doctor visiting senior woman at home for Home Health Care services

Understanding Home Health Care

Home health care includes a variety of professional home health care services that allow a person to stay in their home safely. When a doctor orders home health care, licensed professionals may go to your house to provide in-home care. In addition, many people need home care to help with everyday activities like personal care, dressing, grocery shopping and transportation.  This everyday type help does not need a doctor’s order, and can usually be done by a caregiver, home health aide, or personal care aide.  Read our comprehensive post where we discuss what home care services you may need.

 

What is Home Health Care?

Home health care includes a variety of professional support services. Licensed professionals, for example, therapists (e.g., physical, occupational, or speech therapists) or nurses may provide care in the home, depending on your needs.

 

Home health care services can help someone who is:

  • managing illness, injury, or medical conditions;
  • recovering from a medical procedure or hospitalization; or
  • has a disability, memory issues, or special needs.

 

Home health care is a wide variety of in-home care services that can help you stay in your home even though you need help because of an illness or injury.

Home health care has several benefits.

For example, it is usually less expensive, convenient, and may be as effective as the care you get in a facility, including a skilled nursing facility (SNF).

 

Skilled or Non-Skilled Services

When considering home health care services, it is important to distinguish between whether you need skilled or non-skilled services.

Non-skilled care is also called home care and means non-clinical assistance. On the other hand, skilled care, which is sometimes called home health, requires a doctor’s order. Many people use the terms interchangeably.

 

Type of Care Home Health Care Home Care
Also called Skilled care, Clinical care Non-skilled care, Non-clinical assistance
Doctor’s order needed? Yes No
Examples of services: Physical therapy, occupational therapy, nursing services such as wound care or IV therapy Assistance with showering, dressing, toileting, transportation, meal prep

 

 

 

Nurse holding iv and needle

What are Skilled In home Health Care Services?

The purpose of home health care services is to treat an injury or medical condition.

A doctor’s order is required to get skilled home health services. Usually the doctor sends an order to a home health agency.

The home health agency sends the appropriate staff to assess the patient and develop a care plan.

In addition, the ordering provider  periodically reviews the care plan and the patient’s progress.

 

Skilled Home Health Services May Include:

  • Physical, occupational, speech therapy, and rehabilitative services
  • Nursing care for an injury, illness, disease, or disability—including hospice, tracheostomy, and ventilator care. Care may be short or long-term
  • Education, including patient, family, and also their caregiver
  • Taking care of wounds and pressure sores
  • Nutrition therapy via the intravenous route
  • Intravenous infusions and complex medication management
  • Monitoring of unstable health issues
  • Wound care for surgical wounds or pressure sores
  • Education for the patient and caregiver
  • Intravenous or nutrition therapy
  • Monitoring serious medical conditions

 

 

What to Expect From Home Health Care

The first step to benefit from home health care services is to get a referral from your doctor.

  • Doctor’s orders are needed to start most home health care services.
  • After your physician refers home health services, the home care agency will schedule an appointment. The agency will come to your home, discuss your needs, and ask some questions about your illness, injury, and health.
  • The home care agency will likely talk to your physician about your care and keep your doctor updated about your progress.

 

Some things the home health agency staff may do include:

  • Check your nutrition status (e.g., the type of food you eat, how much fluids you are drinking)
  • Measure your vital signs (e.g., blood pressure, heart rate, breathing frequency, temperature)
  • Confirm that you are taking your medications correctly
  • Check the safety of your home
  • Educate you so that you can take care of yourself
  • Coordination of care. The home health staff should communicate regularly with you, your provider, and the rest of your care team.

 

 

 

 

 

 

home health care caregiver helping elderly patient get slippers on in bed

What are Non-Skilled Home Care Services?

Non-skilled in-home care does not require a licensed professional.

Those who help with this type of care are usually called home health aides, personal aides or caregivers.

 

Non-skilled in-home services may include:

  • Assistance with daily living tasks and activities. This includes helping with personal care needs such as showering, dressing, shaving, toileting, eating, and cleaning.
  • Medication management and ensuring the individual takes needed medications.
  • Transportation to medical appointments, whether by car or public transportation.
  • Assistance with house chores such as housekeeping, laundry, or meal preparation.
  • Help with grocery shopping and other things like getting medications from the pharmacy.
  • Companionship

 

 

In General, Home Care Can Help People:  

  • Get better
  • Regain your strength and independence
  • Become as self-sufficient as you can
  • Improve your well-being, or maintain your current level of functioning

 

To learn more about what a caregiver does to help someone, please read our blog post: Caregiver Duties and Responsibilities.

