Can A Home Health Agency Decline to Provide Care?
Many elder caregivers depend on the help of a home health agency to provide senior care at home. It can be a mistake to assume that a Medicare-funded home health agency will always be available to help. When can a home health agency refuse to provide care for a senior at home?
When a doctor prescribes home health care, both the doctor and the family generally assume that the referred agency will immediately step into the breech and begin sending nurses, therapists, and aids as necessary. However, there are several valid reasons why a home health care agency may refuse to take or keep a case.
The agency may not be a participating provider in the patient's private Medicare health plan. Members in private Medicare plans must use providers who are part of the plan network. Because in most cases the doctor will also be a participating provider, simply request that the doctor make the referral to a participating agency. You can call the plan administrator for a list of participating home health care providers if the doctor's office doesn't have this information.
If the home health agency does not have available staff to provide the necessary care, or if the patient is located outside of their geographic service area, they can decline to accept a new case.
Not every home health care agency can manage every kind of medical treatment. If your senior needs services that the agency does not provide, they will decline to accept him or her as a patient.
For instance, not every home health agency is able to manage "home infusions." More often than not these days IV therapy in the home is managed by specialized homecare agencies. If the agency you selected is not able to provide the specialized treatment your elder needs, they can often refer you to an agency that is prepared to take this kind of case.
A home health agency can, and probably will, decline to provide services in a situation which they believe is unsafe for either the patient or their staff.
If the patient needs to have a capable caregiver present at all times, and the patient is alone or the caregiver is unable to provide the necessary care, a home health agency may determine that the conditions are unsafe for the patient and decline to admit or to keep the patient.
If the patient or the conditions in the home are dangerous for agency personnel, the agency will refuse to accept a patient or terminate their involvement.
If the agency believes that their services would not be covered by Medicare or other health insurance they will not accept your elder as a patient. Because of complex Medicare requirements that Medicare patients and private-pay patients be rigidly segregated, most Medicare certified Medicare home health agencies are not structured to accept patients who pay privately. If another Medicare certified home health agency has discharged the patient because they determined that the patient no longer needed care, a new agency will have access to this information and will be reluctant to accept the risk of admitting the patient.
If a home health agency refuses to admit your elder as a patient you can always call other agencies that serve your area. If the agency and your doctor are unable or unwilling to help you find another agency you can go to the Medicare website, where they provide a list of all participating agencies. You can search by city, county or ZIP code. Click on the front page link that says " Compare Home Health Agencies in Your Area."
However, if both your doctor and the original agency are unwilling to assist you with obtaining homehealth care for your senior, it would be a very good idea to look at the reasons why they are declining. If their reasons have anything to do with the safety of your senior, it may be time to take a good long look at alternatives which could be better and safer for your loved one.