Home Health Care
Home Care | Medicare Home Health
Medicare Skilled Nursing Care at Home – Physical Therapy, Occupational Therapy and Visiting Nursing is Patient’s Choice
The decision to bring a Home Health Care Professional into your home to care for your loved one is extremely personal and important decision. Often times your doctor may recommend a home health care agency, but under Medicare law you have the right to select a home care agency that you desire.
Non-Medicare Personal Care at Home – Private Duty
The task in finding the right skilled professional to fit your personal needs can be time consuming and emotionally exhausting. At Silver Census we are dedicated to placing only licensed Home Health Care Professionals in need of employment situations with families who need their services. Our knowledge of the Health Care field paired with the partnerships we have forged with our affiliates makes us a resource that can ease the stress and burden of finding quality Home Health Care Providers.
Here are a few frequently asked questions about home health care that you may find helpful:
Understanding Qualifying for Skilled Home Care Services – Medicare Certified Home Health Care Agency
Do Home Health Agencies care for minors?
Yes, most will. Some Home Health Agencies specialize in pediatrics. Some Home Health Agencies will not because they may not have anyone on staff that has had previous experience with pediatrics.
Do Home Health Agencies provide hospice care (terminally ill)?
Yes, some agencies are specialized in this care. Medicare Home Health Agencies bill under Medicare Part A and Hospice Services at Home also does. Patients cannot be on both Medicare Home Health and Hospice Services at the same time as that is considered duplication of services.
Do Home Health Agencies provide RNs or LPNs on an hourly basis for skilled care, such as, patients on ventilators or with wounds that need care?
Yes, most agencies do provide this care, however, be sure to ask questions as to whether the healthcare professional has experience in this area. Some agencies are only licensed to provide companions and homemakers only.
Can a Home Health Agency provide a daily shower/bath visit only?
Yes, some agencies provide this care on a 1 hour basis for a flat fee each time the caregiver goes out to the home. However, each agency is different so check with your local home health agencies. Most agencies require a minimum of 4 hours per day.
What kinds of services are provided by a Home Health Agency?
Companions, homemakers, escorts, home health aides, physical therapist, occupational therapist, speech therapist and social workers. Some home care agencies may provide more or less of what is listed; however, this is standard in the home health industry
Will I have the same nurse come to my home for every visit?
Yes, for the most part in order to provide the best in continuity of care, home care agencies like for the same nurse to follow patients in their home. Medicare Home Health Care Agencies are required to open a new patient with a registered nurse NOT a licensed practical nurse. Sometimes Agencies utilize a RN to open a new patient but will assign a LPN to follow the patient and do the home care visits.
Is prior hospitalization required for Medicare home care visits?
Prior hospitalization is not a requirement to receive Medicare Home Health Services. What is required is a patient is 65 years of age or older or receiving Medicare disability, homebound according to Medicare guidelines, and a physician writes a home care order for skilled nursing and/or physical therapy in a home environment. Often times, physicians may order home care after a doctor’s appointment, post hospitalization or a short term stay at a skilled nursing and rehab center.
Can a resident in an Assisted Living Facility receive home health care through Medicare?
A patient can receive Medicare home health care services at an Assisted Living Facility. Keep in mind, there is no duplication of services as an Assisted Living Facility is still a home and does not bill insurance.
What type of patients may benefit from receiving home health care?
Medicare home health is designed for short term, intermittent, skilled care. Medicare home care does not provide custodial care such as cooking and cleaning for a patient. A licensed Registered Nurse (RN) will conduct the initial evaluation to determine how frequent a nurse whether the same RN or a Licensed Practical Nurse (LPN) will come and/or therapist following the doctor’s home care order. During the initial assessment, patients and their family have a great opportunity to be educated on proper care, medications required and frequency and duration of the home care visits.
Will the same nurse or therapist come to my home during each home health visit?
It is a rule of thumb in order to maintain continuity of care; most home care agencies try their best to keep the same clinician for each visit. From time to time a nurse or therapist may leave on vacation or be sick but should resume care upon their return to work.
Does a patient have the right to change home care agencies or nurse if he/she does not like them?
