There are various providers of home care products and services. The California Association for Health Services at Home (CAHSAH) divides providers into the following categories:
Home Care Aide Organizations
These companies provide a wide variety of supportive services such as assistance with home management and non-medical personal care. Home care aide organizations may offer such services as homemaking, meal preparation, live-in attendants, supervision and assistance with feeding, dressing, bathing and toileting, respite/companion and child care, and escort or transportation services. Home Care Aide Organizations are licensed by the State of California.
Licensed Home Health
These agencies provide skilled nursing and, frequently, other services in the home, including continuous care and home care aide services. These agencies specialize in working with private insurance companies, although many are also certified to accept Medicare or Medi-Cal. Home health agencies are certified by the state of California and the services provided are similar to those provided by Medicare-certified home health agencies.
Medicare Certified Home Health
As required by the Medicare Conditions of Participation, these agencies must provide skilled nursing as well as one or more additional therapeutic services, including home health aides, physical, occupational or speech therapy, and medical social services. Medicare-certified home health agencies are licensed by the State of California, are certified to participate in Medicare, and typically provide skilled services on an intermittent basis to Medicare beneficiaries or other individuals with acute conditions.
Hospices provide a specialized interdisciplinary program designed to give palliative care to the terminally ill and supportive care for the primary caregiver and family members. Medicare-certified hospices must meet the Hospice Medicare Conditions of Participation and new California hospices must also be licensed by the State of California.
Home Medical Equipment
These companies provide medical equipment, products and supplies in the home. They may also provide home respiratory therapy or specialized services such as home phototherapy, wheelchair rehabilitation, or home apnea monitoring. They are licensed by the Department of Health Services.
Home Infusion Pharmacies
These companies provide pharmaceuticals and related high-tech services such as enteral or parenteral nutrition, pain management, antibiotics, or chemotherapy. They are licensed by the Board of Pharmacy. Home infusion pharmacies that provide or arrange for skilled nursing services are required to be licensed as home health agencies.
Interdisciplinary Professional Services
These companies provide home care services and products, such as physical therapy/rehabilitation, podiatry, or mobile x-ray or mobile laboratory services, in the home.
In accordance with California law, the provision of services in the home requires the provider to be licensed. The license ensures that agencies have met the necessary requirements to perform such services.
In addition to the above list, there are other types of entities that also provide care in the home. Some entities, referred to as Domestic Referral Agencies or DRAs are employment referral agencies who, after obtaining a job order from a prospective client, refer a job seeker to a client in exchange for a fee based on a fixed percentage of the job cost. Domestic Referral Agencies are not licensed, and the job seeker is either a self-employed independent contractor or an employee of the prospective client.
Other entities, referred to as Nurses’ Registries, are a type of employment agency which obtain and fill commitments for nursing services. Nursing service is defined as the “assignment of a nurse, as a private duty, self- employed, licensed registered nurse, licensed vocational nurse or practical nurse to render service to a patient under the direction or supervision of a physician or surgeon registered to practice in this state”. Nurse Registries must maintain a surety bond and meet other requirements. The assigned nurse is a self-employed independent contractor.
The final option is for the client to hire and employ the worker directly. In this case, the client is the employer and is responsible for paying applicable employment taxes.