Home care is a broad term that describes a wide variety of health and health-related services provided in the home or community. Home care is available to people of all ages with either acute or chronic conditions, as well as the disabled and terminally ill. The home care staff will work with the patient and their families to teach them about their condition as well as how to care for themselves or the patient, so that the patient can be as independent as possible.
The demand for home care has grown for many reasons. As our elderly population increases, more patients and their families prefer to stay at home rather than be in a hospital or a nursing home. Improvements in medical science and technology allow many treatments that could once be done only in a hospital, now be done at home. In addition, home care is usually less expensive and can often be just as effective as care in a hospital or skilled nursing facility.
Medicaid is a state managed program that helps pay the cost of health care services for people with low incomes.
Medicare is a health insurance program administered by the Social Security Administration for which people 65 and over are eligible. It has 2 parts: hospital insurance (Part A) and medical insurance (Part B). Most home care services are paid out of Part A.
Private Insurance will usually provide home health coverage. Veteran’s benefits may also cover home care services. Check individual polices for specific coverage details.
Self Pay is an option with all home care services. Check with individual home care providers for services offered and rates.
Home Health covers the following when they are medically necessary to help treat, restore, rehabilitate or sustain a patient in the home: Skilled Nursing, Physical Therapy, Speech-Language Pathology, Occupational Therapy, Medical Social Work, Home Health Aide and Medical Supplies. Physician orders are required for these services and the patient must meet certain guidelines to qualify. Medicare, Medicaid and Private Insurance cover these services when the appropriate criteria is met.
Home Infusion Therapy provides IV therapy and nutrition, such as chemotherapy, pain management and antibiotic therapy in the patient’s home. Nurses and pharmacists work with the patient and family to teach them to administer the covered medication. The patient should check with their specific insurance, or other payor, for coverage.
Home Medical Equipment/Durable Medical Equipment (HME/DME) are items that help the patient be more independent and improve their ability to function in the home. Some of the equipment included in this category includes canes, walkers, wheelchairs, beds, respiratory equipment and oxygen, apnea monitors and safety equipment such as bathtub rails.
Hospice is a special way of caring for individuals who are in the final stages of their lives due to a life-limiting illness. The hospice approach focuses on managing symptoms as opposed to curing an illness. Hospice services help patients, who are no longer seeking aggressive treatment or a medical cure, manage their terminal illness at home or in a home like environment. Hospice addresses the physical, psychosocial, and spiritual needs of the patient and family.
Personal Care Services (PCS) are in-home aide services (bathing, toileting, feeding dressing, home management tasks, etc) provided to qualified patients that have full Medicaid coverage (blue card). These patients often need the same type of services that patients in an adult care home need. Medicaid limits the number of PCS hours per day, and per month, that a patient may receive.
Private Duty Nursing (PDN) is medically necessary, continuous, substantial and complex nursing services provided by a licensed nurse in the patients’ home. Most of the sickest PDN patients are children. If a patient qualifies, Medicaid and some Private Insurance companies pay for this service. Medicare does not pay for this service.
The Community Alternatives Program for Disabled Adults (CAP/DA) provides an alternative to nursing facility care for disabled adults by allowing them to receive needed care in their homes.
The Community Alternatives Program for Persons with Mental Retardation/Developmental Disabilities (CAP/MRDD) provides services to individuals any age who normally would require care in an intermediate facility for the mentally retarded.
The Community Alternatives Program for Children (CAP/C) provides cost-effective care for medically fragile children who would otherwise require long-term hospital or nursing facility care.