Frequently Asked Questions for Consumers about Home Care

Home care providers (HCPs) may offer a range of services from assistance with tasks of daily living such as bathing, dressing and grooming to health services such as medication management, various treatments or therapies and nursing services.

HCPs must give home care clients a statement of home care services that lists services the licensed provider is authorized to provide and services the provider cannot provide under the scope of their license.

Consumers and families can download Minnesota Department of Health (MDH) sample statements of home care services. These statements list what home care services may and may not be provided with the basic and comprehensive licenses. Not all providers will offer all of the services listed, as providers may specialize in certain types of services.

• Statement of Home Care Services: Basic License (PDF)
• Statement of Home Care Services: Comprehensive License (PDF)

Consumers and their families may want to interview prospective home care providers to determine whether the services offered fit with the needs of the person who will receive care and their family.

"Assisted living" in Minnesota refers to a service or a package of services provided to individuals who reside in registered housing with services establishments. These services may be provided by a licensed home care provider that is part of the housing with services establishment or by licensed home care providers with which the housing with services establishment has made arrangements. Please review 144G Assisted Living Services for more information.

Some housing sites in Minnesota offer home care services to the people who live there. These sites are called housing with services (HWS) establishments. If the HWS establishment offers services to its residents, registration with the Minnesota Department of Health may be required.

Residents who live in HWS establishments will have a contract with the HWS establishment (the landlord). If receiving services from an arranged home care provider, the resident/client will have a separate contract (called a "service plan") with the service provider. Sometimes the HWS (landlord) and the home care provider are part of the same agency. In this event, they may provide the resident/client with one contract that covers both the housing and the home care services.

Review Minnesota Statutes, Chapter 144D for more information and the complete text regarding housing with services.

Home management services are different from home care services. Home management includes only these three services:

• Housekeeping
• Meal preparation
• Shopping

If an individual or an agency is providing at least two of those services to a person who is unable to perform these activities due to illness, disability, or physical condition, these providers must be registered with the Minnesota Department of Health. In addition, they must comply with the provisions of the home care bill of rights and they must attend an orientation session that provides training on the home care bill of rights and on the aging process and the needs and concerns of elderly and disabled persons. They are not surveyed by MDH at this time.

Home care providers must give clients a written service plan. This is a contract between the provider and the recipient of services. The service plan will outline the following:

• A description of the services to be provided to the client
• The frequency of these services
• The fees for services
• Identification of the staff that will provide services
• The frequency of supervision of the staff and by whom
• Emergency information and a contingency plan

The purpose of a service plan is to make sure that providers and clients and their families are clear about what services will be provided, by whom, at what cost and when, amongst other requirements. The service plan must be signed and dated by both the home care provider and by the client or the client’s representative and it must be updated when changes occur.

You can read the complete requirements of a service plan here:

• Requirements for a service plan

Minnesotans who receive home care services have many rights. These rights are outlined in the home care bills of rights, of which there are several versions. Home care, home management and license-exempt providers must give clients and/or the clients’ representatives a copy of the appropriate home care bill of rights.

The bill of rights used depends on the type of license, registration and/or certification the provider holds. The bills of rights are available in several languages.

• Home care bills of rights

There are many types of caregivers who may work for licensed home care providers. Some caregivers are licensed and others are unlicensed. Here is a list of some of these types of caregivers:

Licensed Personnel

Licensed personnel have received training in their fields and have passed the requirements for licensure, which is granted either through a licensing board or through the Minnesota Department of Health.

• Registered Nurse (RN)
• Licensed Practical Nurse (LPN)
• Nurse Practitioner (NP)
• Advanced Practice Registered Nurse (APRN)
• Occupational Therapist (OT)
• Physical Therapist (PT)
• Speech Language Pathologist (SLP)
• Social Worker (SW)
• Registered Dietitian (RD)

Unlicensed Personnel

Unlicensed personnel working in a home care setting must receive training as outlined in the home care laws. Some (such as certified nurse aides) may have completed the required training in a certificate program or in an educational setting. Other unlicensed personnel must complete specific home care training conducted by the RN or other licensed health professionals at the home care agency. Some common titles for unlicensed personnel are:

• Home Health Aide (HHA)
• Personal Care Assistant (PCA)*
• Certified Nurse Aide (CNA)
• Companion
• Home Care Worker (HCW)

*See the following question regarding PCAs.

Personal care assistant (PCA) is a term used for workers who provide personal care services to eligible Medical Assistance recipients. These individuals and/or PCA agencies are not licensed by the Minnesota Department of Health (MDH). They are overseen and regulated by the Minnesota Department of Human Services (DHS).

