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Home Health Care What is home care? Home care is a service provided in the patient’s home in order to help the individual remain independent in their own home. A patient’s home can be a private residence, an apartment, an independent living community or an Assisted Living facility. Generally home care is appropriate when a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family or friends. Home care can consist of both unskilled and skilled tasks. Unskilled Assistance in the HomeProviders of personal care assistants generally can help a patient with the activities of daily living (assistance with bathing, dressing, grooming, eating, toileting, ambulation) as well as housekeeping (light housekeeping, dusting, vacuuming, laundry, errands, etc.). These caregivers may not provide any skilled services or administer medications. Most companies that provide this type of service accept private pay and long-term care insurance. Skilled Assistance in the HomeSkilled assistance can include:
Home Health Aides may also be provided under the Medicare program, however they may only be used when there is a skilled need being provided by a nurse or therapist. Types of Home Care AgenciesThere are many types of agencies that provide home care. They include:
This term usually indicates that the agency is Medicare certified. A Medicare certified agency has met federal minimum requirements for patient care and management and can provide Medicare and Medicaid. Patients requiring skilled home care services usually receive their services from a home health agency. Under the Medicare program the patient must have a skilled need (nursing and/or therapy).
Hospice provides services to the terminally ill individual and can include medical, psychological and spiritual care as well as support for the patient’s family. Most Hospices are Medicare certified and licensed according to state requirement.
Some states require these types of agencies to be licensed and meet minimum standards established by the state. Employees of these agencies are non-skilled and generally assist patients with activities of daily living and light housekeeping chores.
Private duty agencies generally are nursing agencies that can provide individuals with nursing, homemaker, and companion services. Some states do not require this type of agency to be licensed or meet regulatory standards. Availability of ServicesDepending on the patient’s needs, services may be provided on either a part-time, intermittent, hourly or shift basis. Home care services are generally available 24 hours a day, seven days a week. Paying for Home CareHome care services can be paid for privately by the patient or their family, or through a variety of public and private sources.
Home care services that fail to meet the criteria of third party payors must be paid for “out of pocket” by the patient or their families. Fees generally vary from agency to agency.
Most Americans older than 65 are eligible for Medicare which is a federal program. Services are approved and provided by a Medicare Certified agency if the patient meets certain criteria (homebound, skilled need and under a physician’s care). Services can include skilled nursing, therapy (speech, occupational and physical), medical social work and home health aide (in conjunction with skilled need). Services are intermittent (visits).
Medicaid is a joint federal and state medical assistance program for low income individuals. Each states determines its own set of eligibility requirements. Individuals younger than 21 who meet income and resources requirements for Aid to Families with Dependent Children (AFDC) yet otherwise are ineligible for AFDC qualify under the “categorically needy” clause. “Categorically needy” also include certain aged, blind and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels.
Federal funds for state and local service programs that serve frail and older individuals are provided under this program. Services can include personal care, housekeeping, meal delivery, errands/shopping, etc. Eligible recipients must be 60 years of age and older. Services under this program can be requested through the individual’s local Area Agency on Aging organization.
Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care coverage. A physician must authorize these services
Individuals should check with their commercial health insurance companies to determine what home care services may be covered under their individual policies. For additional information please go to the Medicare link on our web-site or contact your local office for more information.
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