According to Federal law, home health care patients have the right to choose which institution, agency or person will provide their home care services. Under Section 1802 of the Social Security Act the law clearly states. Any individual entitled to insurance benefits under this title (such as Medicare) may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him/her such services. Your physician may suggest a particular home health care agency. It is patient’s choice whether you choose to accept care from that particular home health care agency or select one on your own.
What can physical therapy do for a patient at home?
For patients that need strengthening and are considered homebound, physical therapy at home is great for patients recuperating from a fracture or needing to learn to use equipment for ambulation and gait training. Physical therapists also make recommendations about removal of throw rugs in the home that can be considered obstructive and increase risk for falls. In addition, home physical therapist can help patients by teaching and educating families and patients alike of energy conservation techniques.
Why would a doctor order home health care for a patient?
A physician will order home health care services if he/she feels a patient would benefit from increased monitoring at home. Home health care can help reduce emergency care and hospital readmission for patients living with chronic illnesses and can educate patients on disease management process. Home health is a great way to increase patient’s compliance and can help reinforce proper diet, the importance of medications and other interventions in order to promote health aging.
What are some signs/symptoms why a patient may need physical therapy?
Physical therapy may be warranted in an aging adult if:
1. Taxing effort getting in an out of a chair or bed
2. Difficulty standing for a period of time
3. New onset of pain or complaints of pain
4. Increased difficulty retrieving objects
5. Change in balance or poor balance
6. New diagnosis that results in general weakness such as a mini stroke or pneumonia
What type of strengthen exercises are done at home with a physical therapist?
Physical therapy at home may be used for training purposes such as:
1. Stair climbing
2. joint mobility
3. transferring assistance and proper movement
4. Increase in stamina and activity tolerance
5. use of assistive devices
What types of nursing skills may warrant Medicare home health visits?
A few situations that may require home health services are:
1. Teaching a patient about Disease Management Process
2. Instruction in Medication Management
3. Post Operative Care (wound care and monitoring)
4. Catheter Care and Instructions
5. Observing and assessing exasperated health conditions that are unstable
6. Cardiac Assessment
What type of clinician can come to a patient’s home for home health under Medicare?
A clinician able to come to a patient’s home for home health can be:
1. Registered Nurse (RN) /Licensed Practical Nurse (LPN)
2. Physical Therapist (PT) /Physical Therapy Assistant (PTA) Assess and train a patient in strengthening techniques and properly performing activities of daily living.
3. Speech Therapist (ST) Assess and monitor language disorders and dysphasia.
4. Occupational Therapist (OT) Can assist and train a patient with upper body mobility and daily activities of living.
5. Medical Social Worker (MSW) Must be accompanied by a skill at home. The MSW can assess for social and emotional factors related to a patient’s illness and can recommend local outreach programs for the patient to benefit from.
6. Home Health Aide (HHA) Limited assistance such as assisting a patient with bathing up to three times a week.
What can a patient expect from a home health nurse regarding frequency and duration of visits?
Because home health care services is insurance based designed for short term intermittent care, clinicians generally give a patient a 2-3 hour timeframe of when a patient can expect the clinician to come by for a home visit. Family members and patients don’t be shy and be sure to ask for the clinician’s cell phone numbers to gauge visit time.
Can I go to Outpatient Physical Therapy and receive Home Health Care simultaneously?
Under Medicare guidelines, Outpatient Physical Therapy Services can not be utilized simultaneously as home health care. If a patient’s health requires skilled nursing care to monitor a recent health setback it may be best to start with home health care services at home with both nursing and physical therapy. Once the patient is feeling better and doctor approved, then Outpatient Physical Therapy may be appropriate.
What do I need in order to receive home health care services at home?
Contact either your primary care physician or specialist regarding your general health condition. There needs to be a new diagnosis or exacerbation of a current illness in order to receive care by Medicare and the patient must be considered homebound. The term homebound is subject to interpretation and more information can be found on www.medicare.gov. A good rule of thumb is if leaving one’s home environment requires physically a taxing effort, then you may be perhaps considered homebound.
What type of new diagnoses or exacerbation of diseases may be appropriate for home health care service?
