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Medicare Home Health Providers - What You Should Know...

What is Home Health Care?

Home health care includes skilled nursing care as well as other skilled care services, like physical and occupational therapy, speech-language therapy, and medical social services.

These services are provided by a variety of skilled health care professionals in your home. The home health staff provides and helps coordinate the care and/or therapy your doctor orders. Along with the doctor, home health staff create a care plan, which is a written plan for your care. It tells what services you will get to reach and keep your best physical, mental and social well being. The home health staff keeps your doctor up-to-date on how you are doing and updates your care plan as needed.

Since most home health care is temporary and part-time, patients (and their informal caregivers) need to learn how to identify and care for possible problems, like confusion or shortness of breath. While you get home health care, home health staff teach you (and those who help you) to continue any care you may need, including medication, wound care, therapy and managing stress.

The goal of short-term home health care is rehabilitation. It helps you get better, regain your independence, and become as self-sufficient as possible. The goal of long-term home health care (for chronically ill or disabled people) is to maintain your highest level of ability or health, and help you learn to live with your illness or disability.

Examples of skilled home health services include wound care for pressure sores or a surgical wound, respiratory care, like oxygen or a nebulizer, physical and occupational therapy, speech-language therapy, patient and caregiver education, injections and intravenous or nutrition therapy.

Examples of personal care and support services include help with basic daily activities like getting in and out of bed, dressing, bathing, eating, and using the bathroom. It also includes help with light housekeeping, laundry, shopping and cooking.

It is important to understand the difference between home care and home healthcare. Home care can refer to medical and non-medical care but more often it refers to companionship and personal care services. Home health care involves nursing care and the previously listed services. It is also important to realize the Medicare's coverage of homehealth is limited, and home care can supplement the care provided through your Medicare coverage.

If you have Medicare, you can use your home health care benefits if you meet all the following conditions:

Your doctor must decide that you need medical care at home, and make a plan for your care at home.
You must need at least one of the following: Intermittent skilled nursing care, or physical therapy, or speech-language therapy or continue to need occupational therapy.
The home health agency caring for you must be approved by the Medicare program.
You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons such as a trip to the barber or to attend religious services. A need for adult day care doesn't keep you from getting home health care.

If you meet all four of the conditions above for home health care, Medicare will cover:

Skilled nursing care on a part-time or intermittent basis. This includes services and care that can only be performed safely and correctly by a licensed nurse.
Home health aide services on a part-time or intermittent basis. A home health aide doesn't have a nursing license. The aide provides services that give additional support to the nurse. These services include help with personal care such as bathing, using the bathroom, or dressing. These types of services don't need the skills of a licensed nurse. Medicare doesn't cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
Physical therapy, speech-language therapy and occupational therapy for a s long as your doctor says you need it.
Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
Certain medical supplies like wound dressings,
Durable medical supplies like wound dressings
Durable medical equipment such as wheelchair or walker.
FDA approved injectable osteoporosis drugs in certain circumstances.

Currently, Medicare does not cover the following:

Any long duration of personal care, of course including 24-hour-a-day care at home
Meals delivered or prepared in your home.
Homemaker services like shopping, cleaning, and laundry.
Personal care given by home health aides like bathing, dressing and using the bathroom when this is the only care you need.