In-Home Care FAQs | Fortcom Health Services

FAQs

Frequently Asked Questions Find answers about Fortcom Health Services programs, eligibility, caregivers, safety, and home-based healthcare support.

Definitions

What is Adult Foster Care (AFC)?

Adult Foster Care (AFC) is a MassHealth program for eligible members age 16 or older who need daily hands-on assistance or cueing and supervision throughout at least one qualifying activity of daily living. The member lives with a qualified caregiver.

What Is Continuous Skilled Nursing (CSN)?

Continuous Skilled Nursing provides more than two continuous hours per day of medically necessary nursing services by licensed registered nurses (RNs) or licensed practical nurses (LPNs). It supports children and adults with complex medical needs who require extended nursing care to remain safely in the community.

What is Intermittent Skilled Nursing?

Intermittent Skilled Nursing consists of targeted nursing assessments, procedures, or treatments provided by a licensed nurse. Visits are typically less than two consecutive hours and are limited to the time necessary to perform the required nursing duties.

What is Group Adult Foster Care (GAFC)?

Group Adult Foster Care (GAFC) is a MassHealth program that may provide daily assistance from a direct care aide in the member’s home, together with nursing oversight and care management. The direct care aide does not live withthe member.

What Are Home Health Care Services?

Home Health Aide Services provide health-related personal care in the home under professional supervision and the patient's individualized plan of care. A home health aide may assist with approved tasks such as bathing, dressing, grooming, toileting, mobility, and other care-plan activities.

Program Eligibility

Who is eligible for Adult Foster Care (AFC)?

A person may qualify for AFC if they are age 16 or older, have eligible MassHealth coverage, and live with a qualified caregiver in an approved setting. They must also have a primary care provider order, need daily hands-on assistance or cueing and supervision throughout at least one qualifying activity of daily living, complete the required assessment, and receive authorization. MassHealth or the applicable health plan makes the final eligibility and authorization decision.

Can a family member become a caregiver?

Yes. In many cases, a family member or trusted individual may serve as the caregiver if they meet program and training requirements.

Can someone receive services while living at home?

Yes. Fortcom’s programs are designed to help individuals receive care safely in the comfort of their own home whenever appropriate.

Who is eligible for Group Adult Foster Care (GAFC)?

A person may qualify for GAFC if they are generally age 22 or older, have eligible coverage, and have a primary care provider order. They must also need daily assistance with at least one qualifying activity of daily living (ADL), complete the required assessment, and receive prior authorization. Services also depend on location and current staffing availability in the member's area. MassHealth or the applicable health plan makes the final eligibility and authorization decision.

Does MassHealth cover Home Health Care services?

Some Home Health Care services may be covered through MassHealth when they are medically necessary and ordered by a physician. Eligibility depends on the individual’s health needs and coverage plan.

Does someone need a doctor’s referral to begin services?

Certain services, including Home Health Care and skilled nursing, may require a physician referral or medical documentation before care can begin.

Can a family member become a caregiver?

Yes, in many cases. However, the member's spouse, a parent of a minor member, and other legally responsible relatives are excluded. Caregivers must be at least 18, live with (or plan to live with) the member in a qualifying home, and be able to safely provide the required care. They must also complete background checks, health documentation, training, and meet all program requirements. Fortcom Health Services will review the proposed relationship during intake.

Caregivers & Our Team

Who is involved in a member’s care?

Depending on the program, care may involve nurses, caregivers, care managers, home health aides, therapists, and medical social workers working together to support the member’s needs.

Do AFC caregivers get paid?

An approved AFC caregiver may receive a monthly caregiver stipend. Payment depends on program approval, authorized service level, and applicable requirements. Fortcom Health Services does not provide tax advice.

What kinds of services can Home Health Care include?

Home Health Care Services provide medically necessary nursing and home health aide services in the home under an individualized plan of care. Depending on the patient's needs, this may include Intermittent Skilled Nursing, which offers targeted nursing assessments, procedures, or treatments from a licensed nurse, and Home Health Aide Services, which provide health-related personal care such as bathing, dressing, grooming, toileting, and mobility under professional supervision.

How often does Fortcom Health Services visit members at home?

Visit schedules depend on the individual’s program and needs. Nurses, care managers, aides, or clinicians may visit regularly to provide oversight, treatment, and support.

Do caregivers receive training or guidance?

Yes. Fortcom provides education, oversight, and ongoing support to help caregivers understand responsibilities and provide safe, appropriate care.

Safety & Care Coordination

How does Fortcom Health Services help keep members safe at home?

Fortcom’s team evaluates each member’s needs, monitors condition changes, and helps coordinate services that support a safer home environment and daily routine.

What happens if we travel or there’s a hospitalization?

Rules for travel, temporary absences, hospitalization, payment, and continued enrollment vary by program and payer. Notify Fortcom Health Services as soon as possible so the team can explain the applicable requirements and document the change.

How are care plans managed?

Care plans are reviewed regularly and updated based on the member’s health status, physician recommendations, and changing care needs.

What happens if a member’s condition changes?

Caregivers and clinicians communicate changes to the care team so services, treatments, or physician recommendations can be adjusted when needed.

Can Fortcom Health Services help coordinate additional resources?

Yes. Care managers and medical social workers may help connect members and families with community resources, services, and additional support when appropriate.

Choosing the Right Program for You

How are Home Health Care Services and Home Health Aide Services different?

Home Health Care Services is the umbrella for approved nursing and health-related services delivered under a plan of care. Home Health Aide Services is one discipline within that umbrella and provides health-related personal care under professional supervision.

Is Home Health Care the same as private-duty caregiving?

No. Home Health Care involves medically necessary clinical services provided under a physician’s direction, while private-duty caregiving typically focuses on non-medical assistance.

Can multiple Fortcom services be provided together?

In some situations, individuals may qualify for multiple services depending on their medical needs, eligibility requirements, and physician recommendations.

What is the difference between AFC and GAFC?

In Adult Foster Care (AFC), the caregiver lives in the same home as the member and helps with their daily routine and needs. In Group Adult Foster Care (GAFC), a direct care aide does not live with the member. Instead, they visit to provide support. The programs also have different age requirements: AFC is for eligible members age 16 or older, while GAFC is generally for members age 22 or older. Both programs include nursing oversight and care management.

When is skilled nursing needed instead of general caregiving?

Skilled nursing is provided by a licensed nurse when a person needs clinical assessment, treatment, or procedures that cannot be provided as general personal care. The appropriate service depends on the person’s needs, plan of care, coverage, and authorization.

Frequently Asked Questions

FAQs

Definitions

Program Eligibility

Caregivers & Our Team

Safety & Care Coordination

Choosing the Right Program for You

How to Get Started

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