Introduction

1. Marketing – learn the best practices to effectively market this service in both direct and indirect marketing sources

2. Sales – learn how to sell this service to a prospective client at each stage of the sales process

3. Care Delivery – understand the best practices for preparing your caregivers to deliver a high-quality service to your clients

4. Data – identify key metrics to track to ensure you are receiving the best ROI for your business with this service offering

Note - It is important that every Qualicare location research their own local market as there may be geographical, economical, and market differences at the local level. This playbook provides you with the initial framework that you will be able to build upon in your business.

Home and health care is a fast-paced industry with changes happening on a regular basis. As applicable, with validated resources and a data-driven focus, updates will be made within this playbook. 

Qualicare Code of Conduct

The Qualicare Code of Conduct is a set of client-centric standards that are the foundation of the Qualicare Brand Experience. The Code describes the behaviors and actions that, when delivered consistently by our franchise partners, link the Qualicare brand promise to the building of our brand reputation. This Code anchors our mindset and interactions,-bringing our company to life-and giving practical meaning to the Qualicare brand.

Qualicare’s Code of Conduct

1. Be proud of our brand promise and deliver ‘Depth of Care’ – Our brand promise is an idea that lives beyond words. It is something we wear over our hearts and drives our commitment to our clients every day. We exceed expectations with every action and demonstrate a sincere concern for the people we care for.
2. Serve clients with daily acts of kindness, empathy and gratitude – Believe that everything we do in the act of providing care will make a difference in the lives of our clients. Understanding we can improve their lives with simple, respectful actions is the foundation for care that they seek and deserve.
3. Establish health and safety as obvious matters of priority – From day one, our clients should feel that they are in careful and thoughtful hands. Make sure that everything we do while providing care is informed by the latest professional safety information and protocols.
4. Make every interaction with clients an opportunity to create a brand difference – Our everyday actions while delivering care are the most powerful form of marketing we can invest in. From the way we say “hello” to how we leave a client’s home adds value and uniqueness that makes us stand apart from our competitors.
5. Practice immediacy in the moment – Our client’s well-being and time is a priority. Your undivided attention and sincere concern demonstrates a respect that will reinforce trust while providing care.
6. Commit to requiring clients to tell their story only once – Building trust starts with listening and remembering what’s important to our clients’ well-being. People want to know that they’ve been heard and that their concerns are always a priority.
7. Communicate with clients on their terms and in the way they want – Trust and understanding starts when we pay attention to how our clients feel when discussing their care needs. Create a relationship that is customer led and founded in listening.
8. Always be prepared to adjust to client needs – Every client is different. Approach each relationship with an open mind and commit to creating unique care ideas that are responsive and sensitive regardless of what we offer.
9. Remember and respect the difficult journey clients are on – Our clients live with issues that affect the quality of their lives every day. Every conversation should start with what they feel is important – only then can we deliver effective care.
10. Honor the completion of our work for clients – Providing care to our clients is both meaningful and rewarding. Letting them know what a privilege it was to help them build a foundation for the future reinforces the idea that they are more than just a client and we are more than just a company.
    

Throughout this playbook, you will find examples of how to utilize the Qualicare Code of Conduct within this service offering.

Long Term Care Insurance

Long Term Care Insurance and Home Care

Long-term care insurance is a type of insurance policy designed to cover the cost of long-term care services, including home care services. It's generally used by individuals who need help with activities of daily living (ADLs) such as bathing, dressing/grooming, ambulation/transferring, toileting, continence, and eating.

Here's a basic outline of how long-term care insurance works for home care needs and how this applies to you as a Qualicare home care agency:

It's important to note that every long-term care insurance policy is different, and what is covered can vary. It's essential for policyholders to thoroughly understand their policy, including what types of care are covered, how much the policy will pay for care, and what conditions must be met for the insurance to start covering costs. As an expert in the field, you also want to understand which insurance policy may be best for a client so you can properly direct the toward coverage that will hit on their overall needs.

