent years, as more people in this country wanted to participate in the American dream and own their own home, more and more borrowers took out the mortgage packages with home mortgage rates known as a variable mortgage. A variable mortgage has a set term which usually consists of a low introductory rate and a second phase in which the mortgage varies according to some preset index. An example is tying the mortgage rate to prime rate. The original period may be fairly short followed by a balloon payment.


A balloon payment is another way to finance and maintain low home mortgage rates in order to ‘sell’ the mortgage to the lenders. The borrower agrees to have low or zero mortgage rate for a very short time with the expectation that the income will be increasing before the balloon payment comes due. This can be a risky type of home mortgage, but it also works well for people who are in certain types of financial situations. You are the best judge of whether or not to use the balloon mortgage type of loan arrangement.

Reverse Mortgage

A special type of home mortgage rates is one known as a reverse mortgage. This is often taken out by a senior citizen who owns their own home. It can be a way to fund health care. It taps the equity in the house and pays the owner over the life of the person taking out the mortgage. This type of mortgage is probably one of the least understood of all the mortgage types. This should not be entered into lightly. Find out exactly what the long term effects will be in your own situation.

An Introduction To Two Innovative Medical Careers

In the United States, Physician Assistants (PAs) are non-physician clinicians licensed to practice medicine with a physician’s supervision. This supervision, in most cases, need not be direct or on site and many PAs practice in remote or underserved areas in satellite clinics. PAs can treat patients and, in most states, prescribe medicine, and in some states in the US they carry a DEA number that gives them authority to prescribe controlled medications like narcotics. PAs in surgical practices also serve as first assists in surgery. PAs provide medical services that are reimbursed under Medicare and third party insurances.

Physician Assistants held about 65,000 jobs in 2005. The number of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, there were about 58,665 certified PAs in clinical practice as of January 2006.

Just over 56 percent of PAs worked in the offices and clinics of physicians in 2005, either allopathic or osteopathic. About 36 percent were employed by hospitals. The rest were mostly in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs. According to the American Academy of Physician Assistants, about 17 percent of all PAs provide health care to rural communities and those with fewer than 20,000 residents, in which physicians may be in limited supply.

In 2006, there are more than 130 accredited PA programs in existence in the United States. They are all accredited by one body — the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). A majority of them are master’s degree programs (requiring GRE for entry), but some are available as an undergraduate major. A number of these undergraduate programs are making a transition to graduate level training.

A Physician Assistant may use the post-nominal initials PA, RPA, PA-C or RPA-C, where the R indicates Registered and the C indicates “Certified.” The “R” designation is unique to only a couple of states; most Physician Assistants use the PA-C. The certification is granted by one certifying body, the National Commission on Certification of Physician Assistants (NCCPA).

Physician Assistants and Nurse Practitioners both provide similar services in most states, the major distinction being that nurse practitioners are registered nurses by trade. Nurse Practitioners require more training than physicians assistants, such as a Masters Degree in nursing. Both are also known as Advanced Practice Clinicians (APCs) or mid-level practitioners (MLPs).

PAs should not be confused with Medical Assistants, who perform routine clinical and clerical tasks in a physician’s office. A Medical Assistant (MA) is a multi-skilled allied healthcare practitioner who is competent in both a wide variety of clinical and laboratory procedures, as well as many administrative roles. Medical assistants have been described as healthcare’s most versatile, multifaceted professionals. Medical Assisting is an allied health profession whose practitioners function as members of the health care delivery team and perform administrative and clinical procedures.

Formal education of medical assistants usually occurs in vocational or technical institutes, community colleges, proprietary schools, or junior colleges. The course length usually ranges from 1 to 2 year programs, complete with externships. The curriculum presented must always be accredited if its graduates plan to become either certified or registered. In 2002, there were 495 medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and about 170 accredited by the Accrediting Bureau of Health Education School (ABHES). Accreditation by either CAAHEP or ABHES usually requires that the schools curriculum provide sufficient classroom, lecture, and laboratory time (if applicable) to each of the courses below.

