What is Home Health Care?
Home Health care, (also referred to as domiciliary care, social care, or in-home care), is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living (ADL’s) are met. In home medical care is often and more accurately referred to as home health care or formal care. Often, the term home health care is used to distinguish it from non-medical care, custodial care, or private-duty care which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel.
Home Health services help adults and seniors who are recovering after a hospital or facility stay, or need additional support to remain safely at home and avoid unnecessary hospitalization. These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. This care is provided by registered nurses (RNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, primarily through the Medicare Home Health benefit.
The largest segment of Home Care consists of licensed and unlicensed non-medical personnel who assist the individual including caregivers and care assistants may help the individual with daily tasks such as bathing, eating, cleaning the home and preparing meals. Caregivers work to support the needs individuals and this work helps them stay at home versus a facility. Often non-medical home care is paid for by the individual or family. The term private-duty refers to the private pay nature of these relationships. Home Care has traditionally been privately funded as opposed to Home Health Care that is task based and government or insurance funded. These traditional differentiation in Home Care services are starting to change as the age worlds population has increased. Individuals typically desire to remain independent and use Home Care services to maintain their lifestyle. Government and Insurance providers are beginning to fund this level of care as an alternative to facility care. In-Home Care is often a lower cost solution to long-term care facilities.
For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance.
10 signs of a good quality home health agency
Decide if these statements are true to help you identify a good quality home health agency:
- The staff is polite and treats me and my family with respect.
- The staff explains my plan of care to me and my family, lets us participate in creating the plan of care, and lets us know ahead of time of any changes.
- The staff is properly trained and licensed to perform the type of health care I need.
- The agency explains what to do if I have a problem with the staff or the care I’m getting.
- The agency responds quickly to my requests.
- The staff checks my physical and emotional condition at each visit.
- The staff responds quickly to changes in my health or behavior.
- The staff checks my home and suggests changes to meet my special needs and to ensure my safety.
- The staff has told me what to do if I have an emergency.
- The agency and its staff protect my privacy.
Home health services
How often is it covered?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.
Medicare doesn’t pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services
- Personal care
All people with Medicare who meet all of these conditions are covered:
You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than just drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- The home health agency caring for you must be Medicare-certified.
- Your must be homebound, and a doctor must certify that you’re homebound.
- You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.
Your costs in Original Medicare
- $0 for home health care services.
- 20% of the Medicare-approved amount for durable medical equipment.
- Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the “Home Health Advance Beneficiary Notice” (HHABN) before giving you services and supplies that Medicare doesn’t cover.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.