Who Qualifies for Home Health Care Services
Studies show that aging in place has many mental and physical health benefits for older adults. Home health care, also known as “at-home” or “in-home” health care, is health care services provided by trained professionals in the patient’s home. Home health care is given to those requiring medical attention but cannot leave home due to disability, age, or illness. This care can include various services, such as medical care, rehabilitation, and assistance with daily activities, with the goal to be to help patients recover from an illness, injury, or surgery and manage chronic health conditions.
Professionals can provide at-home care, including registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech therapists, home health aides, and companion care services. Services provided are dependent on each patient’s individual needs. Health care can include anything from wound care, medication management, exercise therapy, assistance with bathing, dressing, and grooming, or other tasks to help around the house and make a home livable and functional for the injured or ill.
Overall, home health care is a more personalized and cost-effective alternative to hospitals or long-term care facilities. It maintains patient independence, dignity, and mental health by allowing them to remain in the comfort of their home. However, getting home health care can be challenging.
The Requirements for At-Home Care
Patients must meet specific eligibility criteria to qualify for home health care services paid by Medicare, long-term care insurance, or other insurance policy. Here are some of the basic requirements:
You Must Have Medical Need
The first requirement to qualify for home health care services is medical needs. The potential patient must have a medical condition that requires skilled nursing care or therapy services. Additionally, to receive other forms of at-home care, they must prove they cannot meet their physical needs, such as bathing, dressing, or other simple life tasks. These conditions include chronic diseases, post-surgical care, wound care, and rehabilitation.
You Have Homebound Status
At-home care is primarily limited to those who are homebound. This means the individual must leave the home with a considerable, taxing effort. Whether this is due to physical limitations or cognitive impairment, if a medical professional has declared your loved one homebound, this helps qualify them for home health care services.
Have an Assessment Completed
To qualify for home health services, a patient must undergo a physical and mental assessment by a medical professional to determine eligibility. This is often conducted by a registered nurse or therapist who accounts for your medical condition, functional abilities, and home environment.
Doctor’s Orders on File
You must have a physician’s order to qualify for home health care services. Even though a doctor will not be performing the services, a physician must prescribe the type of care your loved one needs. Similar to ordering a prescription, this doctor’s order should detail the services required, the frequency of visits, the duration of care, and the level and type of professional who will conduct the services.
What Services Are Covered in Home Health Care?
In-home care covers many medical and non-medical services conducted by many trained professionals to help individuals maintain their independence and quality of life while aging in place. Here are some of the services that are typically covered:
Skilled Nursing Care
Skilled nursing care requires the expertise of a registered nurse. This can include medication management, catheter care, monitoring vital signs, wound care, and other medical care.
Various Therapy Services
Therapy services can be provided as a part of in-home care. This could be physical therapy to regain strength and mobility after an injury, occupational therapy to return to daily tasks and work, or speech therapy to restore communication abilities. In some cases, in-home care can also provide mental health therapy.
Medical Equipment and Supplies
Home health providers can supply patients with equipment and devices to help manage their medical conditions at home. This can include supplies such as oxygen tanks, wheelchairs and walkers, hospital beds, vital monitoring systems, emergency alerts, and other devices.
Personal Care and Homemaker Services
Personal care professionals assist your loved one with daily, necessary tasks that they cannot perform alone. These services include bathing, grooming, dressing, and other essential functions. Homemaker services include help with household tasks such as meal preparation, laundry, and light housekeeping required to maintain a clean and comfortable environment.
Relief and Respite Care
At-home care providers may offer respite care to temporarily relieve primary caregivers of their responsibilities. Respite care gives the family a break and allows them to rest and recharge, knowing their loved one is safe with a trained professional.
Which specific services are covered by home health services may vary depending on medical needs, insurance coverage, and eligibility. A physician develops an individualized care plan based on each patient’s needs, and they are provided for accordingly.
How To Pay for Home Health Care Services
Although less expensive than other long-term care options, home healthcare services can be costly. It is critical to know your options for payment. There are several ways you can pay for in-home care.
Medicare Part A & B Coverage
Medicare Parts A and B cover some in-home care services. For those aged 65 and older, Medicare will cover at-home care after a hospital stay, serious illness, or injury. Additionally, it will cover care for those with chronic conditions. The coverage includes skilled nursing, various therapies, supplies, and other services as long as eligibility criteria are met.
Medicaid Eligibility
Medicaid is a federal and state program providing healthcare for low-income individuals. In some states, Medicaid covers the cost of home health care services if a patient meets specific criteria.
Private Health Insurance
Some private health insurance plans cover at-home care. Coverage varies depending on your plan, medical conditions, and services needed. You will likely have to meet your out-of-pocket deductible each year before benefits are fully covered.
Long-Term Care Insurance
Have you been paying a long-term care insurance policy for years? You may be able to receive in-home care through this policy. Individuals must meet specific eligibility requirements, and qualified services are provided for several hours each week. Each insurance policy is different, so it is best to consult your insurance provider.
Veteran’s Association Benefits
Veterans may be eligible for home health services through the VA. The VA provides various services, including skilled nursing, therapy, and personal care to qualified individuals.
Out-of-Pocket Payment
If you do not have insurance or qualify for government programs, you can pay for in-home care out of pocket. Home health care costs depend on the type and frequency of the services and the level of professionalism required to perform each task. However, paying out of pocket usually means you have an increased ability to negotiate on price!
Researching your options and educating yourself on different types of at-home care is essential to determine what is best for you and your family. If you are confused or need clarification, contact a professional company such as Home Instead for help navigating the complicated world of home health care services.
How Home Instead Can Help
Are you searching for solutions to help your parent or loved one age in place? Home Instead is here to help! We have years of experience helping families navigate illness, injury, and elderly care. Our team of trained professionals are experts in providing the high-quality care your loved one deserves. Visit our website for more information, or schedule a free consultation to learn more about our home health care services by filling out this form. We look forward to helping you on your at-home care journey.
