Home Healthcare

What is home healthcare?

Home healthcare is medical care provided in your home. It’s a way to get “skilled care,” such as dressing changes or physical therapy, when you cannot leave your home because of illness or injury. The care is ordered and supervised by your healthcare provider. A care plan is developed by you, your provider, and the home care staff. Any changes must be approved by your primary healthcare provider.

What services are offered in the home?

Home healthcare agencies provide the services of healthcare professionals, such as nurses, medical social workers, and therapists. (You may need a therapist for physical, occupational, speech, or respiratory therapy.) The agencies can also provide home health aides for personal care.

• Nurses assess your condition, change dressings and give other treatments, including injections. They also check your medicines. They can show you how to use equipment you may need.
• Medical social workers will make sure that you have the help you need or are entitled to. They can also help you adjust to being homebound.
• Physical and occupational therapists work with you to improve your strength and ability to do everyday tasks, such as bathing and dressing. They can look at your home and suggest easier or safer ways to do things. They may also recommend devices that can help you.
• Speech therapists can help you with speaking, thinking, other language skills, and swallowing problems. Respiratory therapists can help with breathing problems.
• Home health aides help you with personal care, such as bathing and shaving. They may also do light housekeeping.

Some home care agencies provide other services, such as medical equipment rental. They may have wheelchairs, commodes, or other equipment that you can rent.

Some agencies have help you can hire that is not covered by your insurance. You may want to hire helpers by the hour or by the day. The kinds of helpers may include nurses, home health aides, or personal care aides. (Home health aides are required to have formal training and must follow Medicare regulations. Personal care aides may not have the same level of training and are more of a companion. They are not as regulated as home health aides.)

Can I choose a home care agency?

You can choose the home healthcare agency you want to provide your care. There may be many agencies in your town. A hospital or healthcare provider may give you a list of agencies, but they cannot tell you which agency to use.

Choose an agency that either provides all of the services you need or works closely with other providers. Talk to the nurse who will be involved in your care. Since home care staff come into your home, there needs to be a good fit between you and the staff.

You may have concerns about people you don't know coming into your home. Choose an agency that is accredited or Medicare-certified. Accreditation means that an impartial third party inspected the agency and it met quality standards. All Medicare-certified agencies are reviewed by the state health department. They must meet federal and state regulations.

Does insurance pay for home care?

Many healthcare insurance plans cover home health services. Each plan is different, so review your policy to see what your plan covers. Insurance will not cover nurses, aides, or therapists whose services are not medically necessary. Insurance does not cover services when they are needed for personal care only.

Medicare pays for home healthcare when these 4 conditions are met:

• You need part-time (intermittent) skilled nursing care, physical therapy, or speech therapy.
• You are not able to leave your home.
• Your healthcare provider decides that you need home healthcare and sets up a plan for you to receive home care.
• The home care agency you are using participates in Medicare.

Medicare does not cover full-time nursing care at home.

You don’t have to have previously stayed at the hospital in order to get home care benefits under Medicare. There is no deductible for home care services.

Medicare Part A (or Part B if you do not have Part A) pays for part-time, covered services for as long as they are medically necessary and reasonable. The home healthcare benefit also pays for some medical supplies and 80% of the approved amount for durable medical equipment (DME). DME includes wheelchairs, walkers, hospital beds, portable toilets or commodes, and oxygen supplies.

For more information on home healthcare agencies in your community, contact your hospital discharge planner or social worker or check the Yellow Pages under nursing. For more information on Medicare coverage, call 1-800-MEDICARE.