What’s home health care & what should I expect?
What’s home health care?
Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
Examples of skilled home health services include:
- Wound care for pressure sores or a surgical wound
- Patient and caregiver education
- Intravenous or nutrition therapy
- Monitoring serious illness and unstable health status
The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible.
If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.
If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.
If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area, but must tell you whether their organization has a financial interest in any agency listed.
What should I expect from my home health care?
Doctor’s orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.
The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
It’s important that home health staff see you as often as the doctor ordered.
Examples of what the home health staff should do include:
- Check what you’re eating and drinking.
- Check your blood pressure, temperature, heart rate, and breathing.
- Check that you’re taking your prescription and other drugs and any treatments correctly.
- Ask if you’re having pain.
- Check your safety in the home.
- Teach you about your care so you can take care of yourself.
- Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.
Who Pays for Home Health Care and When?
In general, most of all home health services are paid by some third party and Medicare in particular. All third party payers have specific eligibility requirements and coverage parameters.
Obviously, there are many specifics that relate to each third party payer’s decision about a particular patient situation. Here is the list of some of the most common third party payers:
- Veterans Administration
- Workers Compensation
- Commercial Insurance
- Private Pay
- Other Payer Sources
How Medicare Pays for Home Health Care and When?
Approximately eighty percent of all home health visits are paid by Medicare. The Medicare program covers the elderly (those 65 and over) and individuals who have been disabled for two or more years. Medicare has the most restrictive requirements for payment of home health services. However, it is frequently the only resource the elderly have for needed care.
Medicare is a federal program that has two parts – Part A and Part B. All home health services can be covered under either Part A or Part B while other forms of health care are only covered under one of the parts. For example, hospitals and short term nursing home care are covered only under Part A, while doctor’s visits, durable medical equipment, ambulance and outpatient services are covered under Part B.
Medicare is not an entitlement program, but rather an insurance program. As an insurance program, Medicare covers only certain situations and items that meet the program’s criteria.
To be eligible for home health service under the Medicare program, the client must:
- Have a valid Medicare card or other evidence showing entitlement to Medicare benefits.
- Be essentially homebound (unable to leave home without a considerable taxing effort or able to leave home only for limited, essential medical appointments.)
- Be under a physician’s plan of treatment that specifies Home Health Services.
- Require one or more of the primary services (nursing, physical therapy or speech therapy) on an intermittent basis.
- Have an unstable (changeable) medical condition that will respond to treatment in a “reasonable” period of time.
- Require services on a predictable basis of at least once per 60 days.