Are you an unpaid caregiver and want to see if there are any options to get paid to take care of a family member? Read our post: Family Caregiver Pay: Can a Family Caregiver Get Paid?

 

 

 

top view of stetescope with Medicare text2

Does Medicare Pay for Home Health Care Services?

Medicare usually covers skilled professional medical care in the home.

According to the federal Medicare Payment Advisory Commission, Medicare spent $17.7 million on home health services in 2017, benefiting approximately 3.4 million people.

As we mentioned above, to be eligible for professional health services, your doctor needs to submit a referral to a home health care agency near you.

Always check with your health insurance plan to verify coverage and eligibility, to confirm covered benefits.

 

For more information about health insurance and the different types of plans, read our post:  Understanding Health Insurance.

 

Per Medicare.gov, Medicare Part A (Hospital Insurance) and Medicare Part B (your Medical Insurance) may cover eligible home health services, for example:

 

Usually, it is the home health care agency that coordinates the care and services your doctor ordered.

 

 

However, keep in mind Medicare doesn’t usually pay for long term help with everyday activities.

This includes:

  • Meals delivered to your home
  • Custodial or personal care (for example, help with showering, toileting, or dressing), when this is the only care you need
  • 24-hour-a-day care at home
  • Homemaker services (for example, house cleaning, laundry, and grocery shopping), when this is the only care you need

 

However, it is a good idea to confirm what Medicare will and will not pay for.

If a doctor ordered medical care, Medicare may cover some help with activities of daily living for a short period.

In addition, a Medigap policy may cover some services.

 

Qualifying for Medicare Home Health Coverage

There are several conditions to meet to be eligible for Medicare home health care services, including:

 

Being homebound: this means that you cannot leave your home without the help of another person or device (e.g., walker, wheelchair). The definition also includes considerable effort required to leave the house. A physician must certify that you are homebound.

 

Skilled needs: You must have a skilled need, and a doctor must certify you need skilled care. For example, you may need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy services.

 

Approved by Medicare – the healthcare agency caring for you must be approved by Medicare to be eligible.

 

 

Range of Home Health Medicare Benefits

Home health care services covered by Medicare might include the following:

Occupational, physical, and speech therapy – working with professional therapists to restore or improve your ability to perform everyday tasks is a crucial element of home health services. In general, occupational deficits are the result of injuries and illnesses.

Medical social services include counseling a therapist for emotional support related to the disease or injury you are dealing with.

Skilled nursing care is a broad category that includes changing wound dressings, injecting drugs, and nasogastric feeding.

Medical supplies – supplies related to your conditions (e.g., wound dressings, catheters) provided by your health agency. It may also include medical equipment, such as walkers and wheelchairs. However, Medicare does not pay the total cost for these devices.

 

Medicare usually does not cover the following:

  • Custodial care when it is the only home care you need
  • 24-hour care at home
  • Household services (e.g., shopping, cleaning)
  • Meal delivery to your home

 

 

Medicaid stethoscope

Medicaid Home Health Care

Some people may qualify for Medicaid. Medicaid is a combined federal and state program available to low-income people (and families).

Medicaid covers medical care and usually covers long-term care. Eligibility and coverage vary by state.

In-home care services may be covered by one’s regular state Medicaid plan, but could also be offered through a waiver program like Home and Community-Based Services (HCBS) Medicaid waivers or Section 1115 demonstration waivers.

Usually, covered benefits include nursing services and personal care.

On the other hand, room and board typically are not. However, many states have additional programs that help with long-term care costs.

 

In most states, Medicaid will provide some financial assistance for assisted living for those seniors who qualify.

Typically this coverage is through a 1915(c) waiver program, also known as the Home & Community-Based Services (HCBS) waivers.

Waiver programs are helpful because they provide expanded coverage from your state’s standard Medicaid, and HCBS waivers are available specifically to give seniors more long-term care choices instead of defaulting to a nursing home.

What HCBS waivers are available and what they cover may vary significantly between states, so look into your state’s Medicaid program for additional information on coverage for home care services.

 

 

Medicaid Eligibility for Home Care

In order to be eligible for Medicaid, including in-home care, one must meet the eligibility requirements.

For example, you must be a resident of the state in which you apply.

Additionally, you must meet financial and functional need requirements.

Because there is much variation between state eligibility requirements and what home service programs are offered, it is a good idea to research your state’s Medicaid programs and eligibility requirements.

 

 

 

 

Home care nurse talking to senior in wheelchair at house

 

Types of Home Health Care Services

Home care agencies may offer different types of home care services.

