CareWorks Health Services
Moulton Parkway STE 103C
Laguna Hills, CA 92653
of Business: 24/7 Service
provide Medical/Non-Medical Home Health Care Helping
Seniors and Disabled Adults live independently and safely,
in the place they want most, Home
24/7. Our caregivers believe in and adopt our
Ten Commandments”, the cornerstone of success
for all our “Compassionate Companions”.
provide the most compassionate care to all individuals
- begining with newborns, hospital outpatient care to
seniors. With our dedicated and committed professionals,
our experienced team of caregivers are supported by our
diligent Support Staff making them the best in the industry.
(also referred to as domiciliary care or social care),
is health care or supportive care provided in the patient's
home by healthcare
professionals (often referred to as home health care or formal
care; in the United States, it is also known as skilled care) or
by family and friends (also known as caregivers, primary caregiver,
or voluntary caregivers who give informal care). Often, the
term home care is used to distinguish non-medical care
or custodial care, which is care that is provided by persons
who are not nurses, doctors, or other licensed medical personnel,
whereas the term home health care, refers to care
that is provided by licensed personnel.
"home health care" and "in-home care" are phrases that are used
interchangeably in the United States to mean any type of care
given to a person in their own home. Both phrases have been used
in the past interchangeably regardless of whether the person requires
skilled care or not. More recently, there is a growing movement
to distinguish between "home health care" meaning skilled nursing
care and "home care" meaning non-medical care. In the United
Kingdom, "homecare" and "domiciliary care" are the preferred
aims to make it possible for people to remain at home rather than
use residential, long-term, or institutional-based nursing care.
Home care providers render services in the client's own home.
These services may include some combination of professional health
care services and life assistance services.
home health services could include medical or psychological assessment,
wound care, medication teaching, pain management, disease education
and management, physical therapy, speech therapy, or occupational
services include help with daily tasks such as meal preparation,
medication reminders, laundry, light housekeeping, errands, shopping,
transportation, and companionship.
of daily living (ADL) refers to six activities: (bathing,
dressing, transferring, using the toilet, eating, and walking)
that reflect the patient's capacity for self-care.
activities of daily living (IADL) refers to six daily tasks:
(light housework, preparing meals, taking medications, shopping
for groceries or clothes, using the telephone, and managing
money) that enables the patient to live independently in the
are differences in terms used in describing aspects of home care
or home health care in the United States and other areas of the
world, for the most part the descriptions are very similar.
for the U.S.
indicate that most home care is informal with families and friends
providing a substantial amount of care. For formal care, the health
care professionals most often involved are nurses
followed by physical therapists
and home care aides. Other health care providers include respiratory
therapists, medical social
workers and mental health
workers. Home health care is generally paid for by Medicaid,
Medicare,long term insurance, or
paid with the patient's own resources.
It is not
a requirement that you have a GED or high school diploma, you
will need to check with your local department of health for state
requirements. Often aide workers have experience in institutional
care facilities prior to a home care agency. Workers can take
an examination to become a state tested Certified
Nursing Assistant (CNA). Other requirements in the U.S.A.
often include a background check, drug testing, and general references.
and providers by state
California is NOT a licensure state for non medical or custodial
care services and therefore there are no barriers to entry, no
consumer protection laws, no minimum standards yet and no official
state oversight. In California the consumers and their families
must adopt a "buyer beware" approach, do their homework and hire
caregivers that are bonded and insured. This is why it is important
to use a full service agency that has supervision and oversight
of staff. Full service agencies also do preemployment background
check (criminal), department of motor vehicle checks and reference
checks. Staff become the agency's employee not an independent
contractor or "under the table" person. Full service agencies
also train, monitor and supervise the staff that provide care
to clients in their home.
however, a certification available for home care companies in
California. It is administered by CAHSAH, the California Association
for Health Services at Home. For more information about this,
Florida is a licensure state which requires different levels of
licensing depending upon the services provided. Companion assistance
is provided by a home maker companion agency whereas nursing services
and assistance with ADL's can be provided by a home health agency
or nurse registry. The state licensing authority is the Florida
Agency for Health Care Administration.
