Home Health Care

Home Health Care Verses Home Care

Home health care focuses on the senior's medical needs. Typically performed by licensed professionals, such as nurses, nurse aides, and therapists, a home health care plan is directed by the patient's physician. Appropriate health professionals then perform the recommended services at home.

Conversely,"home care" addresses the non-medical needs of the patient, such as assistance with activities of daily living. An unlicensed professional may also perform home care. Some home health providers offer assistance in both areas. Typical home health services include:

• Rehabilitation
• Medical therapy
• Convalescent care
• Skilled nursing, including
  • Wound care
  • Respiratory care
  • Physical and occupational therapy
  • Speech-language therapy
  • Patient and caregiver education
  • Intravenous medications, nutrition therapy
  • Injections
  • Health monitoring

Home Care Services (non-medical)

• Assistance with activities of daily living (ADL)
  • Bathing, grooming, eating, mobility assistance etc.
• Light housekeeping and cooking
• Transportation
• Medication Monitoring

Health Agency or Individual Care

Home health care agencies and skilled individuals both provide home health care services. Two primary reasons exist for choosing health care by an agency necessary:

• Insurance: Medicare requires the utilization of a licensed home health care agency as part of their reimbursement requirements.
• Availability: An individual, no matter how skilled, will need time off. If there is prolonged absence, due to illness or injury say, the senior patient would be at risk for not receiving the care they need.

Depending on your insurance coverage, you may wish to employ an individual to address non-medical needs. Experience, references and a stable work history are important factors in considering a home care provider.

Payment for Home Health Services

Medicare, Medicaid, and most private insurance plans pay for home health care services. Each plan has unique criteria for eligibility, but the majority of it depends on medical necessity. Individuals may pay out-of-pocket for uncovered services and some agencies receive funding to provide care to low-income individuals.

Medicare

Medicare maintains strict requirements for the approval and payment of home health care. However, many seniors are unaware they remain eligible. A common misconception is over the definition of a "homebound" patient, by Medicare standards. Patients are allowed to leave the home intermittently and may still qualify for home health care.

The recommendations by the senior's personal physician are paramount. Medical reports should include the substantial difficulty involved for the senior patient, if and when they leave their home. For more information about homebound status, see, Myths About Home Care, by the American Academy of Home Care Physicians.

Medicare requires that you meet all four of these conditions:

1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home.
2. You must be homebound, or normally unable to leave home or it takes considerable effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to attend religious services.
3. The home health agency caring for you must be certified by the Medicare program.
4. You must need at least one of the following: intermittent (and not full-time) skilled nursing care; physical therapy or speech-language pathology services; or continued occupational therapy.

Finding a Care Provider

An effective way to find a quality care provider is to ask for recommendations from one's doctor, hospital discharge planner or social worker. Another option is to solicit the opinions of friends and relatives. You may also wish to check with state and local agencies on aging.

Questions to Ask

After you have enough referrals, speak with representatives from each place. Have a list of prepared questions to ask. In addition, check the status of a home health care agency with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The Joint Commission provides accreditation, certification, and reviews of elder care facilities. You may verify the status of an agency online, via JCAHO's Quality Check.

When interviewing a home health care agency, include questions such as:

1. What types of services are provided?
2. How long has the agency been in business?
3. What types of insurance are accepted?
4. Can a list of fees and services be obtained?
5. Will the agency assist in finding financial help, if needed?
6. Are the care workers licensed and bonded?
7. What are the agency's accreditations? If none, why?
8. What additional support is offered (e.g. 24-hour phone access)?
9. Are there references (doctors, patients and family members) that you can contact?

Patients and caregivers should learn additional specifics on the quality and quantity of the staff, equipment, and the level of coordination among care providers. For additional questions to consider see: JCAHO

For More Information

The Eldercare Locator, a public service of the U.S. Administration on Aging, connects seniors and caregivers with information on senior services. Another resource is EldercareOptions.org. they maintain a database of 80,000 elder care providers.

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