When you are caring for an aging relative, navigating the world of healthcare can feel overwhelming, especially after a hospital stay or a change in health. You want to find the proper support that allows your loved one to remain comfortably at home while receiving professional in-home medical support.
To qualify for home health care, an individual needs a doctor’s order, and require intermittent skilled care to treat an illness or injury.
Key Takeaways
- A doctor must certify the need for home health services and create a plan of care.
- The person receiving care is usually considered “homebound,” meaning it is difficult for them to leave home.
- Home health care provides part-time skilled services, not 24/7 care.
- Services are often used for surgery recovery or managing a long-term condition.
What Is Home Health Care and How Is It Different?
Home health care is a range of medical services that a person can receive in their own home for the treatment of an illness or injury. It often helps with recovery after a hospital stay or with managing an ongoing condition. This can include professional skilled nursing and licensed therapies.
Home Health Care vs. Home Care
These terms sound similar, but they are different. Home health care involves clinical services, such as nursing and therapy, ordered by a doctor. In contrast, home care provides non-medical assistance with daily activities, such as meal preparation, light housekeeping, or companionship.
The Main Eligibility Requirements for Home Health Care
To qualify for home health care, especially with Medicare coverage, a person typically needs to meet specific eligibility criteria. These requirements help determine if in-home medical support is the right choice.
A Doctor Must Order and Oversee The Care Plan
A doctor must certify that the individual needs home health services. This happens during a face-to-face meeting. The doctor creates a plan of care and works with the home health agency to manage it.
The Person Receiving Care Is Considered Homebound
This means it is tough for the person to leave their home. To be considered homebound, an individual might:
- Requires assistance from another person or a device, such as a walker or wheelchair, to leave the house.
- Find that leaving home takes a considerable and taxing effort.
- Have a condition where leaving home is not recommended by a doctor.
Leaving home for short, infrequent trips such as medical appointments or religious services is usually okay.
A Need for Part-Time or Intermittent Skilled Care
The care required must be on a part-time or intermittent basis, rather than around-the-clock. This often includes services like skilled nursing care for wound care or medication management. It can also include physical, occupational, or speech therapy.
Common Reasons for Needing Care
While every situation is unique, some common reasons a doctor might order home health care include:
- Help with surgery recovery, such as after a hip replacement.
- Managing a new diagnosis or a worsening long-term condition.
- Learning to use a new medication or medical device at home.
- Gaining strength and mobility after an illness or injury.
For answers to specific questions about eligibility, you can explore some frequently asked questions.
Covered Services and What You Can Expect
A care plan is personalized to meet an individual’s specific health needs. It can include a variety of different services delivered right in the comfort of the home.
Types of Skilled Care and Therapy
Based on the doctor’s orders, a care plan can include a combination of services, such as:
- Skilled nursing care for assessment, education, wound care, injections, or IV therapy.
- Physical therapy to help with strengthening, movement and balance.
- Occupational therapy to assist with activities of daily living.
- Speech-language pathology services to assist with cognition or swallowing issues.
Support From a Home Health Aide
If a person is also receiving skilled care, a home health aide can help with personal tasks. This could include bathing, grooming, or getting dressed. This support is part of the overall care plan. It is also helpful to recognize the signs of caregiver stress, which can affect family members, providing additional support.
Services That Are Not Typically Covered
It’s also helpful to know what is not covered by the home health benefit. This includes:
- 24-hour-a-day care at home.
- Meal delivery services.
- Homemaker services, such as shopping or cleaning, that are unrelated to the care plan.
- Personal care when it is the only care that is needed.
The Process for Starting Home Health Care
If you believe a loved one could benefit from home health care, there’s a straightforward process to follow. Taking these steps can help you arrange the support they need.
- Talk with a Doctor: The first step is to discuss your loved one’s condition and needs with their healthcare provider. Having these conversations can feel challenging, but there are resources available to help guide family caregivers through the process.
- Find a Certified Agency: If the doctor agrees that home health care is appropriate, they will provide a referral.
- The First Home Visit and Care Plan: The agency will schedule a home visit. During this visit, a staff member will talk with you and your loved one, assess their needs, and coordinate with the doctor to finalize the plan of care.
Navigating the Costs of Home Health Care
Understanding how services are paid for can provide peace of mind. For many older adults, Medicare is the primary source of payment for qualifying home health services.
For eligible individuals with Original Medicare, there is typically no cost for covered home health care services. There may be a 20% coinsurance for any medical equipment needed. If you use a Medicare Advantage Plan, check with the plan directly to understand the specific coverage rules and costs.
Besides Medicare, other options may be available to help cover costs. These can include:
- Private health insurance
- Long-term care insurance
- VA benefits
- Private pay
Finding Support for Your Loved One
Exploring care options for older adults, such as home health care, can feel like a daunting task. By understanding the qualification requirements, you can feel more prepared to discuss the possibility with your loved one and their doctor. You don’t have to manage this journey alone. For families in Dayton and the surrounding communities, Bethany Village Home Health Care offers professional and compassionate care. Contact our team today to learn how we can support you and your loved one.
