Patient Rights Requirements in the Home Care Setting

November 16, 2018

Home care involves a wide range of services for individuals who are ill or recovering from an illness or surgery. Services include nursing care; physical, speech, occupational and other rehabilitative therapy; medication administration; monitoring; medical-social services, and medical equipment. Other non-health care services include personal care, which involves assistance with personal hygiene, dressing, getting in and out of a bed or chair, bathing, and exercise. Nutrition, homemaking and social and safety services, including transportation services and companionship, are also services available from home care agencies.

Medicare Part A and/or Part B helps pay for home care for those individuals who are under the care of doctors who accept Medicare assignment, are homebound, have been certified by their physicians that they need in-home health care with a plan created by the health-care provider, and whose care is provided by a Medicare-certified home care agency. Medicare will typically cover in-home skilled nursing services; home health care assistance as long as skilled nursing services are also needed; physical, speech and/or occupational therapy services that are necessary for treating the illness or injury; medical social services ordered by the doctor to help with social and emotional concerns related to the patient’s health condition; certain medical supplies provided by a Medicare-certified home health agency; and durable medical equipment, such as a wheelchair or walker.

According to the most recent statistics available, there are 12,600 Medicare-certified home health agencies throughout the United States serving five million seniors and younger adults.

Individuals receiving home care services must be legally informed of their rights as a patient. Non-compliance of patient rights not only violates the law but also jeopardizes patient care and makes home care agencies vulnerable to professional liability exposures, cyber threats, and other risks. Patient rights include:

  • To be fully informed of all their rights and responsibilities by the home care agency.
  • To have their property and person treated with respect.
  • To be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property.
  • To receive care and services according to a suitable and up-to-date plan and subject to accepted medical or nursing standards, to be informed of his or her condition, and to take an active part in creating and changing the plan and evaluating care and services.
  • To be educated and trained in advance of receiving care about the services that will be provided; the disciplines that will furnish care; the frequency of visits proposed to be furnished; other choices that are available; and the consequences of these choices, including the consequences of refusing these services.
  • To be advised of changes in the plan of care and to take an active part in any changes.
  • To know, in advance, any limits to the services available from a provider, and the provider’s grounds for a termination of services.
  • To receive appropriate and professional care in accordance with physician orders.
  • To receive a timely response from the agency to requests for service.
  • To be informed of their rights to formulate advanced directives.
  • To have the health care provider comply with advance directives in accordance with state law.
  • To know, in advance of receiving care, whether the services are covered by health insurance, medical assistance, or other health programs; the charges for services that will not be covered by Medicare/Medicaid; and the charges that the individual may have to pay.
  • To have personal, financial, and medical information kept private, and to be advised of home health care agency’s policies and procedures regarding disclosure of such information.
  • To voice grievances and suggest changes in service or staff without fear of restraint or discrimination.
  • To a fair hearing if service has been denied, reduced, or terminated.
  • To information concerning the fair hearing procedure.
  • To be informed of what to do in the event of an emergency.
  • To be advised of the telephone number and hours of operation of the state’s home health hot line, which receives questions and complaints about Medicare-certified and state-licensed home care agencies.

About Manchester Specialty

Manchester Specialty provides a total business insurance solution for home care firms, including home health care, companion care, visiting nurse associations (VNAs) and in-home hospice providers. We can help you provide the following insurance lines to your clients: General Liability, Professional Liability, Workers’ Compensation, Management Liability, Cyber Liability and Non-Owned & Hired Auto insurance, among other key coverages. For more information about how we can help you protect your insureds, please contact us at 855.972.9399.