Health care provided in a patient’s home falls into two categories: either certified care or private-duty nursing.

The difference? Certified home-health services are those requiring just a visit to the patient’s home; private-duty nursing “is any service that takes more than a visit,” said Maggie Cain, RN, the administrator for Nurse’s House Call.

“Private-duty nursing, or what we call self-pay nursing, usually involves blocks of time in a patient’s home,” explained Linda Kaine, RN, the president and chief executive officer of New England Home Health Care. Both home-health agencies are located about a quarter mile apart on State Street in Bangor.

Certified home-health services typically fall under Medicare, a major payer (and player) in the industry. Regulations restrict qualified services to visits, with the average length being one hour spent in the home.

Medicaid often pays for private-duty nursing through a program that covers long-term care for certain qualified patients. Again, many private insurers do cover private-duty nursing, and some patients pay for such care out of their own pockets.

Both Nurse’s House Call and New England Home Health Care offer private-duty nursing, but each affords its patients other services, too.

Maggie Cain said that in 1985, Maine investors founded a home health-care business known as 1st Allied Home Health. The firm opened an office in Bangor in June 1990; 1st Allied Home Health had other offices in Lewiston, Waterville, Farmington, Portland, and Brunswick.

Nurse’s House Call, a subsidiary of New Jersey-based Hooper Holmes Inc., acquired 1st Allied Home Health on Aug. 12, 1992. With the acquisition came the six Maine offices and their employees. About 150 people work out of the Bangor office to cover Penobscot, Piscataquis, Hancock, and Washington counties. The publicly-held Nurse’s House Call has more than 100 offices nationwide.

Linda Kaine described New England Eastern Agency on Aging coordinates elderly home-health care Home Health Care as a partnership between Eastern Maine Healthcare and Community Health & Counseling Services. Founded in 1986, NEHHC employs about 200 people to provide home-based health care in the same four counties covered by Nurse’s House Call.

Maggie Cain said that Nurse’s House Call is a licensed home-health agency that provides both certified home health-care services and private-duty nursing. The private-duty nursing division encompasses services provided by RNs, LPNs, CNAs, and homemakers, while CNAs offer such personal-care services as baths, shampoos, and shaves. Homemakers prepare meals, do housekeeping, run errands, and provide companionship. These services are available from three to 24 hours per day and are supervised at least monthly by an RN.

The skilled-nursing services offered by Nurse’s House Call are available to many patients of all ages, including those suffering from adult and childhood cancer, respiratory problems, cardiac problems, or spinal injuries. “We have seen a great increase in pediatric cases,” Cain said.

Most private-duty nursing done by NEHHC “involves personal care, meeting the patient’s immediate needs,” said Linda Kaine. Her agency provides personal-care attendants, CNAs, home-health aides, LPNs, and RNs to work with patients.

The coverage provided by NEHHC “can run any amount of time, but typically depends on the disability,” Kaine said. Estimating that such coverage averages about four hours a day, she mentioned that some patients can receive up to 52 hours of coverage a week.

An RN supervises everyone who visits a patient, even if the NEHHC employee is a homemaker or a choreperson. The latter employee does yard work and routine cleaning, while a homemaker handles the laundry and light meal preparation.

According to Kaine, NEHHC also has qualified employees who can look after children too sick to attend school. “Many parents cannot afford to take a day off from work to stay home with a sick child; it’s a real financial hardship to lose a day’s pay,” she said.

NEHHC does contract its employees to other home-health agencies, hospitals, private institutions, and school districts. A hospital might have a patient who requires one-on-one attention that the hospital staff cannot provide, so NEHHC will send a medical professional to perform that service, Kaine said. She cited another example in which the agency contracts with a school district to have an LPN travel daily to-and-from school with a handicapped student.

Home-health care, which has experienced phenomenal growth in the last few years, will continue to expand in the future. “The community is very eager to accept home-health care,” Maggie Cain commented.

“We see more people being discharged sooner (from hospitals) than in the past, and many people require a higher degree of medical care when they arrive home,” she said.

“I attribute a lot of the growth to consumer awareness…as well as more federal funding for home-health care,” said Linda Kaine. “As the population ages, we will experience an ever greater demand for home-health services.”

“There are more elderly people living alone at home, too,” Maggie Cain stated. “The goal of home-health care is to help such people to stay in their homes, where they’re comfortable and happy.”