The first organized home care program in the United States was created by the Boston Dispensary around 1800 because wealthy people preferred home care to hospitalization. By the end of the century, lay persons began organizing voluntary nursing services which later became Visiting Nurse Associations. As the practice of nursing developed, nurses began to provide home care to sick or injured people. Homecare has grown rapidly with the growth of private insurance and by the 1940s, home health agencies were treating people with long-term illness. Today Medicare covers seniors needing home health, as well as assuming a leadership role in establishing standards for patient care today.
"Home care" is a simple phrase that includes a wide range of health and social services. These services are delivered in the home to recovering, disabled, chronically or terminally ill people in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Generally, home care is appropriate when a person prefers to stay at home. but needs ongoing care that cannot easily or effectively be provided solely by family and friends. More and more seniors want to live independently and are receiving home care services as they age and loose some of their physical abilities. Younger adults who are disabled or recuperating from acute illness are choosing home care whenever possible. Infants and children with long-term illnesses are receiving sophisticated medical treatment in their loving and secure home environments. Adults and children diagnosed with terminal illness also are being cared for at home, receiving compassionate care while maintaining dignity at the end of life.
Homecare services have been growing as hospital stays have decreased to save costs. Now increasing numbers of patients are going home while still requiring highly skilled services. Home health agencies have provided a safety net for these patients and help them to get better.
Does Medicare Cover Home Healthcare?
Medicare covers home health care for many people. Typically you can receive skilled nursing, physical therapy, speech-language therapy, occupational therapy, medical social services and home health aide services in the home if the patient has certain problems or conditions.
If you think homecare would benefit you or a loved one talk to your physician or a social worker in the hospital, they will be able to give you more information. Typically, a person will receive benefits if they meet the following criteria:
- A need for part-time or intermittent care
- Situation where it is reasonable and necessary to treat the illness or injury
- Under the care of a physician
- Homebound
Does Private Insurance Cover Home Healthcare?
Most private insurers cover home health benefits under the major medical portion of the policy. Most insurance companies have a home health agency they contract with to provide care to their customers. If you feel you need home health services you would need to contact your insurance carrier to see if they have a "preferred provider". If your insurance company does not have a "preferred provider" in your area you will have the choice of what agency you use but there may be limitations to the number of visits or hours of service you are allowed to receive on an annual basis. You would need to contact your insurance provider for this information.
Does Medicaid Cover Home Health?
Medicaid is a state covered insurance program and coverage will vary from state to state. Medicaid will pay for nursing and home health services as well as medical supplies but certain coverage requirements must be met and there may be a limitation on the number of visits you will receive.
What Does Homebound Mean?
Medicare and other private insurance companies require that a person be "homebound" to receive benefits in the home from a home health agency. A person is homebound if
- It is hard to leave home without a considerable and taxing effort. And the patient leaves home infrequently and for brief periods, unless the person is out of the home to receive medical care.
- A medical condition that limits your ability to drive for a short period of time.
- Supportive devices are needed to help overcome physical limitations. Note:
This is a factor in determining if a person is homebound.
- A psychiatric problem makes it unsafe for the you to leave home.
Note: A patient's inability to drive does not make him/her
homebound.
How Do I Get Home Health?
If you think you or your loved one needs home health you should talk to your physician or social worker/discharge planner in the hospital. Your physician can recommend home health and request an evaluation from a certified home health agency. A nurse will come and visit you or your loved one and complete an evaluation. If the patient is on Medicare this wonÕt be charge for this service, however, a private insurance company may or may not cover the visit. We suggest you ask the homecare agency to help you find out.
How Do I Make the Right Choice for a Home Care Provider?
Finding a home health agency may require some research but it can be time well spent. You may want to visit www.medicare.gov and view the Home Health Report Cards for agencies in your area. The Report Cards provide a glimpse of the quality of care an agency provides.
You may also consider calling a few agencies and are some questions about their services. Some questions you may ask are listed as follows:
- How long have you been serving the community and what services do you offer?
- What is the average length of time from referral to initial visit?
- Does your physician work with your agency?
- Does the agency have written statements describing it's services, eligibility, requirements, fees, patient rights, confidentiality, complaint procedures, range of services and emergency preparedness?
- Is the provider certified by Medicare if you are a Medicare patient? Only Medicare certified home health agencies can provide services covered by Medicare.
- How does your agency choose it's employees? Does the agency provide written policies and clinical protocols for clinical care? Does the agency have malpractice insurance?
- Will the agency continue services if Medicare or other reimbursment sources are exhausted?
- How does the agency communicate to the family?
- Will the agency discuss with the patient and family the specific plan of care?
- Will the agency provide the family with patient education material to help them get better or learn to live with their condition?