Here are just a few of the many diagnoses/diseases that may be appropriate for a patient to receive home health care:
1. Congestive Heart Failure
2. Unstable Angina
3. Unstable blood pressure
6. Rheumatoid Arthritis
9. Chronic Obstructive Pulmonary Disease (COPD)
11. Bowel Disorders
14. Post Operative Surgery
15. Parkinson’s Disease
16. Multiple Sclerosis
17. Urinary Retention
18. Uncontrollable blood sugar – Diabetes
What can a home health nurse offer me?
Based on a patient’s diagnoses will determine the skill the nurse will be providing. For example, a patient that has a new onset of depression or anxiety may qualify for a behavioral nurse to evaluate and treat. This type of nursing care will educate the patient and family of disease management processes.
Can a home health nurse draw labs at home?
If a patient is in need of labs due to an illness and a true skill set is warranted and ordered by a physician, then it may be appropriate for the home health care agency to schedule a mobile lab company to draw blood.
Does a patient have to purchase medical supplies for wound care?
When a physician orders home health care services, the Medicare certified home health care agency is responsible for providing adequate supplies. Patient’s that are receiving IV antibiotics are responsible for medication and supplies through Medicare Part D plan and not the home health care agency.
How often will a home health care nurse come to my house?
The frequency and duration of a home health care visiting nurse will depend upon a few factors. For example, during the initial Medicare Home Health Care assessment, the nurse will review a care plan and establish a schedule for follow up visits. This will give the patient and family time to be educated on disease management processes and techniques.
Can a visiting nurse insert a picc line at home?
Traditionally picc lines are inserted at an in-patient environment. For example, a patient in need of IV antibiotics may visit an outpatient infusion suite at a physician’s office or visit a local hospital for picc line insertion. Home Health Care Agencies generally are not licensed for this service at home and based on the living conditions of the environment, there may not be a sterile environment. Too many factors may put the patient at risk and a controlled environment like a hospital may be a better solution for patient safety.
What do I do if I believe I may qualify for Medicare Home Health Services?
If you believe you or a family member may qualify for Medicare Home Health Care Services, speak with your physician about this request. Patients must be under the care of a physician who establishes and periodically reviews the home health care plan of care.
If I don’t see my doctor that often, can I get a home health care order?
To receive an evaluation for Medicare Home Health, a patient must have a face to face encounter with his/her physician. This must take place either 90 days prior to the physician ordering Medicare Home Health Services OR will take place within 30 days of the home health care nurse starting care.
How Medicare Health Care Works
Does Medicare require a hospital stay in order to qualify for Medicare Home Health Care Services?
A hospital stay is not required to receive Medicare Home Health Care Services. What is required is a physician’s order, a skill whether nursing and/or physical therapy and the patient must be considered “homebound”. Homebound is defined as a taxing effort to leave the home. Patients cannot be actively driving around and attending social outings. A patient can be considered homebound temporarily from a recent health care setback.
What happens if I am receiving Medicare Home Health and I am admitted to the hospital?
Medicare Home Health Services (Medicare Part A) and hospitalization (Medicare Part A) cannot be used at the same time. Medicare Home Health Services is temporarily put on hospital hold and the home care agency will not bill during this time until the patient resumes services. This holds true as well should a Medicare participant require a short term stay at a skilled nursing and rehab facility after hospitalization.
Can I receive just Occupational Therapy at home?
Occupational therapy at home is dependent on a patient qualifying for physical therapy.
What can an Occupational Therapist assist me with?
An Occupational Therapist can teach assistance with daily living techniques and fine motor skill training.
What can a Speech Therapist offer me at home?
Patient’s living with swallowing issues such as dysphagia can be evaluated for Speech Therapy at home.
When I hear the term homebound to qualify for Medicare Home Health Services, what does that mean?
Homebound means a patient’s condition must be such that leaving home requires a considerable taxing effort to leave the house. This can mean a need for assistive device such as a cane, rolling walker or wheelchair to safely leave the home.
How come when my Mother received Medicare Home Health Care after surgery in New York she had a home health aide that came often and now in Florida the agency is saying Mom can get an aide only twice a week?
It is up to the discretion of the Medicare Home Health Care Agency as to the frequency an aide comes and if it is warranted. Medicare coverage depends on three variables. These variables are Federal and state laws, national coverage decisions delegated by Medicare and coverage and local coverage decisions by home care agencies in each state. The agencies can decide whether a skill or service is medically necessary and is covered.
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