Health Aides Caregivers who work for state licensed agencies
are billed hourly at rate of about $8 to $15 depending
on the state for self employed caregiver or caregivers hired
directly by family. For caregivers hired though agency, rates
are generally 40%-70% higher, since they are employees of the
Aides Live-in aides rates cost between $120–$200 per day
for services. The rates are 20-30% higher for 2nd care recipient.
Live-in aides are available through agencies as well as direct
Fees Agencies' fees for non-medical home care are traditionally
not reimbursed by State, Federal, or private insurance. However,
private long-term care insurance will often reimburse policyholders
for part of the cost of non-medical home care, depending upon
the terms of the policies.
and Skilled Services: In the United States, registered nurses
employed in the home care field receive on average around $22.00
to $30.00 per visit. Some as much as $45–$55, and also receive
52 to 58 cents per mile tax free. Payment/reimbursement of other
Skilled Services vary according to the specific discipline.
Health Aides:' Caregivers working for state-licensed agencies
bill at an hourly rate of about $11.00 to $25.00, depending
on the state. A Home Health Aid employed by the agency is paid
between $7.25 (current US minimum wage) and $10.00 or more per
hour, depending on location.
Hire Caregivers: Direct hire caregivers are either employed
by family or are self employed. A direct hire home care aid
is paid between $8.00 and $15.00 per hour depending on location,
number of hours, and experience.
Supreme Court case: Coke v. Long Island Home Care
home care work has been selectively classified as a “companionship
service” and exempted from federal overtime and minimum wage rules
under the Fair Labor Standards Act (FLSA). The Supreme Court considered
arguments on the companionship exemption, which stems from a case
brought by a home care worker represented by counsel provided
The original 2003 case, Evelyn Coke v. Long Island Care at
Home, Ltd. and Maryann Osborne, argues that agency-employed
home caregivers should be covered under overtime and minimum wage
a home care worker employed by a home care agency that was not
paying her overtime, sued the agency in 2003, alleging that the
regulation construing the “companionship services” exemption to
apply to agency employees and exempt them from the federal minimum
wage and overtime law is inconsistent with the law.
The case has wound its way through the appeals process, and in
January, the Supreme Court decided to hear the case this spring.
In the court
decision, the court stated the Fair Labor Standards Amendments
of 1974 exempted from the minimum wage and maximum hours rules
of the FSLA persons "employed in domestic service employment to
provide companionship services for individuals . . . unable to
care for themselves." 29 U. S. C. §213(a)(15). The court found
that the DOL's power to administer a congressionally created program
necessarily requires the making of rules to fill any 'gap' left,
implicitly or explicitly, by Congress, and when that agency fills
that gap reasonably, it is binding. In this case, one of the gaps
was whether to include workers paid by third parties in the exemption
and the DOL has done that. Since the DOL has followed public notice
procedure, and since there was gap left in the legislation, the
DOL's regulation stands and home health care workers are not covered
by either minimum wage or overtime pay requirements.
2004 Study by
2004, the National
Center for Health Statistics (NCHS) conducted the "National
Home and Hospice Study," which was updated in 2005.
The data was
collected on about approximately 1.3+ million (1,355,300) persons
receiving home care in the USA. Of that total, almost 30% (29.5%
or 400,100 persons) were under 65 years of age, while the majority,
almost 70%, were over 65 years old (70.5% or 955,200 persons).
The 2005 chart
data of estimates based on interviews with non-institutionalized
citizens, however, shows a relatively stable number of about 6
to 7 percent of adults age 65 who needed help for personal care
(ADLs) - this has remained about the same between 1997 and 2004.
(Data has a 95% reliability.) Those aged 85 or older were at least
6 times more likely (20.6%) to need ADL assistance than those
of age 65. Between age 65 and 85 years, more women than men needed
the 2005 Early Release data used, visit the NCHS-NHIS website
to see the PDF files. [NOTE: * The 2005 data reflects data, still
between 6 to 7%, is only based on interviews conducted between
January to June 2005, so it remains to be seen whether the figure
remained constant or changed through the end of 2005.] Again,
the 1998-2005 data is specific for over 65 or older and does not
include any data for adults under 65 years old.