Administrative Courses
Computer Applications
Manual Recording of Patients’ Data
Scheduling Appointments
Maintaining medical Records
Word Processing/Typewriting/Keyboarding
Telephone Triage
Personnel Management

General Courses
Anatomy and Physiology
Behavioral Psychology
Medical Terminology
Patient Education
Medical Law and Ethics

Clinical Courses
l Medical Asepsis/Infection Control
Pharmacology/Administration of Medications
Assisting Techniques/Physical Examination
Assisting with Minor Surgery
Basic Laboratory Procedures/Routine Blood and Urine Testing
Cardiopulmonary Resuscitation (CPR)
X-Ray Theory and Positioning
Electrocardiogram (EKG)

Certification is a voluntary process which is strongly backed by the AAMA and a number of other well respected certification bodies in the USA as a way to guarantee competency of a medical assistant at a job-entry level. However, in order to be eligible for certification one must attend a school which has been accredited by either CAAHEP or ABHES. Certification is usually achieved by taking a test issued by the National Board of Medical Examiners and AAMA, or AMT, or NHA and is offered twice yearly, simultaneously, at over 200 different test sites across the United States.

Successful completion of the rather intense exam earns the taker the proper credentials to become a Certified Medical Assistant, or CMA. National certification is legally required in order for any medical assistant to adhere to CMA status. The title CMA then follows postnominally.

Recertification must occur every 5 years in order for one to maintain their credentials. There are two ways to do this; one may either continually earn continuing education hours by attending CMA meetings, conventions and seminars, or by completely retaking the initial exam to prove they still possess a certain level of knowledge.

A medical assistant may choose another possible credential over CMA, and become a Registered Medical Assistant (RMA) instead. Again, credentialing is completely voluntary. The American Technologists (AMT) agency is responsible for certifying MAs who choose this course.

AMT first began offering this certification in 1972 on the months of June and November, through a computerized exam, much like the one offered by the AAMA. AMT therefore has its own conventions and committees, bylaws, state chapters, officers, registrations and revalidation examinations.

To become eligible to hold the title of RMA a student must be at least 18-years-old, pass a medical assisting curriculum at a school accredited by either ABHES or CAAHEP and possess a minimum of 5 years experience. The initials RMA then follow the individual’s name.

RMAs have historically been very active in legislation, seeking protection for medical assistants, as well as continuously encouraging improved educational curriculums.

When To Consider Professional Senior Care Services

The choice to seek out professional senior care services for a beloved member of your family can be a tough decision to make, but the eventual results can be beneficial to everyone involved. While many people feel like enlisting the help of outside resources is akin to pawning off your loved one on someone else, the opposite is actually true: you are showing your love for them by getting the best care possible. So when is it appropriate to consider professional senior care in Portland? Here are a couple of warning signs that you should look for that can help you indicate if it is time to seek our professional assistance.

When Everyday Tasks Become Difficult

A surefire sign that your loved one may need a little bit of extra help is when everyday tasks become difficult. When things such as making meals, getting dressed in the morning, and cleaning up around the house become burdensome, then it is a good idea to consider how home senior care help or a senior care facility can help ease that burden. There are a number of options available, and with a little bit of research you can find something that works best for your loved one.

When Specific Medical Needs Arise

Medical conditions can arise later in life, and some of these medical conditions necessitate professional assistance, sometimes around the clock. If your loved one is starting to exhibit signs of a medical condition, such as Alzheimer’s or dementia, that could potentially pose some form of danger to them personally, then you should seriously consider seeking out professional assistance. Whether in the form of a home health care provider or a care facility, the benefits of professional is worth the money that you pay to ensure the comfort and safety of your loved one.

