Navigating home care options can be confusing and complicated.
There are two types of home care: private duty home care and Medicare-certified home care. Medicare-certified home care consists in services that Medicare covers. These include in-home nursing care, and physical and occupational therapy. Private duty home care encompasses those services that Medicare does not cover, but that are essential components of a safe care-environment.
It is often the case that an individual receives both types of services at once. The right combination of Medicare-certified and private duty services is the one that provides a client with the best possible home environment at the most reasonable cost.
Always There provides private duty services, and we partner with Medicare-certified agencies to provide optimal plans of care for our clients.
Medicare Home Health is a term used to refer to Medicare-certified agencies that provide services which are paid for by Medicare. Medicare is not, and was never intended to provide long term in-home care. Services are "reimbursement driven,” meaning that the patient has to fit into a specific category for which care is reimbursed by Medicare.
Medicare services include skilled nursing care, occupational and physical therapies and certain other health care services one receives in a home setting for the treatment of an illness or injury. Medicare covers some home health care if all the criteria below are met:
- A doctor decides medical care at home is needed, and makes a plan for that care at home
- At least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy is needed
- The patient is homebound—meaning being normally unable to leave home and leaving home is a major effort. If one does leave home, it must be infrequent, for a short time. The patient may, however, attend religious services or leave the house to get medical treatment, including therapeutic or psychosocial care. Receiving care in an adult day-care that is licensed or certified by a state or accredited to furnish adult day-care services is also permitted while receiving home health benefits paid for by Medicare.
- The care must be medically reasonable and necessary. It must be related to problems encountered by the illness or injury and the care plan must address realistic outcomes. The plan and care needed has to show potential for an improvement in health/activities of daily living.
- The home health agency providing the care must be approved by the Medicare program
Hospice Care (covered by Medicare) is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments. Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management. It is generally depicted as end-of-life care and can be in a home or a hospital setting, but one requirement is that someone be with the dying patient at all times.
Most hospices accept patients who have a life expectancy of six months or less and who are referred by their personal physician. The goal of hospice care is the improvement the quality of a patient's last days by offering comfort and dignity. Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.
Hospice coverage is widely available—offered by most private insurance providers and through Medicare nationwide, and by Medicaid in Connecticut.