Home Health Care Information for Both Physicians and Patients

What is Home Health Care?

At its basic level, “home health care” means exactly what it sounds like – medical care provided in a patient’s home. Home health care can include a range of  care given by skilled medical professionals, including skilled nursing care, physical therapy, occupational therapy and speech therapy. Home health care can also include skilled, non-medical care, such as medical social services or assistance with daily personal activities provided by a highly qualified home health aide.

As the Medicare program describes, home health care is unique as a care setting not only because the care is provided in the home, but the care itself is “usually less expensive, more convenient, and just as effective” as care given in a hospital or skilled nursing facility.

When we say “home care” a common thought is senior care.  However; in  today’s society wellness draining diagnosis occur in every age group. Some of the more chronic, long-term illnesses greatly benefit from receiving home health care vs extended stays in acute care facilities and other health care in-patient services depending upon individual living situations and over-all health conditions.

Who qualifies for Home Health Care?

Each individual must contact their insurance provider to inquire about this skilled care provided within their home.  There may be co-pays per visit, limitations of the number of visits per episode and per calendar year, there may additional stipulations and should be understood by the patient and their families prior to discussing with a Medicare enrolled Physician.

To be eligible for Medicare home health services a patient must have Medicare Part A

and/or Part B.

To  be eligible for Home Health Care Services: (1)

  • Be confined to home.
  • Need Skilled Services.
  • Be Under the Care Of a Medicare -enrolled Physician.
  • Receive Services Under a Plan Of Care Established and Reviewed by a Physician and Have Had a Face-to-Face Encounter With a Physician or Allowed Non-Physician Practioner (NPP).  Care Must Be Furnished By or Under Arrangements Made by A Medicare-Participating Home  Home Health Agency (HHA).
  • Patient Eligibility—Confined to Home
    Section 1814(a) and Section 1835(a)
    of the Act specify that an

    individual is considered
    confined to the home” (homebound) if the following two criteria are met:
    First Criteria: One of the Following must be met:
    1. Because of illness or injury, the individual needs the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the
    assistance of another person to leave their place of residence
    2.  Have a condition such that leaving his or her home is medically contraindicated.

    Second Criteria Both of the following must be met:
    1. There must exist a normal inability to leave home.
    2. Leaving home must require a considerable and taxing effort.

     

     

    Home Health Aids May Be Included In the Home Health Care Assessment and Assigned To Assist With Personal Care – Activities of Daily Living  (ADL’s), Bathing, Feeding, Dressing, and Walking.

    To learn more about Home Health Care Nursing and being treated in the home environment, listen to Linda Jablonski, MS, BSN, RN-BC – Director of Nursing Home Health.   Click on the C.diff. radio logo below to listen to the podcast.

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Sources:

(1) CMS  (article se1436)  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/se1436.pdf