Home Health Services offer a comprehensive array of medical care options delivered directly in your home, catering to individuals recovering from illness, injury, or managing chronic health conditions. Often, receiving care at home is not only more affordable and convenient but also equally effective when compared to similar care provided in hospitals or skilled nursing facilities (SNFs).
For those eligible, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover home health services. Coverage is available if you require part-time or intermittent skilled care and are considered “homebound.” Being homebound, as defined for Medicare eligibility, means specific conditions limit your ability to leave home. These conditions include:
- Needing assistance to leave home due to an illness or injury, which might involve aids like a cane, wheelchair, walker, or crutches, special transportation, or help from another person.
- A medical condition for which leaving home is not recommended by your doctor.
- A general inability to leave home due to the significant effort it requires.
Home health services covered under Medicare include a range of skilled care and support:
- Part-time or Intermittent Skilled Nursing Care: This involves medically necessary care provided by registered nurses. Examples include:
- Expert wound care for pressure sores or surgical wounds to promote healing and prevent infection.
- Comprehensive education for patients and their caregivers on managing health conditions and treatments at home.
- Administration of intravenous (IV) medications or nutrition therapy.
- Delivery of necessary injections.
- Diligent monitoring of serious illnesses and unstable health statuses to prevent complications.
- Physical Therapy: Personalized programs to help regain mobility, strength, and manage pain.
- Occupational Therapy: Therapy focused on improving your ability to perform daily activities at home and work.
- Speech-Language Pathology Services: Treatment to help with speech, language, communication, and swallowing difficulties.
- Medical Social Services: Support from social workers to address the social and emotional aspects of your illness, including counseling and resource planning.
- Part-time or Intermittent Home Health Aide Care: Provided in conjunction with skilled nursing care or therapy services, home health aides assist with personal care needs like:
- Support with ambulation and movement around the home.
- Assistance with personal hygiene, including bathing and grooming.
- Help with changing bed linens to maintain a clean and healthy environment.
- Aid with feeding, if necessary.
- Injectable Osteoporosis Drugs for Women: Medication administration to treat osteoporosis.
- Durable Medical Equipment (DME): Coverage for necessary medical equipment for home use, such as wheelchairs, walkers, or hospital beds.
- Medical Supplies: Provision of medical supplies needed for your care at home.
- Disposable Negative Pressure Wound Therapy Devices: Advanced wound care technology for complex wounds.
To initiate home health services, a physician or a qualified health care provider, such as a nurse practitioner, must conduct a face-to-face assessment to confirm the medical necessity of home health care. Following this assessment, a doctor or authorized provider must create a care plan, and the services must be delivered by a Medicare-certified home health agency.
Upon determining your need for home health care, your provider should furnish you with a list of home health agencies in your area. Medicare’s Care Compare tool (https://www.medicare.gov/care-compare/?providerType=HomeHealth) is also a valuable resource for finding agencies. Providers are required to disclose if they have any financial interest in any agency they recommend.
“Part-time or intermittent” care typically allows for up to 8 hours per day of skilled nursing and home health aide services combined, 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 a maximum of 35 hours per week, while still remaining under 8 hours per day.
It’s important to note what Medicare does not cover under home health benefits:
- 24-hour care at home.
- Home-delivered meals.
- Homemaker services, like shopping or cleaning, that are not directly related to your medical care plan.
- Custodial or personal care services focused solely on assisting with daily living activities such as bathing, dressing, or using the bathroom, when these are the only services needed.
Eligibility for home health benefits is contingent on needing no more than part-time or intermittent skilled care. You are permitted to leave home for medical appointments or infrequent, short 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.
Home health services offer a vital option for receiving necessary medical care in the familiar and comfortable setting of your own home, promoting independence and well-being.
