Home health care agencies offer a wide array of health services delivered right in your home, catering to individuals recovering from illness or injury. Often, home health care presents a more affordable, convenient, and equally effective alternative to receiving care in a hospital or skilled nursing facility (SNF).
Primarily, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) extend coverage to eligible home health services. This coverage is available if you necessitate part-time or intermittent skilled services and are considered “homebound.” Being homebound, in Medicare terms, means specific conditions apply to your ability to leave home. These conditions are defined as:
- Requiring assistance to leave home due to illness or injury. This assistance can include using mobility aids like canes, wheelchairs, walkers, or crutches, needing special transportation, or relying on another person’s help.
- A medical condition for which leaving home is not advised.
- A general inability to leave home without considerable effort.
Home health care agencies provide a comprehensive suite of services, which can be categorized as follows:
- Skilled Nursing Care: This includes medically necessary part-time or intermittent care delivered by registered nurses. Examples of skilled nursing care are:
- Expert wound care for pressure sores or post-surgical wounds.
- Thorough education for patients and their caregivers on managing health conditions and treatments.
- Administering intravenous therapy or specialized nutritional support.
- Providing necessary injections.
- Diligent monitoring of serious illnesses and unstable health conditions.
- Therapeutic Services: To aid recovery and rehabilitation, home health agencies offer:
- Physical therapy: To restore mobility and physical function.
- Occupational therapy: To help with daily living activities and improve functional abilities.
- Speech-language pathology services: To address speech, language, and swallowing difficulties.
- Medical Social Services: Support from medical social workers to assist with emotional and social needs related to illness and treatment.
- Home Health Aide Services: Part-time or intermittent assistance from home health aides is available, but it’s contingent on also receiving skilled nursing care or therapy services (physical, occupational, or speech). Aide services encompass:
- Assistance with ambulation and movement.
- Personal care tasks such as bathing and grooming.
- Help with changing bed linens.
- Feeding assistance if needed.
- Medical Supplies and Equipment:
- Administration of injectable osteoporosis drugs for women.
- Provision of durable medical equipment (DME) necessary for home care.
- Supply of medical materials for home use.
- Disposable negative pressure wound therapy devices for advanced wound management.
To initiate home health care, a physician or a qualified health care provider (such as a nurse practitioner) must conduct a face-to-face assessment to certify the medical necessity of these services. A doctor’s order is required for care, and the services must be delivered by a Medicare-certified home health agency.
Your healthcare provider is responsible for offering a list of agencies serving your locality if home health care is deemed necessary. Transparency is key, and providers are required to disclose any financial interest they might have in any listed agency.
The definition of “part-time or intermittent” care generally allows for skilled nursing and home health aide services up to a combined total of 8 hours daily, with a weekly maximum of 28 hours. In specific situations, if deemed medically necessary by your provider, more frequent care—up to 8 hours per day and no more than 35 hours weekly—may be authorized for short durations.
It’s important to note what Medicare does not cover under home health care benefits:
- Round-the-clock, 24-hour care at home.
- Home-delivered meals.
- Homemaker services (like general shopping or cleaning) that are not directly linked to your care plan.
- Custodial or personal care focused solely on assisting with daily living activities (such as bathing, dressing, or using the restroom) when this is the only form of care required.
Eligibility for home health benefits is not met if your care needs surpass the part-time or “intermittent” skilled care threshold. However, you are permitted to leave home for medical appointments or brief, occasional outings for non-medical reasons, such as attending religious services, without jeopardizing your home health care. Participation in adult day care programs also does not disqualify you from receiving home health care services.
