Home Health Awareness

Crash Course

This page contains information about the basics of home health care.  Most all of your questions about home health will be answered here.  If you have a question you can’t seem to find the answer to, please submit it here on the online form.


What is home health care?

In general, the goal of home health care is to provide treatment for an illness or injury, in your home. It helps you get better, regain your independence, and become as self-sufficient as possible. If you have long-term health problems, the goal of home health care is to maintain your highest level of ability or health, and help you learn to live with your illness or disability.
Home health care includes part-time or intermittent skilled nursing care, as well as other skilled care services like physical and occupational therapy, and speech-language pathology (therapy) services. Services may also include medical social services, and assistance from a home health aide (when needed, if you are also getting skilled care). In order for Medicare to pay for these services, you must meet certain eligibility criteria, and the services must be reasonable and necessary for the treatment of your illness or injury. Usually, a specific home health care agency coordinates the services your doctor orders for you.
Health care professionals from a Medicare-certified home health agency work with you and your doctor to evaluate your health care needs and write your plan of care (see page 15). The plan of care tells you what home care services you need. Your home health agency must provide you with all the home care listed in your plan of care, including services and medical supplies. The agency may do this through its own staff, through an arrangement with another agency, or by hiring nurses, therapists, home health aides, and medical social service counselors to meet your needs.
The home health agency staff will teach you (and your family or friends who are helping you) to continue any care you may need, including wound care, therapy, and disease management. You should learn to recognize problems like infection or shortness of breath, and what to do or who to contact if they happen. (Information from the Medicare publication “Medicare and Home Health”) Click here to download a complimentary copy.


What to consider when deciding on what home health agency to choose.

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What if I am unhappy with my current home health agency?

You may choose to stop using your current agency and receive services from a different agency at any time. You must tell both the agency you are leaving and the new agency you choose that you are changing home health agencies.


Who can get Medicare-covered home health care, and what services does Medicare cover?

If you have Medicare, home health care services are covered if you meet all the following conditions:

1. Your doctor must decide that you need medical care at home, and make a plan for your care at home.

2. You must need intermittent skilled nursing care, physical therapy, speech-language therapy, or to continue occupational therapy.

3. The home health agency caring for you must be approved by the Medicare program (Medicare-certified).

4. You must be home-bound, or normally unable to leave home without help. To be homebound means that leaving home takes considerable and taxing effort. You can be homebound and still leave home for medical treatment or short, infrequent absences for non-medical reasons, such as trips to a barber or church. A need for adult day care doesn’t keep you from getting home health care.

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

* Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
* Home health aide services on a part-time or intermittent basis. A home health aide doesn’t have a nursing license, but supports the nurse by providing services such as help with bathing, using the bathroom, dressing, or other personal care. 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 as long as your doctor says you need it.
1. Physical therapy includes exercise to regain movement and strength in a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
2. Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills.
3. Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care.
* 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 (but not prescription drugs or biologicals).
* Durable medical equipment, such as a wheelchair or walker.
* Food and Drug Administration (FDA)-approved injectable osteoporosis drugs in certain circumstances.

Currently, Medicare does not cover (does not pay) for any of the following:

* 24-hour-a-day care at home;
* Meals delivered to your home;
* Homemaker services like shopping, cleaning, and laundry; and
* Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.

Most of the time, your doctor, a social worker, or a hospital discharge planner will help arrange for Medicare-covered home health care. However, YOU have a say in which home health care agency you use.

Who pays for my home health care?

If your health care benefit is provided by the Original Medicare Plan, Medicare pays 100% of all covered services. Medication is NOT covered.

If you have a Managed Care Plan (Insurance), then you will need to check with your insurance company to find out what services will be covered, and for how long.

How do I get services started for me or someone I know?

Hospital Stay – Your physician may prescribe home health for you when you are being discharged from the hospital, rehab facility, long term care facility or nursing home. Feel free to ask for home health care if it is not mentioned.

Doctor’s Appointment – You may also request home health care from your primary care physician. Some specialist will prescribe it too, but most like for your primary care physician to. A physician follows your care while on home health services, that’s why it’s usually best for your “regular” physician to prescribe it.

Family / Friend Referral – You may know someone that would benefit from home health services.  There are many seniors that do not have a strong care giving network in around them.  This means that many times their needs go unseen.  Do NOT hesitate to discuss their need for home health with them and then make a referral.  You can contact their physician or a home health agency.  Either way, you will receive assistance in getting the home health services started.

Who holds the agency accountable?

1. You do. Please report any problems to the agency’s Director of Nurses, Director of Clinical Services or the Administrator. Your agency must leave information with you that explains how to get in touch with them 24 hours per day. This folder should also contain information as to how to contact the state, should a serious offense occur!
2. Your physician also holds the agency accountable. Your physician is responsible to review your Plan of Care in order to insure that the patient will receive appropriate and effective treatment.

Is there a maximum or ceiling to my home health care benefit?

There are many physicians and home health consumers that assume there is a cap or ceiling to the Original Medicare Plan home health benefit.  This is NOT true.  Many insurance companies that are marketing their products to seniors (i.e. Medicare replacements and long term care plans) are telling seniors that there benefit “runs out”.  For the home health benefit, this simply is NOT true.  Home health is Goal Driven and Physician Approved…meaning that as long as there are goals to be reached (per the Plan of Care your physician has signed off on) you can continue to receive home helath services.

An individual receives home health services for up to 60 days!  At the end of 60 days, if the predetermined goals have not been reached, the physician will approve another Certification Period or 60 days.  If the patient reaches their goals prior to the 60 days, the patient is discharged.

Home Health Awareness