Trump Administration Threatens Net Neutrality

Tom Wheeler, the previous chairman of the FCC, utilized his last public speaking engagement before leaving office to caution organizations and buyers that their choice of cloud services and business applications could be extremely constrained if the approaching organization strikes down the 2015 open internet arrangement that he and his team set up. This request situated the FCC’s unhindered internet control that keeps Internet Service Providers from abating or blocking activity on their systems. This gives all activity level with circumstance and speed and counteracts arrange bias.

Wheeler additionally demonstrated sympathy toward the Internet of Things, a territory of financial development that is rapidly getting to be distinctly top of brain to numerous organizations and strategy creators in Washington.

“[T]he development of the web of things is another territory that relies on upon the open network of those things,” Wheeler said. “On the off chance that ISPs can choose subjectively which IoT gadget can be associated, or support their own IoT action over their rivals, the splendid eventual fate of IoT diminishes.” Wheeler proceeded, “As everything goes into the cloud, the capacity to get to the cloud free of guardians is basic. In the event that ISPs get the chance to pick which applications and mists work superior to anything others as far as get to, speed and dormancy, they will control the cloud future,”.
Wheeler’s position may not be an unexpected now but rather given his past as a lobbyist for the link and remote area his support of internet fairness may come as a stun.

Bill Wilson, an expert for BBL, Broadband Landing, stated, “Wheeler might underplay the earnestness of the circumstance. Internet fairness is the greatest arrangement that nobody truly gets it. On the off chance that customers and private companies really acknowledged what the web would look like after it was purchased and sold by substantial partnerships that was be stressed. This would be every one of that was being discussed.”

Wheeler has a similar question numerous organizations do, specifically will Trump disassemble an arrangement that is unmistakably working? With republicans straightforwardly contradicted to internet fairness things do appear to be desperate for the approach.

Wheeler’s discourse not just goes about as a notice to the approaching organization additionally unmistakably endeavors to extend the extent of the internet fairness wrangle all in all. Shopper effect of the open web request is quite often the lead in any talk of internet fairness yet here Wheeler’s concentration was on the threat to organizations and their expanding utilization of distributed computing. Interference or the moderating of these administrations is more damaging than a video playing moderate. Organizations may be required to totally change back office administration frameworks. An organization like could have their client base separated between clients that have an ISP that permits their activity and ISP’s that won’t. Circumstances of this sort could be rehashed crosswise over numerous business administrations. On the off chance that AT&T purchases a firm that gives CMS to deals and advertising bunches, it is not unfathomable that they would demonstrate inclination to this firm over others.

Wheeler particularly gets out Verizon and AT&T for the “zero rating” programs that give a few organizations free access by not charging clients for the information they utilize. While this isn’t the dreaded “Fast track” unhindered internet has been attempting to stay away from, it might really be more regrettable.

Wheeler completed his discourse with, “It now tumbles to another arrangement of controllers, to another FCC and to the individuals who advocate before it and the Congress to decide the street that they need to take from here,” Wheeler said. “We are at a fork in that street. One way leads forward and alternate leads back to relitigating arrangements that are certifiably working.”

While the byway similarity fits, it’s really more extraordinary than Wheeler makes it appear. One street leads forward and alternate leads back 10 years and afterward off a precipice into a gap loaded with crocs.

Home Health Care vs Assisted Living

Home Health Care in Los Angeles

Home health care is health care that is provided to patients inside their home, and usually by either health care professionals or family and friends. The term “home care” suggests that the care provided is non-medical and more of a custodial nature, whereas “home health care” may suggest licensed staff members. The differences here are similar to the differences between assisted living facilities and nursing homes. Much like assisted living facilities, home health care lets seniors enjoy a good measure of independence. An elderly individual or couple will appreciate having privacy as well as assistance in daily living needs.

What Home Health Care Provides

What kind of services does home health care provide? Home health care may help seniors with daily living needs such as bathing, dressing, house keeping and cooking and dining preparation. Depending on the needs of the resident, there may be special provisions such as transportation services and errands, volunteer programs, exercise and walking, and toileting assistance. More extensive forms of home health care would also provide rehabilitation programs, including visits from physical therapists and nurses. Other qualified home health care professionals may include respiratory nurses, occupational nurses, social workers, mental health workers and physicians.