PCAs help people with day-to-day activities in their homes and communities. Assistance could include health-related procedures and tasks, observation and redirection of behaviors, activities of daily living such as dressing, personal hygiene, and toileting, and instrumental activities of daily living such as meal preparation and shopping. Specific details of what is covered by PCA services can be reviewed here:

PCA Consumer Information

If the service receiver (client/consumer) is not a recipient with coverage through a Minnesota Health Care Program (Medical Assistance) and been assessed as eligible for PCA program services, the PCA/PCA agency is required to have a basic or comprehensive home care license to provide the services above.

Although there are some similarities in the types of services provided under a home care license and PCA, if the client/consumer is not eligible for PCA services through a Minnesota Health Care Program, home care laws will apply. The type of home care license is dependent on the services provided.

When an employee begins work at a home care agency they must be provided with an orientation to the following:

• Home care laws
• Provider’s policies and procedures
• How to handle emergencies
• Requirements for the reporting of maltreatment of clients
• Home care bill of rights
• Handling of client complaints
• Consumer advocacy services
• Review of the types of home care services the employee will be providing and the provider’s scope of licensure
• Alzheimer’s disease and related disorders

In addition, staff providing home care services must be oriented specifically to each individual client and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically.

All staff providing home care services must be trained and competent in the provision of home care services consistent with current practice standards. In addition to the above orientation, unlicensed home care personnel must meet specific training requirements. Training topics include such areas as:

• Documentation requirements
• Basic infection control
• Maintenance of a clean and safe environment
• Personal hygiene and grooming
• Assisting with activities of daily living
• Agency emergency preparedness plan

Effective January 2016, the training requirements for caregivers who work with clients who have dementia and Alzheimer’s in housing with services settings will change. Both the current and the new requirements are listed below.

Current Requirements for All Home Care Providers

All direct home care staff and supervisors working with clients who have dementia and related disorders must receive training on topics related to dementia. This training must include:

• A current explanation of Alzheimer’s disease and related disorders
• Effective approaches to use to problem-solve when working with a client’s challenging behaviors
• How to communicate with clients who have Alzheimer’s or related disorders

Home care providers must provide to clients and their families a description of the training program (Minnesota Statutes, section 144A.4791, subdivision 2). This description must:

• Be in written or electronic form
• List the categories of employees trained
• State the frequency of training
• List the basic topics covered

New Requirements (to take effect on 01/01/2016) for Providers Serving Clients in Housing with Services Settings

Effective January 1, 2016, home care providers who serve clients in housing with services settings must meet additional training requirements. Minnesota Statute 144D.065 outlines the content, the hours and frequency, and the types of staff who must receive the training. In addition to specifying the number of hours of training and the frequency, the new law requires that training in dementia care be extended to more types of employees including maintenance, housekeeping and food service staff.

For more information about this topic review 144D.065 - Training in Dementia.

A list of providers is available on the Minnesota Department of Health (MDH) website. Enter the desired search parameters to find a list of providers.

• Directory of Facilities and Providers

You can also find providers by searching the MinnesotaHelp.info website.

The answer to this question depends on many factors. The simple answer is that for Medicare to pay for your home care services, you must use an agency that is Medicare certified. Ask the agency if they are both state licensed and Medicare certified. Medicare pays for services in your home such as nursing, help with daily activities like bathing and dressing, physical, occupational and speech-language therapy as well as certain medical supplies and equipment. However, it is usually only on a short-term basis following events like being in the hospital. Your health care team will help you find out if you qualify.

Anyone can choose to use a home care provider that is both state licensed and Medicare certified. The MDH website has a list of Medicare certified home health agencies (HHAs) in the Health Care Provider Directory. Follow these steps:

1. Choose "Home Care and Home Health Agencies" in the drop down menu.
2. Choose additional criteria (for example: county, city, and/or provider name) to narrow your search.
3. Click the "submit" button to get a list of providers that meet the criteria you chose.

If the provider is Medicare certified the listing will say "Federal Classifications: (Medicare Certified Home Health Agency)". If the listing does not say that, the provider is not Medicare certified and Medicare will not pay for any services from that home care provider.

To find out more about the rules for Medicare certified HHAs, visit the Centers for Medicare and Medicaid Services (CMS) website.

Follow the link below to read the home care (144A), housing with services (144D) and assisted living (144G) statutes.

• Home Care Statutes

The Minnesota Department of Health does not set nor regulate home care fees. Consumers/recipients of home care services and their families can find more information about fees and what services may be covered by insurance from the following sources:

• Licensed home care providers
• Medicare website (for Medicare recipients)
• Your health insurance company

In addition, you can get more information about home care services, long-term care, consumer rights and contracts with providers by contacting:

• Ombudsman for Long Term Care

To determine whether you qualify for Minnesota Health Care Programs contact:

• Minnesota Department of Human Services