Home health care is a service designed to provide skilled medical care in a person’s home, helping those who can no longer care for their needs independently. It can help people remain at home for longer, promoting their health and delaying the need for facility-based care. In this article, we’ll explain the services you can and can’t get with home health care, who it is for, and how to pay for it.
Services provided in home health care
Home health care focuses on medical services, including pain management, monitoring vital signs, wound care, physical therapy, medication management, and more. Many of these services are the same as those provided at a hospital or skilled nursing facility, which are vital for supporting people with significant health issues.
While the services under this type of care are medically focused, home health care staff can provide some nonmedical custodial care, such as assistance with activities of daily living (dressing, bathing, etc.), when these are relevant to the patient’s medical care plan.
Services not provided in home health care
Because of the medical emphasis, home health care typically does not include activities like cleaning, shopping, meal delivery, and companionship. These types of support are offered through nonmedical home care, which excludes skilled medical services.
Assistance with activities of daily living is an interesting exception. These services can be provided as part of home health care but only if prescribed as part of a medical care plan. If someone needs only nonmedical support with activities of daily living without the need for medical care as well, they’ll need to go through home care instead.
Combining services
Home health care and home care aren’t mutually exclusive. Some families may hire someone from each type of service to provide the most comprehensive support. Doing so may involve paying for home care out of pocket while possibly receiving financial support for home health care costs.
Who provides the care?
Home health care services are delivered by medically trained professionals, such as registered nurses, licensed practical nurses, occupational therapists, and physical therapists. As such, you can be confident that the care is of high quality and provided by people with extensive training.
Who is home health care for?
Home health care is for people with significant medical needs who wish to remain at home. It is most often used for individuals with serious illnesses or injuries and those with complex medical conditions. Seniors are regular recipients, whether due to chronic health conditions or the health challenges associated with aging.
Home health care may be a short-term service, such as for an individual recovering from surgery or an injury. In these cases, services include supportive and rehabilitative care, including physical therapy, speech therapy, and occupational therapy. The service can help individuals regain their previous level of functioning.
It can also be a long-term service, especially for people with progressive illnesses, such as seniors with dementia or cancer. Here, the patient’s abilities tend to decline over time.
Home health care may not be suitable for people with considerable needs. It can get expensive quickly, especially if the individual needs extensive care for long durations. Funding options may not cover all needed care in the home.
Paying for home health care
The exact cost of care depends on multiple factors, including location, level of care, provider, and number of hours. This type of care is often prescribed by a doctor, who must deem it medically necessary. Such a prescription increases funding options for the service, as insurance may cover it, so the individual may not need to pay much at all. Let’s go over some ways to pay for home health care services.
Medicare
If a doctor prescribes home health care, Medicare Part A and/or Part B may cover it. However, this is only true in very specific circumstances. To qualify, an individual first needs to be considered homebound, meaning that leaving the home is extremely difficult without a mobility aid or another person or that their medical provider has advised against doing so.
Even then, Medicare will pay only for part-time or intermittent care. Typically, recipients can receive up to 28 hours of care per week, with no more than 8 hours per day. They may be eligible for up to 35 hours per week, but only for a limited time.
Medicaid
Medicaid may pay for in-home care if an individual qualifies. Participants need to meet Medicaid’s financial criteria and functional requirements.
A crucial consideration for Medicaid’s home health care coverage is whether the individual needs a nursing home level of care. Each state uses its own assessment tools and methods to determine mental and physical functioning requirements for needing a nursing home level of care, creating significant variability from state to state. In addition, some states provide 24/7 nursing care or close to it, while others allow only for part-time care.
Home- and community-based services are also available through Medicaid waivers. These waivers allow individuals to receive care in their homes rather than needing to move to an institutional setting. They may have criteria similar to those for standard Medicaid coverage but can offer additional services. The catch is that Medicaid waiver programs often have a waiting list, which can be frustrating if support is needed now.
In some states, Medicaid recipients may be able to hire a family member or even a spouse as a caregiver. However, for home health care, anyone hired must have the appropriate qualifications, which excludes family members without the proper medical training and education.
Other ways to pay
Veterans benefits can help eligible people with the costs of home health care. Long-term care insurance may help, too, although it must be purchased long before it is needed. In other cases, people must pay out of pocket to meet care needs.
Final thoughts
Home health care provides valuable support, helping seniors remain safely at home while receiving the medical care they need to stay healthy. It is especially beneficial for seniors with relatively minor health needs who can receive adequate support from a few hours of skilled nursing care daily.