Contact your provider and discuss your concerns and also the care needs of your loved one.

This will help you find the right solution, as care is customized based on the care receiver’s needs.

 

Below is a quick guide identifying the different types of in-home care services available.

TYPES OF HOME CARE      

TYPE OF CARE

PERSONAL CARE AND COMPANIONSHIP

PRIVATE DUTY NURSING CARE

HOME HEALTH CARE

WHAT IS IT?

Help with everyday activities. For example, showering, dressing, laundry, meal preparation, house cleaning, getting to medical appointments, and other tasks that keep you safe and enable independence. Hourly skilled nursing care for an injury, chronic illness, or disability. Usually long-term. In-home health care must be ordered by your doctor. It is usually for recovering from an injury, illness, or hospital stay. Usually short-term.

WHAT ELSE IS IT CALLED?

Home health aide, personal care aide, caregiver, assistive care, companion care, homemaker care,  non-medical care, senior care Nursing care, long-term nursing care, home-based skilled nursing, shift care, hourly nursing, shift nursing, ventilator, tracheostomy, and catastrophic care. Professional skilled care, visiting nurse services, intermittent skilled care, Medicare-certified home health care, home health nurse.

WHAT TYPE OF SERVICES ARE PROVIDED?

Help with self-care. For example, brushing teeth, bathing, grooming, dressing, shaving, and using the toilet.  In addition, assistance with ambulation, keeping the home safe, fall prevention, transfers (e.g., from wheelchair to bed, from bed to bedside commode).              Also, help with shopping, meal preparation, medication reminders, housekeeping, getting to medical appointments, errands, laundry.      Furthermore, it includes engaging in exercise, outside activities, companionship, hobbies, socializing.   Supervising for someone with memory issues like dementia or Alzheimer’s disease Care for medical conditions and diseases with a skilled nursing need. For example, spinal cord injury, traumatic brain injury, MS, or ALS. In addition, providing skilled care such as ventilator care,  tracheostomy care, ostomy/gastrostomy care, catheter care, feed tube care, administering medications, monitoring vital signs. Physical therapy, occupational therapy, medical social work, short-term nursing services, speech-language pathology, home health aide services.

HOW IS IT PAID FOR?

Check whether your insurance or benefits cover it. Companionship and personal care services are usually paid by the person getting the care (private pay), long term care insurance, workers’ compensation, Veterans’ benefits, or through Medicaid. Check whether your insurance or benefits cover it. Various funding sources may pay for private duty nursing, including Private pay, workers’ compensation, health insurance, Veterans’ benefits, long-term care insurance, and Medicaid. Check whether your health insurance to see if your benefits cover it. Usually, your physician orders services, and they have been deemed medically necessary. The following may cover in-home health care services: Medicare, Medicaid, workers’ compensation, or Private health insurance.  Check the requirements, for example usually an agency provides the care (e.g. Medicare requires using a Medicare certified agency ).

 IS A DOCTOR REFERRAL NEEDED? 

 

 CAREGIVERFEED.COM

No. A physician does not need to prescribe personal care and companionship care. Care can be provided as the person needs it. For example, care can be provided a few hours a week, or up to 24 hours a day, 7 days a week, and also including possible live-in care. Yes. A doctor needs to prescribe private duty nursing (for it to be covered by insurance). In addition, a referral should be made to an agency. Yes. A doctor needs to prescribe home health care. In addition, the doctor sends a referral to an agency.

 

 

Daughter taking care of her mother, sitting on sofa at home

Thinking About Hiring an In-Home Caregiver?

If you are considering hiring a caregiver, please read our post Hiring a Caregiver for In-Home Help for more information.

We also have a FREE downloadable caregiver job description template that may be helpful in your hiring process.

In addition, check out our FREE downloadable caregiver checklist to have an easy caregiver to-do list that helps ensures the important things get done.

 

 

Where to Find Help

Caring for a loved one can get complicated and demanding.

Stress and financial burden is not uncommon in caregivers.

There may be resources available in your community that could help you or your loved one.

For example, there may be low or no-cost meal delivery programs, visiting nurses, or respite care programs available in your community.

These programs can be beneficial to your loved one and also alleviate some of your stress.

For an in-depth list of community resources, please read our post Senior Resources- Guide for Caregivers.

 

 

 

Conclusion

Home care can be vital to aging at home, maintaining independence, healing from an injury or illness, and maximizing quality of life. It can also enable safety, security and provide the necessary management of your medical condition. Furthermore, understanding what home services are available and how they can help will enable you to advocate for the services needed by your loved one.

 


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