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Caregiving Chronicles

News and analysis on caregiving topics in MetroWest and beyond.

Caregiving Chronicles


Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.

Caregiving Chronicles Q&A: Discussing what caregivers need to know about patient choice in home health care
By Douglas Flynn / April 12, 2017
Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. 

In this entry, we discuss what new caregivers need to know about "patient choice," and in particular about patient choice regarding home health care. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at info@natickvna.org or 508-651-1786.

Caregiving MetroWest: Let’s start from the beginning. Caregivers may hear the term “patient choice” but don’t necessarily understand what that means. What does “patient choice” mean?
“Patient choice” is important in many areas of health care, including hospitalization, long-term care, and use of other health care services.  In general, it means that individuals have the right to choose their health care providers and legally-designated proxies, i.e. individuals a patient chooses to be legally able to make decisions for a patient, should the patient be unable to do so for her/himself.   In this discussion, I will focus attention on patient choice as it applies to home health care.

CGMW: Why is it so important that patient choice is protected?
Health care is a vital personal concern; one that needs to be well-thought out and tailored to an individual’s needs.  It is important that this individual freedom to choose one’s health care providers and health care services be preserved, as this is one way of assuring high quality care and patient satisfaction at reasonable cost.  We hope that health care consumers can be educated regarding what constitutes high quality, reasonably-priced health care services and can then make educated choices.  One can liken patient choice in health care to that same individual choice when grocery shopping, purchasing a car, etc.  We all want to be able to choose products and services ourselves, using pertinent information to help us make good choices.

CGMW: Are there legal protections to ensure patient choice? Are there documents that need to be filled out and signed?
When protecting one’s rights to choose health care, it is important that you execute legally-acceptable documents, known as advance directives, health care proxies or health care powers of attorney.  These documents legally ensure that your care choices will be honored if/when you are incapable of making decisions for yourself.  These documents are especially helpful when someone is in a life-threatening situation, is near the end of life, and/or cannot verbally or otherwise provide direction to significant others, family members, caregivers, and/or health care providers.  These documents can be completed, signed and shared with the individuals named as proxies or powers of attorney and also with your health care providers.

More information about health care proxies, advance directives and health care powers of attorney can be found at the American Bar Association and MedicareInteractive.org

CGMW: Outside of that legal documentation, how can you make sure that you or the loved one you are caring for can exercise the proper patient choice in all areas they are entitled to?
With respect to home health care, in particular, both Medicare (42 USC# 1395a) and Medicaid (42 USC #1396a [23]) laws guarantee patients the freedom to choose their provider of services.  Further, federal Conditions of Participation (CoPs) for the Medicare and Medicaid programs require that a hospital undertake no action that may be construed as a restriction or obstruction to the patient’s freedom of choice of care providers.  Accordingly, a hospital that steers patients to a particular care provider by withholding information that is crucial to that patient’s choice, e.g. whether the hospital has a financial interest in the home health care provider, may be considered as having violated the Medicare and Medicaid CoPs and freedom of choice provisions.

In exercising personal “choice,” patients and their families/caregivers need to consider many factors related to a particular choice.  When choosing a home health care provider, for example, you should consider the following:
Quality of Care:    

- Certification for Medicare/Medicaid services; the provider’s Medicare STAR rating
- Accreditation by a recognized organization (JCAHO; CHAP) References from previous users of the service or physicians
- Patient satisfaction survey results


- Timeliness of service initiation
- Scheduling of services and availability of services; on-call after business hours
- Services provided (nursing, therapies, home care aides, etc.)
- Location of offices and staff; ease of travel to patients’ homes

- Specialty programs: Alzheimer’s care; maternity or pediatrics;
- IV therapy; wound care; disease management; telehealth; etc.)


- Cost-comparison to other area home care providers
- Use of technology to enhance productivity an improve cost-effectiveness

  Financial - Business Ties to Other Providers:  

- Are there financial arrangements between the home care agency and hospital or physicians?

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