Can you tell me if I qualify for home care services covered by Medicare?
There are three basic guidelines to meet:
- A person must be considered homebound—you may go out to the doctor, occasionally to church or to the barber/beautician, but you must not drive yourself.
- You must be under a doctor’s care who agrees home care is necessary.
- There must be a skilled need: nursing care, physical, occupational, speech therapy or medical social worker.
For home care to be covered under Medicare, services provided must be “skilled.” What are skilled services and how long can patients receive home care?
To determine if care is skilled, the nurse assesses the condition of the patient and the complexity of the patient’s needs. If the average non-medical person could provide the care without teaching, then the service is not skilled. There are many services that require skilled care, such as diabetic teaching, wound care, insertion of a catheter, teaching gait training for walker ambulation and more. For questions regarding skilled need, call a Medicare-certified home care agency. Usually a home care patient receives services from a nurse, home health aide, therapy or social worker for two months. As long as there is a skilled need that requires continued teaching or observation, visits can continue with physician orders. At the end of 60 days, each case is reviewed for continuing needs for services.
Is there a limit to the times per year someone can have home care services? My neighbor received home care visits three months ago after a fractured hip repair. Now she’s been sick with the flu which turned into pneumonia. Could home care services be started again?
With her doctor’s order, home care services can be restarted. Even though she was discharged from home care services after the hip fracture episode, she now has a new problem that qualifies her for home care services again. There is no limit to the number of days or number of times per year a Medicare recipient can receive home care services.
Of the questions I receive, many are about discharge planning related to home care, like this one:
My 88-year-old father is in a nursing home after a stroke. He wants to go back to his home but needs help. What do we need to do to plan for his return home?
Talk to the social worker/discharge planner at the nursing home and develop a discharge plan and time frame. Almost anyone discharged from a nursing home qualifies for home care. A nurse, home health aide for bathing assistance or a physical, occupational or speech therapist can provide care upon return home. Equipment may need to be ordered such as a hospital bed, wheelchair or walker, bedside commode or lift chair. The discharge planner and therapists at the nursing home can assist in identifying needed items, and assist in arranging home delivery. If additional hourly, private duty nursing assistant services are needed, they are available through licensed agencies, but these services are not covered by Medicare.
My husband was in the hospital and before we were expecting it, he was discharged over the weekend. We wanted home care, but since his doctor didn’t order it, we don’t have it. Is it too late to get help?
Sometimes discharge happens quickly, especially on weekends when most discharge planners are off. Call your doctor and his office will be able to contact a home care agency to start services. You can request any area Medicare-certified home care agency. Any equipment needed can still be ordered also.
I have stayed in a nursing home on the Medicare floor for the past three weeks. My Medicare coverage is up and I will return home soon. Does this mean I can’t have home care covered by Medicare after my return home?
You would start over regarding Medicare coverage for home care. With an MD order, home care can start upon your arrival at home. Medicare coverage for nursing home care and home care are not related. TPW
The owner of Home Health Care Plus, Inc., located in Pekin, Debbie Davison is also a Registered Nurse and holds a Master of Science in nursing. The Medicare-certified company has been serving clients and their families in central Illinois since 1994. Each client’s personal physician is directly involved to help HHCP bring an optimal level of independence and skilled nursing care, home health aide services and therapy. For more information visit www.homehealthcareplus.net or call 353-7300.