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Considerations When Choosing a Home Care Agency

Steven Plogsted, PharmD, BCSNP, CNSC

Your life has changed, and now you need help from a home care agency to provide you with needed services. Initially, a hospital discharge planner or your clinician may set you up with a home care agency. You do, however, have the right to be involved in the decision or to later switch to another home care agency, as long as the company you choose accepts your insurance. What should you consider or what questions do you need answered to determine if a new home care agency will meet your needs?

 

Quality and Clinical Expertise

Your first consideration should be quality. Before you decide on an agency, try to ask others about the agency’s reputation. This may be a difficult task because home care agencies can’t give you a list of their customers due to confidentiality laws. You may know other consumers who require the same level of care that you do or you can discuss your options with the doctor who prescribes your home parenteral and/or enteral nutrition (HPEN). Many of them will be familiar with different companies and any problems associated with them.

There are also questions you can ask that will indicate the agency’s level of quality and clinical expertise:

  • What level of education and training do the clinicians possess? Specialty certifications in nutrition support are available for pharmacists, nurses, dietitians, and physicians. These certifications require at least a minimum level of knowledge in clinical nutrition. Although not a requirement to practice, the certification does demonstrate a higher level of commitment to the consumer by the agency (see chart below).

  • Does the agency have a consultant physician? Your own physician may have a different level of knowledge about clinical nutrition issues and it is helpful if the agency has an expert who will work with your physician to provide the best outcomes for you.

  • Does the agency employ a nursing staff or does it contract with a nursing service? Do they train the contracted employees? Do the nurses have experience with line care? Are nurses available on an urgent basis?

  • Does the agency have a social worker available? A social worker can be invaluable in advising you on insurance issues, disability, and so on.

  • Does the agency have a consumer advocate available, or can they direct you to a local support group to help you through issues that you need help with?

  • Is the agency active with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and/or Oley? Is the agency up-to-date on the latest research and protocols (particularly in relation to parenteral nutrition)? Does the agency have experience with your disease state? These questions can be more or less important, depending on your physicians’ level of experience with HPEN and/or your disease state.

Most agencies are available twenty-four hours a day, seven days a week, to help with any issues that arise, but you shouldn’t take that for granted. Ask about their availability.

 

Insurance

Another important consideration in choosing a home care company is determining what agencies your insurance carrier has in its network. Insurance carriers usually develop contractual arrangements with several agencies in order to keep their costs down; these agencies will be considered “in network.”

What if the new home care agency you’d like to have serve you is not in your insurance carrier’s network? It doesn’t entirely rule them out. You can contact the agency’s insurance representative and ask them to contact your insurance carrier to see if they can work out a contract. If you are insured through an employer, the employer’s human resources representative may also be able to help you in discussions with the insurance carrier. If the home care agency you choose is not in the insurance carrier’s network, make sure you understand your financial responsibility; there should be no surprises.

You should make a habit of contacting your insurance carrier periodically to make sure your home care agency is still in its network—or will be in the network during the next benefit year—as sometimes the contracts change. Often your home care agency will automatically check this for you. A good home care agency is proficient at two-way communication, and doesn’t rely on the consumer to make all of the calls.

Likewise, if you change insurance companies (or if your employer requires you to change insurance companies), check to make sure your home care agency is in the new insurance company’s network. You don’t want to discover when you are down to your last bag of parenteral nutrition (PN) or last can of formula that your new insurance company doesn’t have your agency in its network. Ask your insurance company if they routinely notify consumers of changes to their coverage.

 

Geography

When evaluating a new agency, make sure it serves the geographical area where you live. Some agencies have a limited service area and may not be able to deliver or ship outside of that area. Some agencies will not do business across state borders (more on this later).

Consider your plans and habits. Do you want to be able to travel? If so, how often and how extensively? Home care agencies are often required to obtain a license to do business in a state. While some smaller agencies may not want to spend the money to obtain multiple licenses, larger agencies often have branches in many states. This is especially important if you do a lot of traveling for long periods of time. Some home care companies simply won’t ship to other locations—license or not.

If you are going to travel, you will have to consider how you are going to replenish your nutrition-related supplies after your initial supplies are exhausted. Will your company be able to ship to you or do they have any special arrangements with other home care agencies that can supply you where you are going? If necessary, can the agency obtain premixed parenteral nutrition formulas, which have extended expiration dates? Will the agency charge extra for any of these services?

 

Supplies

Another important consideration is what kind of equipment and supplies the agency will provide you. Are there limitations to the number and types of pumps, catheter supplies, dressing kits, and/or enteral formulas available? Or will they provide to you, within reason, alternatives that fit your particular condition or lifestyle? How difficult is it to obtain an “off formulary” pump? (While you may be able to get one, will you have to fight to get it?) Will they provide you, at no additional charge, additional pumps if you are traveling or have other special circumstances?

Does the agency deliver your supplies? A few institutions and agencies still require that the consumer pick up the supplies. If the agency delivers, do you have to be home for the delivery? Will the agency provide a refrigerator for supplies? Is it easy to order supplies?

Additional Considerations

  • Determine how important it is to have a company that will be with you from beginning to end—there with your first bag of HPN and there with your last can of formula.

  • Are they concerned about your quality of life? For example, will they help you take on something new, like an exercise plan? Or help you work your infusion schedule around your job or a special event?

  • Do they have resources to help improve your quality of life?

  • Do you both have the same goals for your outcome?

  • How does the company handle obtaining orders from your physician?

  • Will the agency notify you of drug or product shortages, and keep you updated on how they are handling shortages?

  • Will the agency notify you of any product recalls?

  • Will the agency advocate for you as an HPEN consumer?

  • Does the agency treat you well?

 

Conclusion

There are many questions you should ask yourself and others when evaluating the quality of a home care agency. You must determine what qualities are most important to you, and whether are you satisfied with your current agency. Even if your agency doesn’t provide all of the benefits you would like, you may feel a sense of loyalty to them because they have served you well for a long time. Don’t be shy about asking them if they can provide additional services or supplies that can benefit you. The worst they can say is no.

Certifications

CNSC = Certified Nutrition Support Clinician
CNSP = Certified Nutrition Support Physician
CNSN = Certified Nutrition Support Nurse
CNSD = Certified Nutrition Support Dietitian

The National Board of Nutrition Support Certification, Inc. (NBNSC) certifies proficiency for physicians, nurses, pharmacists, physician assistants, and dietitians. In 2008, certification exams for each discipline (i.e., physician, nurse, dietitian) were replaced by a single exam that recognizes nutrition support as a multi-disciplinary endeavor and the CNSC was established. It encourages attainment of a credential based on job performance and the development of cross-coverage skills. More information at www.nutritioncare.org/NBNSC.

 

LifelineLetter, March/April 2012

more Calendar

9/26/2016 » 9/30/2016
Malnutrition Awareness Week

5/6/2017
Oley Regional Conference

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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