Home Healthcare

What is home healthcare?

Home healthcare is medical care provided in your home when you are confined there due to illness or injury and need "skilled care," such as dressing changes or physical therapy. This care is ordered and supervised by your healthcare provider. A plan of care is developed by you, your healthcare provider, and the home care staff. Any changes must be approved by your primary healthcare provider.

What services are offered in the home?

Home healthcare agencies provide the services of healthcare professionals, such as nurses, medical social workers, and therapists (physical, occupational, speech, and respiratory). They also provide home health aides for personal care.

Nurses assess your condition, change dressings and give other treatments, including injections. They also monitor medicines and show you how to use equipment.

Medical social workers will make sure that you have the assistance you need or are entitled to. They will also work to make sure your emotional needs are addressed while you are adjusting to being homebound.

Physical and occupational therapists work with you to improve your strength and ability to do everyday tasks, such as bathing and dressing. Therapists can look at your home and suggest easier or safer ways to do things. They may also recommend assistive devices to help you.

Home health aides help you with personal care such as bathing and shaving. They may also do light housekeeping.

Some home care agencies provide other services, such as medical equipment rental. They may have wheelchairs, commodes, or other equipment that you can rent.

Some agencies have help available for you to hire that is not covered by your insurance. You may want to hire helpers by the hour or by the day. The kinds of helpers may include nurses, personal care aides, or home health aides.

How do I choose a home care agency?

You have the right to choose the home healthcare agency you want to provide your care. There may be many agencies in your town. A hospital or healthcare provider may give you a list of agencies but cannot tell you which agency to use.

Choose an agency that either provides all of the services you need or works closely with other providers. Interview the nurse that will be involved in your care. Since home care staff come into your home, there needs to be a good fit between you and the staff.

You may have concerns about people you don't know coming into your home. Choose an agency that is accredited or Medicare-certified. Accreditation means that an impartial third party inspected the agency and it met quality standards. All Medicare-certified agencies are reviewed by the state health department and must meet federal and state regulations.

Does insurance pay for home care?

Many healthcare insurance plans cover home health services. Each plan is different, so review your policy to see what your plan covers. Insurance will not cover nurses, aides, or therapists whose services are not medically necessary. Insurance does not cover services when they are needed for personal care only.

Medicare pays for home healthcare when these 4 conditions are met:

• You require intermittent (not 24-hour) skilled nursing care, physical therapy, or speech therapy.
• You are not able to leave your home.
• Your healthcare provider decides that you need home healthcare and sets up a plan for you to receive home care.
• The home care agency you are using participates in Medicare.

A prior stay in the hospital is not required to receive home care benefits under Medicare. There is no deductible for home care services.

Medicare Part A (or Part B if you do not have Part A) pays for part-time, covered services for as long as they are medically necessary and reasonable. The home healthcare benefit also pays for some medical supplies and 80% of the approved amount for durable medical equipment (DME). DME includes wheelchairs, walkers, hospital beds, portable toilets or commodes, and oxygen supplies.

For more information on home healthcare agencies in your community, contact your hospital discharge planner or social worker or check the Yellow Pages under nursing. For more information on Medicare coverage, call 1-800-MEDICARE.