Home Health Care - Frequently Asked Questions |
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What kinds of home health care will Medicare pay for?
If you meet all the requirements for home health care Medicare will pay for:
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Occasional skilled nursing care: This is care that can only be done safely and correctly by a licensed nurse (either a registered nurse or alicensed practical nurse).
- Physical therapy: Physical therapy includes exercise to regain movement and strength to part of your body, and training on how to use special equipment to take care of yourself.
- Speech-language therapy: Speech-language therapy is exercise to help you speak more easily and clearly.
- Occupational therapy: Occupational therapy helps you do daily activities by yourself, such as eating, putting on your clothes or combing your hair.
- Medical social services: These services can help you with social and emotional concerns related to your illness. For example, you might need counseling or help finding resources in your community.
- Some medical supplies such as wound dressings, but not prescription drugs.
- Some medical equipment such as a wheelchair or walker.
Does Medicare pay for personal care like bathing, help using the toilet or help with dressing?
Medicare might pay for these services, if you are also receiving skilled care such as nursing care or other therapy. Medicare does not pay for 24-hour-a-day home care, prescription drugs, meals delivered to your home or homemaker services such as cleaning, laundry and shopping.
I live alone and can’t care for myself. Will Medicare pay for 24-hour-a-day home health care?
No. Medicare pays for occasional or part-time home health care, but not for around-the-clock home health care.
Who provides home health care in my home?
Depending on your health care needs, various individuals may be assigned to provide care in your home. (See Home Health section for a list of the Lifecare Home Health Team)
When is an individual homebound?
An individual does not have to be bedridden to be considered homebound. However, the condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.
Generally speaking, patients are considered homebound if they have a condition (due to an illness or injury) that restricts their ability to leave their place of residence, except with the aid of a supportive device such as crutches, canes, wheelchairs, and walkers, the use of special transportation, the assistance of another person or if leaving home is medically contraindicated. In most circumstances, if a patient drives, he/she would not be considered homebound.
Please note that the homebound criteria are not met when: (1) frequent absences from the home are for social reasons, for shopping or business purposes; or (2) the patient attends adult day care for non-medical reasons.
What are some examples of homebound patients?
Some examples of homebound patients that illustrate the factors used to determine whether a homebound condition exists include:
- A patient recently paralyzed from a stroke who is confined to a wheelchair or requires the aid of crutches in order to walk;
- A patient who is blind or senile and requires the assistance of another person to leave his/her residence;
- A patient who has lost the use of his/her upper extremities and, therefore, is unable to open doors, use handrails on stairways, etc., and requires the assistance of another individual to leave his/her residence;
- A patient who has just returned from a hospital stay involving surgery suffering from resultant weakness and pain and, therefore, his/her actions may be restricted by his/her physician to certain specified and limited activities such as getting out of bed only for a specified period of time, walking stairs only once a day, etc.;
- A patient with arteriosclerotic heart disease of such severity that he/she must avoid all stress and physical activity; and
- A patient with a psychiatric problem if the illness is manifested in part by a refusal to leave home or is of such a nature that it would not be considered safe to leave home unattended, even if he/she has no physical limitations.
What if the patient is able to leave the home?
If the patient does in fact leave the home, the patient may still be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive medical treatment. Occasional absences from the home for non-medical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain health care outside the home.
What is the difference between Physical Therapy and Occupational Therapy?
The primary purpose of physical therapy is to optimize human performance through the evaluation, prevention and treatment of acute and chronic movement dysfunction.
Physical therapists focus on the large motor groups that contribute to standing, walking, and transferring. They work on strength, balance, range of motion and pain.
Occupational therapy is a health profession that helps people regain, develop and build skills that are important for independent functioning. Occupational therapists work with patients to maximize independence and safety withactivities of daily living: grooming, dressing, bathing, toileting and home chores.
Does Home Health provide medications?
No, medications are not provided by the home health agency.
Where exactly can Home Health services be provided?
Home Health services are provided in what is considered to be the client’s home. This could be a private home, assisted living, residential care home, etc.
Is my physician still in charge of my care when I am on Home Health Services?
Yes, your physician or the physician that has ordered home health services is in charge of your care. Home Health services can not be provided without a physician’s order and an approved plan of care by the physician. -back to to
Will Medicare allow someone to set up my medications for me?
Medicare does not cover medication set up for clients. Medicare will cover medication set up during the time a home health agency is providing another skill to a client in the home.
Are blue pads and diapers provided to clients under the home health Medicare benefit?
Diapers and blue pads are not part of the bundled supplies provided to the client. Medicare will only pay for diapers and blue pads that are used to provide care at a routine visit.
Will my Ostomy supplies be covered under Medicare while on service for home health?
Yes, ostomy supplies are covered and will be supplied to the client while on home health service providing that they are the same brand and type that the client is using. Most home health agencies stock only one brand and those that are typically used. The home health agency is not required to carry other brands that the client wants to use.
Is Medicare the only payor source for Home Health Services?
No, MediCARE, MediCAID, and private insurances such as BCBS and Aetna.
Does Medicare pay for Home Health Aide services?
Medicare will pay for home health aide services only during the time that the client has another skilled service providing care. Those skilled services include: nursing, physical therapy, occupational therapy, and speech therapy. Additional home health aide services can be provided under Faith In Home Services, LLC. (insert link)
How long can I have Home Health Service?
Home Health services can be provided as long as there is a skilled need for the home health agency to provide service. With physical therapy, the client will need to show improvement. With most of the private insurances, a client’s needs will be assessed by a case manger. There could be restrictions as to the benefits that the insurance covers, also. If you have private insurance, it is important you are familiar with what your insurance will cover.
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Norman OK, 73069
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