Home health care encompasses a broad spectrum of health services delivered right in your home, designed to aid recovery from illness or injury. Often, receiving care at home is not only more affordable and convenient but also as effective as the care provided in hospitals or skilled nursing facilities (SNFs).
For those eligible, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover home health services. Eligibility hinges on needing part-time or intermittent skilled services and being considered “homebound.” According to Medicare, “homebound” is defined as:
- Difficulty leaving home independently due to illness or injury, requiring aids such as canes, wheelchairs, walkers, crutches, special transportation, or assistance from another person.
- A medical condition for which leaving home is not recommended.
- A general inability to leave home without significant effort.
Medicare-covered home health services are comprehensive, including:
- Medically Necessary Skilled Nursing Care (Part-Time or Intermittent): This includes vital services such as:
- Advanced wound care for pressure sores or surgical wounds.
- Comprehensive education for patients and their caregivers on managing health conditions at home.
- Administration of intravenous therapy or specialized nutritional support.
- Delivery of necessary injections.
- Continuous monitoring of serious illnesses and unstable health conditions.
- Physical Therapy: To help regain mobility and strength.
- Occupational Therapy: To assist with daily living skills and adaptations.
- Speech-Language Pathology Services: To address communication and swallowing difficulties.
- Medical Social Services: Providing emotional support and connecting patients with community resources.
- Part-Time or Intermittent Home Health Aide Care: This is provided in conjunction with skilled nursing care or therapy services and includes assistance with:
- Mobility and walking.
- Personal hygiene, such as bathing and grooming.
- Changing bed linens to maintain a healthy environment.
- Assistance with feeding, if necessary.
- Injectable Osteoporosis Drugs for Women: Specific medications to treat osteoporosis.
- Durable Medical Equipment (DME): Necessary medical equipment for home use.
- Medical Supplies: Consumable medical supplies required for your care at home.
- Disposable Negative Pressure Wound Therapy Devices: Advanced wound care technology.
To initiate home health care under Medicare, a face-to-face assessment by a doctor or qualified health care provider (like a nurse practitioner) is required to certify the need for these services. Furthermore, a physician’s order is necessary, and the services must be delivered by a Medicare-certified home health agency.
Upon determining the need for home health care, your provider should offer a list of agencies in your area. This list can also be found on the Medicare website’s Care Compare tool. Transparency is key, and providers are obligated to disclose any financial interests they might have in the listed agencies.
“Part-time or intermittent” care typically translates to skilled nursing care and home health aide services for up to 8 hours daily (combined), with a weekly maximum of 28 hours. In situations where medically necessary, more frequent care, up to just under 8 hours per day and 35 hours per week, may be approved for short durations, as determined by your provider.
It’s crucial to understand what Medicare does not cover in home health care:
- 24-hour-a-day care at your home: Medicare is designed for part-time or intermittent care, not continuous, 24 Hour Home Care. If round-the-clock supervision is needed, other arrangements are necessary.
- Home meal delivery services: While nutritional needs are considered, meal delivery is not a covered home health benefit.
- Homemaker services: Services like shopping and general cleaning, if not directly related to your medical care plan, are not covered.
- Custodial or personal care alone: If the primary need is assistance with daily living activities such as bathing, dressing, or using the bathroom, and no skilled care is required, Medicare home health benefits won’t apply.
Eligibility for home health benefits is contingent on needing no more than part-time or “intermittent” skilled care. Leaving home for medical appointments or occasional, brief outings for non-medical reasons, such as religious services, does not disqualify you from receiving home health care. Participation in adult day care programs is also permissible while receiving home health services.
Understanding the scope of Medicare home health benefits, particularly regarding the distinction between intermittent and 24 hour home care, is essential for planning and accessing appropriate care at home. While Medicare provides valuable support, it’s structured for specific levels of care and not intended for continuous, round-the-clock supervision.
