For many caregivers and families who are searching to find out more information on how they can care for their elders and loved ones, it can seem like a daunting task. One of the most important distinctions that have to be made on your information gathering quest is to know the difference between Medicare covered Home Care vs. all other forms of home care. In this article, we will explain what Medicare Home Care is and how to find out if you or your loved one qualifies.
What is Medicare Home Health Care?
Home Health Care is skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury.
One of the services offered to senior citizens by Medicare is Home Health Services. Medicare recipients must qualify for services, and they must be recommended by the individual’s primary care physician or specialty care physician.
Medicare beneficiaries who feel they may need Medicare home care should always look into whether they can actually qualify for Medicare home health services. It is not a general personal care or chore-worker service. Rather, Medicare home care covers limited, specifically defined at-home care related to diagnosed medical conditions, and sometimes includes personal care services.
These Medicare home care services must be prescribed by a physician, and provided through a licensed home health agency. The beneficiary must have a medical condition, or combination of conditions, that require periodic services from a skilled nurse or therapist. A plan of care will be developed that describes the specific services covered. Eligibility and coverage are evaluated strictly so the beneficiary’s conditions and care needs must be aired fully.
Medicare Home Care Qualifications
It is common for an elderly person to need assistance upon discharge from a hospital or in-patient rehabilitation stay. That individual’s physician, sometimes in concert with family members and the patient him/herself, would determine the in-home health care need and complete paperwork that refers the patient to home health care.
Other common situations include the slow physical decline elderly people experience; when that decline includes inability to care for oneself on a daily basis-but nursing home care is not yet required-the physician may recommend home health care for just those tasks the senior is unable to perform.
These four conditions must be met before homecare services can be prescribed and covered by Medicare:
1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech-language pathology services or continue to need occupational therapy; and
3. You must be home bound or normally unable to leave home & leaving home takes a considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons; and
4. The home health agency caring for you must be approved (“certified”) by the Medicare program.