Services – Home Care – FAQs
At Life Care, our goal is to provide the information you need to make educated decisions about retirement communities, nursing homes, and elderly care in general. If you can’t find the information you need, please do not hesitate to contact us.
Home care is a broad range of professional health care and support services provided in peoples’ homes. People who are recovering from an illness or accident, disabled, chronically or terminally ill, most often use these services. Typically home care is appropriate when a person can safely stay at home but still needs ongoing care that cannot easily or effectively be provided solely by family and friends.
Home care services are usually provided by home care organizations. Home care organizations include: Medicare certified home health agencies; hospices; area agencies on aging, homemaker agencies; staff and private duty nursing agencies. Other companies may be utilized to deliver specialized services and products such as medical equipment and supplies, pharmaceuticals, and drug infusion therapy.
Services range from skilled nursing, physical, occupational and speech-language therapy, home health aide services, and medical social services to community wellness and adult day health programs. Hospice and palliative care services that assist patients and families with terminal illness are provided by many.
People of all ages with acute and chronic health care needs can receive home health care services. Home health care is for persons who require health care from a professional or who need supportive assistance in the home environment. The payer(s) for these services typically determines what type of care is covered and who qualifies. In most cases medical orders from a physician are required for care.
If the care is medically necessary and the patient meets certain coverage requirements, Medicare, Medicaid and most private insurance plans will usually pay for home health care services. Medicaid coverage varies depending on the state in which you reside and of course, different private insurance carriers have different policies. For services that are not covered, patients may choose to pay out of their own pocket. Community groups subsidize some agencies and some receive funding from local and state government to assist patients in paying for their care when they have no available resources.
There are many important factors to consider in choosing the best agency to meet your needs. First you must assess what types of services you will need and find an agency that offers those services. Ask the agencies you are considering about their accreditations, licenses and certifications. You’ll also want to evaluate the quality of care, and the skills and training of personnel at the agencies under consideration.
Services – Home Care – Service & Amenities
To receive Medicare benefits for home health services, patients must have a doctor’s order. After obtaining this order, Life Care at Home professionals work with the patients and their families to develop a plan of care. This plan is reviewed and signed by the doctor upon development and every 60 days thereafter for as long as home care is needed. The services generally prescribed by a doctor are described below.
Skilled or intermittent care services
Patients needing skilled/intermittent care may require injections, dressing changes, instruction in their disease process or the administration of medication. Some common diagnoses for those requiring skilled/intermittent care include diabetes, cancer, congestive heart failure and wound care.
After surgery of an extended illness, patients often require physical therapy to help them regain strength and mobility. Instruction in using walkers, transferring from the bed to a wheelchair, and implementing home exercise programs are examples of the services provided by physical therapists.
Patients may need occupational therapy to improve their function of tasks such as dressing, bathing or eating after an injury or illness. By using rehabilitation techniques and training patients in the use of special equipment, occupational therapists can help patients achieve greater independence.
Patients with communication or swallowing disorders, which are commonly the result of traumas such as surgery or stroke, often require speech therapy. This therapy discipline helps retrain patients in breathing, swallowing and muscle control.
Sitters and private services
Sitters are available to stay with patients at home or in the hospital when family or friends are unable to do so. In the home setting, sitters may also provide private services such as light housekeeping, meal preparation, running errands and grocery shopping. However, sitters do not provide hands-on care.
Live-in services are for patients who should not be left at home alone because of medical or safety reasons. These services are offered on a 24-hour basis and may include assistance with personal care, household tasks, meal preparation and other services requested by the client.
A medical social worker is sometimes needed to evaluate the social and emotional needs affecting a patient. Social workers also help patients and family members identify and access available community resources.
Services – Home Care – Medicare & Payment
Home care services are covered under Medicare Part A for those who meet the eligibility requirements as well as certain criteria defined by Medicare. When patients are not sure if they meet Medicare qualifications, Life Care at Home agencies will do a complimentary evaluation to determine whether or not they are eligible. For those who do not qualify for Medicare coverage, other payment options may include Medicaid, private insurance, private pay and HMOs.
Medicare Part A coverage requirements
To be eligible for home care benefits under Medicare Part A, a patient must:
Occupational therapy, medical social worker services, and/or home health aide services are only covered by Medicare if the physician recommends the service along with skilled/intermittent care, physical therapy or speech therapy.
Medicaid, state health insurance programs may pay the cost of home care services; however, coverage guidelines vary from state to state. To find out which services may be covered in your area, contact your state’s medical assistance office.
Private insurance typically covers the cost of skilled/intermediate care, physical therapy and speech therapy. Some insurance companies provide supplemental policies to cover additional home care services such as occupational therapy and sitter services.
For those who are not eligible for Medicare or Medicaid benefits and are not covered by private insurance, expenses for home care services can be paid by the individual or his or her family.
Individuals enrolled in an HMO can expect the cost of skilled/intermittent nursing care, physical therapy and speech therapy to be covered. However the policies regarding coverage for other home care services varies depending on the HMO. For more specific information about payment of home care services, contact your HMO.