Who pays for home health care? This type of outside assisted living program can be paid by private resources from the resident or family, by public payers such as Medicare and Medicaid or by employer-sponsored health insurance plans. Medicare will usually not pay for home health care on a long term basis while Medicaid is more likely to help low-income families with little or no assets. Employer-sponsored home health care is likely to be on a short term basis unless the insurance plan is very generous. Most of the time home health care will be paid for by a family’s own resources.

Comparing Home Health Care with Assisted Living

How does home health care compare with in-house stays at nursing homes and assisted living facilities? Most seniors would prefer home health care, of course, as people always do value their privacy. However, there are also circumstances that would necessitate constant supervision of the resident at an assisted living facility, and not only occasional visits. Home health care is basically assisted living, but with even more independence. Therefore a resident that cannot be left alone for long periods of time would be better suited in a nursing or board and care type home.

It might appear that home health care would be cheaper than a stay in a nursing home. However, home health care costs can be just as expensive, depending on the number of hours aides work. Some residents have admitted that full time home health care usually costs twice as much as a stay in a board and care or assisted living home. Most home health care agencies will charge about $20.00 an hour or over. If the resident is relatively independent then the fees associated with the service can be controlled. However, don’t forget that if your needs are minimal to begin with, you could hire a trusted individual to perform the same tasks and save money from paying an agency fee.

Home health care is ideal for seniors who feel well and can easily get around but who need occasional doctor visits and help with housekeeping. It is also a preferable choice if a senior needs full time care but does not want to become a resident in a public nursing home. Full time home health care provides the most privacy and personal attention possible. If you are looking for this type of senior assistance, you should always be mindful of the qualifications of workers, as opening one’s home to a stranger could always be a security risk. The best home health care agencies have screened workers who are well qualified in their field.

How We Can Help You

ElderHomeFinders is a company dedicated to helping seniors locate assistance in the southern California area. We inspect assisted living facilities and retirement communities in the area so that our clients will find the perfect home at a price they can afford. Can ElderHomeFinders also help seniors find home health care? Yes. Our company can put you in touch with the right home health care agency, according to your special needs and budget limitation. We can also advise you on the differences between home health care services and assisted living and board and care facilities and which choice would better work for you. Seniors have worked hard all their life and surely deserve the best health care possible – whether in a senior living facility or in their own home.

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Hiring a Home Health Care Employee

Providing the primary care for an elder loved one can be difficult. When you cannot deliver all the elder care yourself and support from friends, family, and community organizations is not enough, it may be useful to hire a home health care worker. He or she can offer care from a few hours a week to 24 hours a day, and can provide many other helpful services. Types of in-home health care services include:

General Health Management like administration of medication or other medical treatments
Personal care such as bathing, oral hygiene, dressing, and shaving
Nutrition help like preparing meals, assisting eating, and grocery shopping
Homemaking services including laundry, dishwashing, and light housework
Companionship for example reading to the senior or taking them on walks

Recruiting and Interviewing Applicants

There are many avenues for hiring a home health care employee. Generally, home health care workers can be hired directly or through an agency. Home health care agencies often have a staff that includes social workers and nurses that will manage your care. However hiring an independent home health care worker is generally more cost effective, it will also give you more control over the type of care you receive.

Senior home care workers should be carefully screened for proper training, qualifications, and temperament. Fully discuss the needs of the elder care recipient during an interview with a prospective home health care employee. There should be a written copy the job description and the type of experience you are looking for.


Have applicants fill out an employment form that includes the following information:

Full name
Phone number
Date of birth
Social Security number
Educational background
Work history

Before hiring, you should ask to see the senior home care worker’s licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.

