Most of us know that people with a long-term illness or disability enjoy the control and flexibility of receiving health care in their homes--and family caregivers benefit as well. But choosing a home health agency and knowing which questions to ask can be daunting.

Representatives of two nationally known home care agencies provided tips at the Seventh International Family Conference in San Antonio: Jennifer Lopez , regional director of quality assurance at ResCare Home Care, and Dr. John Langley, chief medical and quality officer for Maxim Healthcare Services. Patricia Wood, NBIA president and a user of home health services, provided a consumer’s perspective.

Many home health organizations offer personal as well as medical care, including cooking meals, companionship and transportation.

Insurance plans may cover services, but there can be limits, so it’s important to know what services you wish to receive, how often and how much of that is covered, Lopez advised. Also, make sure that the organization you choose is properly licensed and/or accredited and that caregivers carry the proper credentials.

ResCare and Maxim offer supportive services to patients when they are in the hospital or being cared for by private physicians. Care managers on staff can help tailor services to meet the family’s needs and can tell you what is needed to manage a chronic illness or disability.

“I think home care is about the future of medicine,” Langley said. “Home care is really the way things are going.”

The Accreditation Commission for Health Care is one of the accrediting organizations for home health companies. Accreditation from that group means that the home health agency is reputable and committed to complying with standards set by experts.

Home health nurses undergo various background checks and get ongoing education, Langley said. “We assess skills upon hiring and do it annually,” he added.

Families planning seeking home health services should ask:

• What kinds of training do caregivers receive?
• What are their educational backgrounds?
• Is a nurse is available 24/7?
• Will there be coverage if the night nurse is ill and can’t come?
• What are the agency’s outcomes for patients?
• What are the organization’s hospital readmission rates?
• What are the company’s patient satisfaction scores?

“The goal for all of us in health care is to improve the quality of life,” Langley said. “You need a company that understands the changing needs of the patient.”

Wood said she interviews the nurses before they come out to her home. Many are in their 40s and 50s and some are limited to lifting 40 pounds. Her daughter, Kimbi, weighs 72 pounds.

“We want you to interview those nurses,” Lopez said. “We try to lay out the expectations up front.”

Langley says at Maxim, the nurses will visit the patient in the hospital several days before discharge to make sure they are on the same page as the other health care providers.

Wood recommended a practice the Leap family in Virginia follows: giving the caregiver a sheet with information about NBIA and a complete list of all of her child’s symptoms, problems and medications to minimize difficulties.

It’s important to set boundaries for home caregivers and establish rules. “Even if you’ve never been a boss before, they’re your employees,” Wood said.

Having caregivers in the home gives Wood some time out to bike or go out with friends. But she also looks to see whether Kimbi likes being with the person. If she doesn’t, Wood will call the agency and say, “We have a bonding problem.” She doesn’t want anyone around her daughter who acts bored.

She gives the nurses the NBIA newsletter to acquaint them with the disorder but adds: “You have to train them all” because there are so many different symptoms. “You need to be like the head nurse.”

Although it takes time to get used to being the “employer,” Wood said it’s well worth it. They have improved not only Kimbi’s quality of life, but her own.

“I couldn’t live without the nurses now,” she said.