(Please print this page for your personal safe keeping)
Is the agency licensed? Yes___ No___
Check with your Area Agency On Aging
Does Medicare certify the agency? Yes___ No___
This means the agency has met the minimum health and safety requirements that the Federal Government has established. If they are not certified, Medicare will not reimburse for the services.
Is the agency accredited? Yes___ No___
Does the agency have a contract with your insurance company/HMO? Yes___ No___
Does the agency bill Medicare or your insurance provider or is the family responsible? Yes___ No___
Will the agency provide you with a written description of the services and charges? How much will be paid by Medicare, private insurance etc. so you will know what you are responsible for? Yes___ No___
How does the agency screen their staff?
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What type of training, supervision and monitoring does the agency provide to it’s staff?
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Does the agency develop a plan of care with the types of services, the frequency and the length of time the patient will need? Yes___ No___
How often is it reviewed? ________________________________________
Who does the review? _________________________________________
Will a nurse, therapist, or social worker provide the initial assessment? Yes___ No___
Is there an additional charge for this? Yes___ No___
Does the agency provide the aid and your family with training on high-tech equipment in the home? Yes___ No___
Is there a 24-hour emergency contact for your questions, problems, emergencies or complaints? Yes___ No___
Does the agency assure you that their staff is available at your requested times? Yes___ No___
How do they they assure you? __________________________________________
How does the agency insure you about the consistency of their care providers?
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Is there a charge for canceling a scheduled appointment or shift? Yes___ No___
Is there a cancellation period when you will not be charged? Yes___ No___
If yes, please indicate: ________________________________________________
© Copyright 2000 by Gail R. Mitchell