References should be checked out thoroughly. Prospective employees should provide the employer with names, dates of employment, and phone numbers of previous employers and how to contact them. It is best to talk directly to previous employers, rather than just to accept letters of recommendations. Also ask the applicant to provide or sign off on conducting a criminal background check

Special Points to Consider

Make sure the person you are considering hiring knows how to carry out the tasks the elder care recipient requires, such as transferring the senior to and from a wheelchair or bed. Training may be available, but make sure the worker completes the training successfully before hiring him or her.

No one should be hired on a seven-day-a-week basis. Even the most dedicated employee will soon burn out. All employees need some time to take care of their personal needs. No worker should be on call 24-hours a day. If the elder care recipient needs frequent supervision or care during the night, a family member or second home health care worker should be able to help out or fill in.

Live-in assistance may seem to be more convenient and economic than hourly or per-day employees but there can be drawbacks. Food and lodging costs must be calculated into the total cost of care, and it could be difficult to dismiss someone without immediate housing alternatives. If you decide to utilize a live-in arrangement, the employee should have his own living quarters, free time, and ample sleep.

Job Expectations and Considerations

Before hiring a senior home health care worker, you should go over the tasks you expect them to perform and other issues, such as promptness, benefits, pay scale, holidays, vacations, absences, and notification time needed for either employer or employee before employment is terminated. If you work and are heavily dependent on the home health care worker, emphasize the importance of being informed as soon as possible if he or she is going to be late or absent so that you can make alternative arrangements. Be clear about notification needed for time off, or what to do in the case the home health care worker experiences a personal emergency that requires them to abruptly leave work. It is important to have a backup list of friends, family, other home care workers, or a home health care agency you can call on.

Be clear about issues concerning salary, payment schedule, and reimbursement or petty cash funds for out of pocket expenses.

You should spend the day with the home health care worker on his first day to make sure you are both in agreement over how to carry out daily tasks. It would also be helpful to supply the home health care worker with a list of information on the elder care recipient such as: special diets, likes, dislikes, mobility problems, health issues, danger signs to monitor, possible behavior problems and accompanying coping strategies, medication schedule, therapeutic exercises, eye glasses, dentures, and any prosthetics.

You should also provide the following information to your home health care worker: your contact information, emergency contacts, security precautions and access to keys, clothing, and locations of washing/cleaning supplies, medical supplies, light bulbs, flashlights, fuse box, and other important household items.


Another big consideration in hiring a senior home care worker is how he or she is going to get to work. If they do not have a reliable car or access to public transit, then you might want to consider hiring someone to drive him or her, which might be more economical than using taxis. Inform your insurance company if the home health care worker is going to drive your car when caring for the senior. Your insurance company will perform the necessary driving background checks. If the home health care worker is using his or her car to drive the elder care recipient, then discuss use of her or his car, and conduct a driving background check.

Insurance and Payroll

Check with an insurance company about the proper coverage for a worker in your home.

Make sure all the proper taxes are being drawn from the employee’s check by contacting the Internal Revenue Service, state treasury department, social security, and the labor department. If you do not want to deal with the complexities of the payroll withholdings yourself, than you can hire a payroll company for a fee.

Even if your home health care worker is working as a contractor, you are still obligated to report the earnings to the IRS. Talk to your accountant or financial adviser about making sure you are following IRS rules.

Ensuring Security

You should protect your private papers and valuables in a locked file cabinet, safe deposit box, or safe. If you are unable to pick up your mail on a daily basis, have someone you trust do it, or have it sent to a post box. You should check the phone bill for unusual items or unauthorized calls. You should put a block on your phone for 900 numbers, collect calls, and long-distance calls.

Keep checkbooks and credit cards locked up. Review credit card and bank statements on a monthly basis, and periodically request credit reports from credit reporting agencies. Lock up valuable possessions or keep an inventory of items accessible to people working in the house.

