Home health care encompasses a spectrum of health services delivered in the comfort of your own home, designed to aid recovery from illness or injury. Often, receiving care at home is not only more convenient and cost-effective but also equally effective compared to treatment in a hospital or skilled nursing facility (SNF). For those eligible, Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) offer coverage for home health services, provided you require part-time or intermittent skilled care and meet the definition of being “homebound.”
To be considered “homebound” under Medicare guidelines, you must meet one of the following criteria:
- Difficulty leaving your home without assistance, which could include aids like a cane, wheelchair, walker, or crutches, special transportation, or the help of another person due to an illness or injury.
- A medical condition for which leaving your home is not recommended.
- A general inability to leave home without considerable and taxing effort.
Medicare-covered part-time home health services are comprehensive and include:
- Medically Necessary Part-Time or Intermittent Skilled Nursing Care: This encompasses a range of essential services, such as:
- Expert wound care for pressure sores or post-surgical wounds to ensure proper healing and prevent infection.
- Comprehensive education for patients and their caregivers, empowering them with knowledge for effective ongoing care at home.
- Administration of intravenous or nutrition therapy, delivering vital treatments directly at home.
- Skilled injections as prescribed by a physician.
- Diligent monitoring of serious illnesses and unstable health conditions, ensuring prompt response to any changes.
- Physical Therapy: Tailored programs to restore mobility, strength, and function, crucial for recovery and independence.
- Occupational Therapy: Focused therapy to improve daily living skills and enhance the ability to perform everyday tasks.
- Speech-Language Pathology Services: Addressing speech, language, and swallowing difficulties, vital for communication and safe eating.
- Medical Social Services: Providing support and resources to address the social and emotional aspects of health and recovery.
- Part-Time or Intermittent Home Health Aide Care: This support is available if you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy concurrently. Home health aides assist with:
- Mobility and ambulation support, aiding safe movement within the home.
- Personal care assistance, including bathing and grooming, to maintain hygiene and comfort.
- Assistance with changing bed linens, ensuring a clean and healthy environment.
- Feeding assistance, if necessary, to ensure proper nutrition.
- Injectable Osteoporosis Drugs for Women: Providing access to necessary medications for managing osteoporosis.
- Durable Medical Equipment (DME): Coverage for essential medical equipment needed at home, like wheelchairs or walkers.
- Medical Supplies for Home Use: Ensuring you have the necessary medical supplies for ongoing care.
- Disposable Negative Pressure Wound Therapy Devices: Advanced wound care technology delivered at home.
Before you can begin receiving home health services, a doctor or a qualified health care provider, such as a nurse practitioner, must conduct a face-to-face assessment to confirm your need for these services. Furthermore, a physician or another authorized health care provider must formally order your care, and the services must be delivered by a Medicare-certified home health agency.
Upon determining that you require home health care, your provider is obligated to furnish you with a list of agencies serving your local area. This list can also be found on the Medicare website’s Care Compare tool. Transparency is key, and providers must disclose if they have any financial interest in any of the listed agencies.
The definition of “part-time or intermittent” care generally means that you may receive skilled nursing care and home health aide services for a combined total of up to 8 hours per day, with a maximum of 28 hours per week. In situations where medically necessary, your provider may authorize more frequent care for a short duration, up to but not exceeding 8 hours daily and 35 hours per week.
However, it’s important to understand what Medicare does not cover under home health care benefits:
- 24-hour-a-day care at home, which is outside the scope of part-time or intermittent care.
- Home meal delivery services.
- Homemaker services like shopping and cleaning that are not directly related to your medical care plan.
- Custodial or personal care solely for assistance with daily living activities such as bathing, dressing, or using the bathroom, when these are your only needs.
Eligibility for home health benefits is contingent on needing no more than part-time or “intermittent” skilled care. It’s permissible to leave home for medical appointments or short, infrequent outings for non-medical reasons, such as attending religious services. Participation in adult day care programs does not disqualify you from receiving home health care.
