When we become elderly or ill, it often can become a taxing effort to leave our home independently and safely to obtain medical services. At one point in time, many health care services could only be offered to a patient in a hospital, inpatient facility, or in a doctor’s office. Many of these medical services can now be provided in the comfort of your own home and are typically less expensive than the inpatient setting. In fact, with many insurance providers, such as Medicare, private home care is covered at 100 percent, if certain criteria are met.
Medicare eligibility for skilled services provided under the home care benefit is focused on teaching self-management of a disease process and/or rehabilitation.
Examples of qualifying criteria would include:
- You are homebound. This means that due to illness or injury, leaving your home is a considerable, taxing effort.
- You got a new medical diagnosis or an existing condition is exacerbated.
- You were recently discharged from a hospital or inpatient facility.
- You have a knowledge deficit regarding medical care or treatment.
- Your medication or treatment has changed.
- You have difficulty with activities of daily living.
- You need intermittent care.
- Your need for care is both reasonable and necessary.
- Your condition requires a nurse or therapist.
Once eligibility is established, a start-of-care visit is made by a registered nurse or physical therapist and a comprehensive assessment of needs and medication reconciliation are done per Medicare guidelines.
A complete and thorough medication reconciliation is vital in the prevention of hospitalization due to medication errors. The home health care team, in collaboration with the primary care physician, develops a plan for care and goals are established to assure all the medical and social needs are met.
Services offered under Home Health Care include:
- Skilled Nursing – provides care under the direction of the primary care physician. This may include, but is not limited to medication administration and teaching, blood glucose monitoring and diabetes education, wound care, cardiac monitoring and teaching and/or ongoing assessment of a medical condition.
- Physical Therapist – evaluates and treats issues with large motor function. The PT develops a home exercise and fall prevention program to restore the highest functional level of strength and mobility.
- Occupational Therapist – evaluates and treats issues with small motor function. The OT develops a home exercise program, splinting and assistive devices to increase abilities in feeding, dressing, grooming and household tasks.
- Speech Therapist – will evaluate and assist a patient who has difficulty speaking and/or swallowing due to illness or accident.
- Medical Social Worker – provides counseling and assistance with social and financial difficulties arising from a medical condition. The Medical Social Worker also provides access to community resources to assist with financial concerns, emotional support and counseling as needed.
- Home Health Aide – provides personal care, light housekeeping, and/or assistance with exercise under the supervision of a registered nurse.
Because home health care is intermittent, a plan should be developed in advance to help support independency after discharge from home care services through a private duty service for those who require continued support. Private duty care may not be covered by insurance, but there are many programs available in the community that can assist with the cost. When choosing this type of home health care service, look for accreditation with ACHC.