You can help to prevent elder abuse to your loved one by:

Make sure the home health care worker thoroughly understands his or her responsibilities, the elder care recipient’s medical problems and limitations, and how to cope with stressful situations.
Do not overburden the home health care worker.
Encourage openness over potential problems.

The following are possible signs of elder abuse or neglect:

Personality changes
Crying, whimpering, or refusing to talk
Sloppy appearance
Poor personal hygiene
Disorganized or dirty living conditions
Signs of inappropriate sedation, such as confusion, or excessive sleeping
Mysterious bruises, pressure sores, fractures, or burns
Weight loss

If you suspect abuse, act immediately. Do not wait until the situation turns tragic. Investigate the situation by talking to the elder care recipient in a safe situation, or install monitoring equipment. Examples of abusive behavior include yelling, threatening, or over controlling behavior that could involve isolating the senior from others. If the situation is serious, you should replace the home health care worker as quickly as possible. If you fear the elder care recipient is in danger, he or she should be separated from the home health care worker as soon as possible. Place the elder care recipient with a trusted relative or in a respite care facility. Make sure your loved one is safe before confronting the home health care worker, especially if there is concern about retaliation.

Report the situation to Adult Protective Services after ensuring the safety of the elder care recipient. The police should be contacted in the case of serious neglect, such as sexual abuse, physical injury, or misuse of funds.

Supervising a Home Health Care Worker

The most important thing to remember after hiring a home health care worker is to keep the lines of communication open. You should explain the job responsibilities clearly, and your responsibilities to the home health care worker. Do not forget that the home health care worker is there for the elder care recipient and not the rest of the family. For live-in arrangements, the maximum amount of privacy should be set up for the home health care worker’s living quarters. Meetings should be set up on a regular basis to assure that problems are nipped in the bud. If conflicts cannot be resolved after repeated attempts, than it is best to terminate the employee. In such a case, you may have to either place the elder care recipient in a nursing home temporarily or hire a home health care worker through an agency. Reserve funds should be kept on hand in the case of such an emergency.

General Eligibility Requirements for Home Care Benefits

Hiring a home health care worker directly is usually less expensive than hiring through a home health care agency; but if the elder care recipient is eligible and you wish to use assistance from Medicare, you must hire someone through a certified home health care agency. For the senior patient to be eligible, three or more services must be ordered by a physician. Other factors or eligibility are the required need for skilled nursing assistance, or one of the following therapies: physical, speech or occupational. The elder care recipient’s medical needs will determine asset and income requirements.

Hiring Home Health Care Workers through Home Health Care Agencies versus Independently

Different health professionals can assess the elder care recipient’s needs. A nurse or social worker can help with design and coordination of a home care plan. Your care manager, doctor, or discharge planner can help with services being covered by Medicare. They generally help make the arrangements with a home care agency.

You should ask the home health care agency how they supervise their employees, and what kind of training their employees receive. Find out the procedures for when an employee does not show up. Also ask about the fee schedule and what it covers, there may be a sliding fee schedule. Furthermore, find out if they have a policy for minimum or maximum hours. Ask the agency if there are any limitations on the types of tasks performed.

Especially if you have to pay for the care services yourself, find out if there are any hidden costs such as transportation. If all the costs for hiring a care worker through an agency become too much, you may want to consider hiring directly.

Hiring independent home health care workers is not only more economical than using an agency, but it also allows more direct control over the elder care.

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My Husband Fell Down a Flight of Steps

When my husband fell down a flight of steps, we were both so grateful that he was just sore. He didn’t break any bones, which is a miracle in itself. We have both heard of people falling down a flight of steps and losing their life, so we felt especially blessed that he just had to deal with pain. It wasn’t until a few weeks after his fall that he decided to see a San Jose chiropractor. We both felt that the pain would get better with each passing day, but he was not getting any relief from it.

Neither of us had ever been to a chiropractor before, but we did feel that was the best place to go. He felt if he went to our family doctor, the only recourse would be medication to mask the pain. Continue reading →