Becoming a Preferred Home Care Vendor for Long Term Care Insurance

Some insurance companies may require that services be provided by an approved agency. As an agency interested in providing consistent care to these types of clients, it is beneficial to become one of those approved providers. This requires you to follow certain steps (some of which may differ depending on the insurance company)

Here's a general process for a home care agency to get set up for handling long-term care insurance claims:

1. Understand the Policy: Every insurance policy is different, and coverage can vary widely. Home care agencies should encourage their clients to thoroughly understand their insurance policies and what types of home care services are covered. The agency may need to communicate with the insurance company to understand the specifics of coverage and any necessary procedures for submitting claims.
2. Provider Approval: In some cases, the home care agency would need to go through the insurance company's approval process. This could involve proving licensure, meeting certain standards of care, demonstrating financial stability, and other criteria set by the insurance company.
3. Documentation of Care Needs: Typically, the insurance company will need documentation showing that the care is medically necessary. This could include an assessment of the individual's needs, a doctor's prescription for home care, or other types of documentation.
4. Service Agreement & Care Plan: The home care agency will need to establish a service agreement with the client, outlining the services to be provided. In addition, a detailed care plan should be developed, indicating the specific services and frequency of care that the client will receive.
5. Billing & Claims Submission: After services have been provided, the home care agency would prepare and submit a claim to the insurance company. This typically involves detailed invoicing that specifies dates of service, the type of services provided, the provider of the service, and the cost. In some cases, the insurance company may require the client to pay the agency directly and then seek reimbursement.
6. Follow Up & Payment: The home care agency will need to follow up with the insurance company to ensure the claim is being processed. If the claim is approved, the insurance company will send payment directly to the agency (or reimburse the client if that's their process).
   

Remember that this is a general process and can vary depending on the specific insurance company's policies and procedures. It's important for you to establish good communication with your clients' insurance companies to ensure they understand the requirements for coverage and claims submission. It's also crucial to maintain accurate and detailed records of the services provided, as these will be necessary for the claims process.

How Clients Get Long Term Care Insurance

As described above, long-term care insurance is a type of insurance that is specifically designed to cover the cost of long-term care services, including home care. Often, a potential client may not be aware of what type of coverage they may be able to use for home care services and you can help point them in the right direction for taking advantage of these resources.

Below is an example of how you can walk a potential client through the steps of acquiring long term care insurance that can help them pay for their home care needs.

1. Research Insurance Companies: Look for insurance companies that offer long-term care insurance policies. You can do this by searching online, asking for recommendations from friends or family, or consulting with a financial advisor or insurance agent.
2. Compare Policies: Not all long-term care insurance policies are the same. Compare the features, benefits, and costs of different policies. Specifically, look for policies that include coverage for home care services. Be sure to also check the policy's benefit ttriggers (what must happen for the policy to start paying benefits), elimination period (how long you must pay for your own care before the policy starts paying), and daily or monthly benefit amount (how much the policy will pay per day or month for care).
3. Review the Details: Once you've found a policy that includes home care coverage, review the details carefully. What specific home care services are covered?Are there any restrictions or limitations on home care coverage? Is there a waiting period before home care coverage starts? Understanding these details can help you choose a policy that best meets your needs.
4. Apply for Coverage: Once you've chosen a policy, you'll need to apply for coverage. This typically involves completing an application and undergoing a health assessment. The insurance company will use this information to determine if they will offer you coverage and how much your premiums will be.
5. Start Your Coverage: If your application is approved, you'll start your coverage by paying your first premium. You'll need to continue paying your premiums to keep your coverage in effect. Once you're covered, you'll be able to use your insurance to help pay for long-term care services, including home care, when you need them.
6. File Claims: When you need care, you'll file a claim with the insurance company. The claim should include a plan of care from a licensed health care practitioner and proof that you've met the policy's benefit triggers. Once the claim is approved, the insurance company will start paying for your care up to the policy's benefit amount.

1. Email the family a summary of policy details
2. Review how their policy works (after you disconnect insurance company representative) and determine next steps

1. If this is a new claim, you should know the ADL’s that your nurse (and level of care) determined in the assessment.
2. During the claim call, after introductions, provide a clean verbal summary of the claim and the ADL support provided. The process is either a phone interview (in that moment) or paperwork being sent to the family to be filled out and sent back to insurance. Note - Sometimes insurance companies do NOT let me summarize and they ask the family. The best way to handle this is to have provided the language of the ADL’s needed (e.g. hands-on assistance for bathing and dressing) to the family so when they are asked they can say, “Qualicare’s caregivers are providing hands-on assistance for bathing and dressing.
3. In addition, the insurance company will send a Nurse from their company to do a phone, Zoom or in-person assessment to see how their assessment compares to the one done by your Nurse.