In the 2004
data, just over 30% (30.2% or 385,500) of the total 1.3+million
persons lived alone, but the study did not break this down by
age groups. A large portion, 1,094,900 or 80.8% had a primary
caregiver, and almost 76% (75.9% or 831,100 lived with the primary
caregiver, typically the spouse, child or child-in-law, other
relative or parent, in that order. (Paid help and the category
of neighbor/friend/ or unknown caregiver would be, for the majority,
were living with non-family (4.3%) or unknown living arrangement
.) Most patients still need external help, even if the primary
caregiver is a spouse.
A total of
600,900 persons received personal care.
described in the 2004 study
Page 4 of
the study describes the population break-down by type of payment
used. Of the 1.3+ million:
by Medicare - Medicare often is the primary billing source, if
this is the primary carrier between two types of insurance (like
between Medicare and Medicaid). Also, if a patient has Medicare
and that patient has a "skilled need" requiring nursing visits,
the patient's case is typically billed under Medicare.
by Medicaid - This number seems low for Community Based Services
(CBS) or Home Care (HC), especially as a nationwide statistic.
by private insurance, or self/family - Private insurance includes
VA (Veterans Administration), some Railroad or Steelworkers health
plans or other private insurance. "Self/family" indicates "private
pay" status, when the patient or family pays 100% of all home
care charges. Home care fees can be quite high; few patients &
families can absorb these costs for a long period of time.
other payments - including patients unable to pay, or who had
no charge for care, or those whose payment "source not yet determined
or approved." Sometimes after "opening a case" (the formal paperwork
process of admitting a patient to home care services, there can
be a short period of time when the office has not yet received
approval by one of two or more insurances held by the patient.
This is not unusual. There can also be cases where the office
must make phone calls to be sure a particular diagnosis is "covered"
by the patient's primary insurance. This is not unusual. These
delays explain, in part, a couple circumstances where payment
source would be listed as "unknown."
In the United
Home care providers
purchased by the service user directly from independent home care
agencies or as part of the statutory responsibility of social
services departments of local authorities who either provide care
by their own employees or commission services from independent
agencies. Care is usually provided once or twice a day with the
aim of keeping frail or disabled people healthy and independent
though can extend to full-time help by a live-in
nurse or carer.
Kingdom Homecare Association (UKHCA)
care providers in the UK are able to join the United Kingdom Homecare
which is the professional association of domiciliary care providers
in the independent, voluntary and statutory sectors. The Association
represents the views of over 1,600 home care providers, each of
which agrees to abide by the UKHCA Code of Practice.
UKHCA is often
a point of contact for members of the public who wish to contact
agencies in their local area using a searchable list of home care
providers in the UK.,
Their leaflet Choosing care in your Home
is a straight-forward explanation of what home care is and how
members of the public can select the best provider for their needs.
a bi-monthly digest of the latest news and analysis of the domiciliary
care sector, and a range of publications for homecare providers,
many of which are available to the public, such as CareWorks
Home Health Care
agencies are regulated by statutory bodies in three of the four
home nations. The regulator's function is to ensure that home
care agencies work within the applicable legislation:
The Care Quality Commission (CQC)
- The Care
Standards Act 2000
- The Domiciliary
Care Agency Regulations 2002
The Care and Social Services Inspectorate Wales (CSSIW)
- The Care
Standards Act 2000
- The Domiciliary
Care Agencies (Wales) Regulations 2004
The Care Commission
- The Regulation
of Care (Scotland) Act 2001
covering the homecare sector in Northern Ireland is not yet fully
operational (as at December 2007).
The Regulation and Quality Improvement Authority (RQIA)
- The Health
and Personal Social Services (Quality, Improvement and Regulation)(Northern
Ireland) Order 2003
Care Agency Regulations (Northern Ireland) 2007
Care Agencies National Minimum Standards (not published as at
and program accreditation
& Lee found that by comparing with nursing home services,
home nursing is more suitable for the patients who are not seriously
ill and who do not need the services of after-hospital discharging.
Modin and Furhoff regard the roles of patient's doctors are more
crucial than their nurses and care workers. However from epidemiological
view, the risks of some community acquired infections are more
higher from home nursing than from nursing home. In regards
to financial expenditure, the home nursing is more cost effective
than nursing home. The quality aspect of home nursing
has been reviewed by Riccio.