Male Home Health Aide Helping a Client

Families often ask us to explain the difference between a nurse registry and a home health agency. This is a particularly common question from clients who split their time between Florida and other states, as well as from out-of-state adult children seeking home care for their elderly parents.

Three Models

This is because in the Unites States, three different models have developed for delivering in-home care and services to seniors:

  • Licensed home health or home care agencies;
  • Licensed nurse registries; and
  • Unlicensed businesses that refer to themselves as home care agencies. 

Different models have become more or less prevalent in different parts of the country. In Florida, the most common model is the licensed nurse registry. In fact, there are over 1,000 licensed nurse registries in the state of Florida.

The Florida Home Health Landscape

Florida’s Agency for Healthcare Administration issues licenses to both nurse registries and home health agencies. Obtaining and maintaining either type of license requires strict adherence to regulations and policies including client rights and caregiver screening. Each type of business has a well-organized association that provides guidance on best practices in serving their respective clients: the Homecare Association of America for home care agencies and the Private Care Association for nurse registries. These national organizations both have active Florida chapters.

The primary difference between a nurse registry and a home health agency is the technical relationship between the homecare company and the caregivers. At home care agencies, caregivers are W-2 employees of the agency, whereas at nurse registries, caregivers are 1099 independent contractors engaged by the client. 

This difference generally puts the client in greater control of their care – including their selection of a caregiver – at nurse registries, whereas the client can only make requests of a home health agency. Nonetheless, both models must use certified Home Health Aides and Nursing Assistants on whom the company has performed reference checks and federal level-II background screens. Accordingly, the overall quality of the caregivers and, by extension, the care provided in the home is exactly the same between homecare agencies and nurse registries. 

In Florida, nurse registries have become the most prevalent model for matching clients with Home Health Aids for in-home care such as bathing, dressing, companionship, meal prep, errand assistance, transference, and other activities of daily living. As needs evolve, a nurse registry can also refer a Nursing Assistant or a Registered Nurse to provide higher-level care in the home.

Importantly,  all long-term care insurance companies cover the cost of care arranged through a nurse registry. Other third-party payor programs including Medicaid, the Department of Veterans’ Affairs’ Aid and Attendance program and several Medicare Advantage plans also cover the services of a nurse registry. 

The Unique Role of Home Health Agencies in Florida

Why, then, does Florida also license home health agencies separately? This is because nurse registries are not as common elsewhere in the country as they are in Florida and, as a result, “Original” or “Traditional” Medicare prefers to rely on the nationally ubiquitous agency license. To be clear, Traditional Medicare does not cover the cost of a Home Health Aide in any event, except in limited circumstances such as bathing visits during an authorized rehabilitation period. Medicare does cover in-home nursing and therapy services provided by a licensed home health agency. Your physician may refer you to a home health agency if they believe you would benefit from these services, particularly following an injury or surgery.

How to Choose a Nurse Registry or Home Health Agency

If you are seeking at-home personal care for yourself or a loved one, either a homecare agency or a nurse registry can help you find a qualified, compassionate and talented Home Health Aide. We generally do not recommend hiring privately because of the burden that puts on the family.

Always ensure that the company you are considering using is licensed without any demerits from the governing state agency. We strongly suggest using a company that is a member of the relevant association so that you know they are operating under the best practices appropriate for their model, and not simply the minimal standards. The depth and breadth of a company’s caregiver network will impact how easily they can find the right fit for your family. A company’s tenure of operations is also a fairly good indicator of quality, client satisfaction and professionalism.

As member of the CareGivers of America network, Boca Home Care Services can offer another advantage. We provide all the benefits of a nurse registry – the client control, the caregiver screening, the round-the-clock on-call service – while being affiliated with and being able to seamlessly coordinate with Medicare-certified home health agencies that are also part of the network. This means that we are able to help our clients with a full orbit of care that changes as health needs evolve, from supplemental in-facility care to rehabilitation to assistance with everyday activities.

If you are considering in-home care for yourself or a loved one, please give us a call. Our care specialists would be happy to discuss the range of options available through our nurse registry or refer you to trusted local partners if we cannot meet your needs.