Navigating the Home Health Maze
Information
BCPA | 1 CEU General
Long-term care services in the home support those who want to “age in place.” The Centers for Disease Control and Prevention describes aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”
According to an AARP survey, 75% of Americans 50 years and older want to live in their home for as long as possible. But almost half of them realize that may not be possible. Many older adults and their families have concerns about safety, daily activities, and just getting around. Aging in place at home requires consideration, planning, and knowledge of the available resources and cost. And that is where homecare services come into play.
Homecare is an essential piece of long-term care (LTC) but Medicare’s coverage of the services is very limited. Advocates needs to know how homecare services fit into an aging-in-place plan so they can help their patients and clients get the help they need.
There are two types of care that can be provided in the home.
1. The first is personal homecare.
These are generally non-medical, unskilled services, mainly designed to help with activities of daily living and maintain the individual safely in the home.
Personal care workers, often provided through a personal care agency that meets the state’s requirements, provide this care.
The payer source is generally private pay, although LTC policies, Medicaid programs, and other sources can help cover costs.
2. The second is Medicare home health, which has specific coverage criteria.
- A Medicare-certified home health care agency must provide the services under a plan of care.
- The patient must be considered homebound.
- The agency must provide skilled services.
- The services must be part-time or intermittent.
- Medicare will also cover home health aide services in specific situations.
If meeting the criteria, there are no costs to the beneficiary.
In too many cases, patients do not get home health care because the system is very confusing. Advocates can help patients and clients by recognizing when they need and qualify for Medicare services, and help them receive the necessary care.
Objectives
- Identify the two types of care that can be provided in the home.
- List two points about personal homecare.
- Describe the three important criteria for Medicare home health services.
