New To Home Health
Puzzled about what kind of care is available in the home? You are not alone. Navigating the different options can be confusing. Everyone has heard of nursing homes and most have heard of assisted living and retirement communities. But how many can really say they understand the different options for home care?
As a new or prospective client, you probably have multiple questions regarding these services. This guide was created to give you a quick overview of home health care and provide you with the information you will need to determine if these services are right for you. Click the questions for the answers and feel free to contact us with any additional questions.
- What assistance is available in the home setting?
At this point, it is important to understand the difference between Home Health Care and Homecare services. Although they sound the same, they are quite different.
Home Health Care vs. Homecare
Home Health Care is medically oriented or skilled care. The high level of assistance provided by home health care requires a physician’s order and is covered by Medicare and most private insurance plans. It can provide the client with a wide range of professional licensed health care services, including nursing, therapy and medical social work. These services are focused on assisting the client to recover from an acute illness or injury and teaching them how to manage their own care effectively. The primary goal of home health care is simple – provide the client with the medical support they need to remain in their home for as long as possible.
Homecare is not medically oriented care and therefore does not require a physician’s order. The focus of homecare services is custodial in nature, with trained – but usually unlicensed - individuals providing assistance to clients with activities such as housekeeping, errands, meal preparation, transportation assistance and personal care. These services are often structured on an hourly basis, with the individual providing assistance to the client for an agreed upon period of time. (example: 3 hours a day, Monday – Friday) While the availability of these services can have a positive impact on a client’s ability to remain in the home, Medicare or most private insurance plans do not cover this type of care. Unless a client has a long term care policy which provides for this benefit, the cost of homecare services is usually the client’s responsibility. Some states cover homecare services through their state funded Medicaid program, but the eligibility for these services is extremely limited and the waiting lists are long.
Homecare services are called by many names…such as sitter, homemaker, private pay, primary homecare or paid caregiver services.
- What type of care does Renew Home Health provide?
Renew Home Health is a licensed and Medicare certified agency that provides skilled home health care to the patients we serve. Renew does not offer any non medical homecare, private pay, sitter or paid caregiver services.
- What kind of services could I expect with home health care?
Home health care utilizes a team of skilled professionals to provide specialized care within the client’s home and under the direction of a physician. Services may include nursing care, rehabilitative therapy and assistance with personal care.
- Would I qualify for home health services?
Medicare and most private insurance plans cover home health services for qualified clients.
To qualify, the following conditions must be met:
The client must be under the care of a physician and that physician must be willing to establish and regularly review the client’s home health plan of care.
The physician must certify that you have a skilled need – which is one or more of the following: Skilled Nursing, Physical Therapy, Speech Therapy or continued Occupational Therapy
The client must be homebound.
- What exactly is a “skilled need”?
A skilled need is a physician ordered service that requires the expertise of a medical professional, such as a nurse, physical therapist, occupational therapist, or speech therapist to perform. A few examples of skilled need are:
- assessment of an unstable client status
- evaluating effectiveness of new medications and instructing on their dosage/safe use
- providing instruction of a disease process or treatment regimen
- wound/catheter care
- IV therapy
- a decline in functional status such as an increased difficulty in walking
- new caregiver that requires teaching/assistance to be proficient in managing a clients care
- decreased ability of a client to safely and effectively care for themselves
- difficulty in swallowing
- deteriorating mental status
This list is only a small sampling of typical skilled needs for home health patients. If you have any questions regarding whether or not you may have a skilled need, please contact us for further information.
- I’m not sure I meet the homebound criteria. Can you explain what homebound means?
While home health services require that a client be “homebound”, that does not mean that a client is unable to leave the home. It simply means that, because trips outside the home require assistance and are a taxing effort for you, they are infrequent and of short duration. Medicare understands that there are times that clients need to leave the home….such as to obtain food and medications, attend physician visits, church services or special family functions. These trips are perfectly acceptable and do not keep you from qualifying for home health. Also consider that many times a client’s “homebound” status is temporary. While they may normally go outside the home frequently and with little effort, a hospital stay or recovery from an acute illness can change that…..if only for a few weeks. If you have any concerns about whether or not you would meet the “homebound” criteria, please contact us for further information.
- How much does home health care cost?
Traditional Medicare does not require preauthorization for home health care and all the services provided are covered at 100%. That means no deductible, no copay and no out of pocket expense for the traditional Medicare recipient. If you have traditional Medicare, you will not receive any bills from Renew Home Health or Medicare regarding your home health services. It is also important to note that traditional Medicare imposes no limit to your home health benefit. Therefore, there is no need to worry that using your home health care benefit now will prohibit you from receiving home health care services in the future.
If you have a Medicare replacement or private insurance policy, you will need to refer to your policy to establish any deductibles, copays or maximum benefit amounts that may apply.
Many Medicare replacement and private insurance policies also require preauthorization for treatment. In these cases, the agency will provide a report to your insurance provider and request authorization for your care. Unfortunately, insurance companies do not always agree with the physician’s recommendations for home health care services. In those cases, the agency will do everything we can to provide you high quality care within the service limits imposed by your insurance provider. If you wish to receive care outside of those service limits, we can provide that care to you at your cost.
- How long can I receive home health services and why would my services end?
Upon admission, the physician will establish a 60 day plan of care. Towards the end of the 60 days, a RN will reevaluate your need for further home health care. If you continue to require services, you can be recertified for another 60 day period. Traditional Medicare does not have a limit on how long you can receive home health care. If you meet traditional Medicare criteria, your home health services can continue for as long as you need them.
Once again, If you have a Medicare replacement or private insurance policy, you will need to refer to your policy for any preauthorization needs or benefit limits.
Your services will end when your goals are met, you no longer have a skilled need and/or you are no longer homebound. The agency will give you a minimum of 5 days discharge notice. Of course, you or your physician may request discharge at any time.
- What kind of situations will home health care not be able to help me with?
There are times when a patient’s needs are too great and home health is not an appropriate choice. The availability of a willing and capable caregiver is the most important factor to consider in cases such as these. For example: An individual, who lives alone and has no available caregiver, becomes significantly confused and begins to wander outside the home. While home health staff would be able to make regularly scheduled visits, those staff members would only be in the home for thirty minutes to an hour…depending on what is required. This would leave the client unattended for the rest of the time and put his safety in jeopardy.
A similar example that demonstrates when home health care could be an inappropriate avenue: A post surgical patient is sent home. She lives alone and is unable to get out of a bed or chair without assistance. Because of her immobility, she is unable to perform the simple tasks that we often take for granted – such as making a meal, dressing ourselves or going to the bathroom. The home health staff could assist her while they were making their scheduled visits but that would leave her unattended several hours a day.
Once again, home health care does not provide 24 hour care or sitting services. Because of this limitation, it is crucial that prospective clients either be able to meet their basic needs safely or have a family member or other caregiver available to them that can do so. If that is not the case, then an inpatient facility – such as a rehab or skilled nursing unit – would be a better choice….at least temporarily. Once the individual has recovered to the point of being able to safely stay alone, home health services could begin and help them transition safely back in to their home setting.
- I would like to start home health services. How do I move forward from here?
Please contact Renew Home Health. We will discuss your specific situation and provide guidance to you regarding whether home health is a good option for you. If it is, we will obtain your information, verify your home health benefits and request an order from your physician for a home health evaluation.
Once our intake staff will has received the physician’s order for home health care, you will be contacted and your home health evaluation visit will be scheduled.
We hope this information has been helpful to you in determining whether or not home health care is the right choice for you. If you have any other questions or concerns, please do not hesitate to call.