Navigating the Alternate Dimension of Home Health Services

Rick Jobus avatar

by Rick Jobus |

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“You’re traveling through another dimension, a dimension not only of sight and sound but of mind. … That’s the signpost up ahead — your next stop, the Twilight Zone!” Rod Serling

I took my eyes off the figurative road and missed the signpost entirely.

It began one week ago. My morning aide of over two years failed to show. No advance notice had been given, and no after-the-fact explanation was received. This occurrence was unprecedented. Over the course of our association, she had never missed a scheduled day.

As I was contemplating what might have happened, my physical therapist showed up. I was eager to resume therapy after a hospitalization. When I shared my enthusiasm, the PT remarked that she was unaware of my hospital stay. She did something with her phone, and then we began my session.

Midway through, she received a call, then abruptly announced that owing to my time in the hospital, I would require a new care plan before the home health agency (HHA) could continue to provide service to me.

This was not a surprise. Being familiar with Medicare home health coverage, I know about partial episodes. They are invoked in response to intervening events, such as hospital discharge and subsequent return to home health. That warrants a new assessment. I was surprised that this fact could be news for the agency.

Then, like a “Twilight Zone” script, the plot thickened.

During my time with the PT, my wife finally reached my aide and found out the agency office had told her to stop caring for me because l had chosen another agency. I hadn’t. My wife then contacted the agency’s office, who explained that they were told I had opted for hospice services. Again, not true. If correct, that decision would have disqualified me from all other Medicare-covered home care.

Since “physician ordered services are not to be terminated by home health agencies without the consent of the treating physician,” I contacted my doctor’s office. Their understanding was that the HHA was unable to resume services due to staffing issues.

The next day, armed with all that conflicting information, I reached out to the HHA owner. Although on vacation, he quickly responded to my email. Maybe he is dutiful, or perhaps his timeliness was inspired by my assertion that HHAs are required to give written notice when there is a change in care, particularly when covered care is reduced or terminated. This notice, called a Home Health Change of Care Notice, must be given before loss of services occurs.

The owner’s take was an amalgamation of the above reasons, with a twist. He’d heard my care was being transferred to a different provider, and said that a hospice representative had contacted his office about me the week prior. He added that despite whatever short-term solution we found to the issue, I needed to start considering an alternative long-term provider, as his company was winding down its adult care division to concentrate on pediatric care. He ended with a commitment that the office would get back to me by the end of the business day.

When the promised follow-up didn’t happen, I reminded him of my available recourse: If I don’t believe my issue is being resolved, I can call the state home health hotline. Less than an hour later, I had a reply, confirming arrangements to resume my care that day. Both aide service and physical therapy would be reinstated. The owner would contact my doctor to discuss a transition plan in the near future, and would strive to have my current aide continue with me, even if through another provider.

All told, I was without “official” care for three days. Thanks to my angelic aide, who cared for me off the clock for two of the three, I only had one unattended day. The anxiety caused by the prospect of abandonment, with no backup, however, was staggering, and the focus and energy required to manage the process to a successful conclusion was taxing.

The “Twilight Zone” stories often included a subtle moral. What lessons have I learned from my experience? Three are rather obvious.

The first is that my care system doesn’t always behave the way it was designed or the way I would like it to.

Because of reason one, the value in being my own most knowledgeable and loudest patient advocate cannot be overstated. I am reminded to diligently endeavor to be expert in all matters care-related. The alternatives, the associated expense, cost-sharing options, and if pertinent, the regulatory landscape are rightfully my domain. When necessary, I will not hesitate to become the system’s pain in the ass.

Lastly, I must maintain a tireless vigil for all oncoming signposts.


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Judy E King avatar

Judy E King

Excellent information and well written and humorous post!

susan jaworski avatar

susan jaworski

Thank you for this important information I do not have home care YET, but I certainly will be on top of it. Thanks so much Blessings

Dave Reckonin avatar

Dave Reckonin

Well done Rick. You know how to keep them on their toes.
One might usefully examine the motivations for their bizarre, if not dismissive behavior.
Someone, somewhere along the line, said to themselves and/or others, 'we are going to avoid this guy.'
The motivation? The mighty Greenback.
A useful rule in life says that if unexpected and confusing changes occur, look for the money angle and you invariably take a short-cut to the correct answer.

Rick Jobus avatar

Rick Jobus

I agree. With every up-tick in services for severely ill patients who need chronic on-going care, comes additional expense to treat. In a prospective payment environment HHAs must have concerns about the cost of these cases and about their patient mix. Although contrary to the spirit of the law, I suspect they are terminating services for “business reasons.”

Les avatar


Wow! Thank you for the information. I've just been approved for home health and am overwhelmed by all of the information that they have given me. I've bookmarked the links that you provided. Thanks!

Patricia avatar


You are very lucky Les, may I ask with state are you from? All I have received from my inquires are excuses, the agencies are very careful giving their reasons (excuses) to appear very legitimate.

Patricia avatar


Rick, if this kind of BS is given to you.... what are the hope to the less knowledgeable like me?
Too bad that you have gone through so much lately!


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