In-Home Care of Elderly Woman


What Is Home Health Care?

Home health care — frequently referred to simply as "home health" — is skilled care delivered directly to a patient's home. This type of care is provided by licensed medical professionals including nurses, therapists, and aides for the purpose of treating or managing an illness, injury, or medical condition.

Home health care services can be delivered to the patient's residence (which may be a private home or adult foster home), an assisted living or long-term nursing facility, or a memory or residential care facility.

Services that may be covered include medical services such as skilled nursing, physical therapy, occupational therapy, and speech therapy, as well as non-medical services such as social services or assistance with daily living.

Is Home Health Care the Same as Home Care?

No, home health care (i.e. home health) is significantly different than home care. While the two services sound similar (both take place at a patient's home or residence), home health is administered by licensed medical professionals. Further, the type of care encompassed by home health care covers a myriad of ailments and diseases, including physical therapy, post-operative care, and treatment of Alzheimer's, dementia, and chronic health conditions.

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What Does "Homebound" Mean?

Home health care is available to any patient who needs it, but in order for it to be covered by Medicare, the patient must be deemed "homebound."

Homebound simply means that the patient's condition prevents them from being able to safely leave the home without assistance from others or assistive devices (e.g. canes, walkers, crutches, or wheelchairs).

In most cases, patients are still considered homebound even if they leave the home as needed for medical treatments that cannot be provided in-home. Brief and occasional non-medical absences may also be allowed, such as going to church, the beauty shop, or special family events.

What Are the Benefits of Home Health Care?

The primary benefit of home health care for the elderly is that it can be delivered directly to the patient's residence, whether it be a private home, adult foster home, assisted living or residential care facility, memory care facility, or long-term nursing home. By delivering care directly to the patient, expensive hospital bills can be avoided.

Family members are encouraged to be active participants in the planning process to help set and meet goals, working with home health care professionals for the benefit of the patient.

Additional benefits of home health care for seniors include:

  • Faster recuperation and recovery from illness or injury
  • Improved independence (over time)
  • Maintaining or improving of current condition or level of function
  • Regaining of self-sufficiency in the home
  • Slowing of the decline of serious conditions
  • Better symptom management

Pros of Home Health Care

  • Care is delivered directly to the patient's residence (either a home or facility)
  • Medical services are provided by skilled professionals
  • Home health care staff follow the physician-prescribed plan
  • Patients regain independence and self-sufficiency at home
  • Care is typically less expensive than hospitalization or a long-term nursing home
  • See additional benefits of in-home doctor visits

Cons of Home Health Care

  • Home care services like cooking and cleaning may not be included
  • Patients must meet the "homebound" requirements to qualify for Medicare
  • May not be adequate for patients who require 24-hour monitoring
  • Can be expensive if not covered by insurance or Medicare
  • Number of home health care providers may be limited depending on location

How Does Home Health Care Work?

The first step toward receiving home health care is to obtain a physician's orders and work with a home health care company to develop a detailed care plan. From there, you will be asked to complete an initial consultation with the patient, during which they assess the patient's needs and develop a plan for treatment. Family members and other caregivers are encouraged to participate in this planning process to ensure consistent and comprehensive care.

When services begin, home health care staff will implement the plan – following all physician orders – and keep the physician updated about the patient's progress. The frequency and type of home health visits will vary depending on the patient's needs. Some patients require daily care while others require only a short visit once or twice per week.

All services are tailored to the patient's needs.

What Does Home Health Care Do for Patients?

Home health care is designed to help the patient rest, recover, and receive treatment in the comfort of their own home or residence. Services provided by home health care are offered with the goal of helping the patient regain independence to become as self-sufficient as possible while also managing their disease or condition.

Home health care can benefit both acute and chronic conditions, including but not limited to the following:

  • Alzheimer's Disease
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Heart disease
  • Recovery from illness or surgery
  • Chronic conditions or injuries

In addition to providing medically necessary services for the treatment of the above conditions, home health care professionals act as a liaison between the patient, the patient's family, and the patient's doctor. Home health care professionals keep a log for each visit and provide updates on the patient's condition to the doctor as needed. This helps to ensure continuity of care.

What Services Does Home Health Care Provide?

Home health care consists of medically necessary, skilled services prescribed by a physician for the treatment of an illness, injury, or medical condition.

Skilled services provided by home health care may include the following:

  • Infusion therapy
  • Medication management
  • Nursing care
  • Nutrition services
  • Pain management
  • Psychiatric services
  • Social work
  • Therapy (physical, occupational, speech)

Services provided by home health care professionals are tailored to the patient's individual needs. Examples include checking vital signs, assessing pain, monitoring food intake, managing medications, helping with basic hygiene, and ensuring safety in the home.

What Services Does Home Health Care Not Provide?

Home health care only provides medically necessary services – skilled services prescribed or recommended by a medical doctor. It does not provide unskilled services or daily necessities such as cooking, cleaning, bathing, and transportation. These services are covered by personal home care assistance. Some home health care services offer personal home care assistance at an additional cost, which may or may not be covered by insurance or Medicare.

What Is a Medical House Call?

A medical house call is a medical visit performed by a physician in the patient's place of residence. These visits are typically administered to homebound adults who otherwise have limited or no access to regular medical care.

What Is a House Call Doctor?

A house call doctor, or house call physician, is simply a doctor who performs medical visits in the patient's place of residence. House call doctors may be employed by an agency, or they may have their own practice.

What Are the Benefits of Physician House Calls?

The primary benefit of physician house calls is that patients receive quality care, from qualified physicians, in the comfort and convenience of their own home or place of residence. Additional benefits of physician house calls include the following:

  • It ensures regular medical care to patients who have few or no other options (e.g. homebound adults, people who live in rural areas)
  • It helps monitor and treat both preventable and chronic conditions to keep patients out of ERs and hospitals
  • It encourages patients to keep up with regular medical visits by bringing the doctor directly to the patient's home
  • It saves the patient time and money traveling to the doctor's office

Though there are many benefits associated with medical house calls, there are also some challenges, namely that house calls are not ideal for emergency medical problems, and availability of physicians and scheduling options may be limited in some areas.

How Often Do House Call Doctors Visit?

House call visits can be scheduled as often as required by the patient, but on average patients are seen on a monthly basis. Visits are typically scheduled on weekdays, though the physician may be available by phone on weekends or after hours.

House call patients can be seen in their own home or in an adult foster home, assisted living or residential care facility, memory care facility, or long-term nursing home.

What Is Home Care Nursing?

When it comes to administering home health care, there are two types of skilled professionals who deliver care – nurses and physical therapists.

Home health care nurses must be trained medical professionals licensed to practice in their state and equipped to follow a physician's plan of care. Home care nurses typically work with elderly patients but may also provide services for children with mental or developmental issues, as well as patients with disabilities.

What Does a Home Health Nurse Do?

A home health nurse provides skilled services in keeping with a physician's plan of care for a home health care patient. These services may include the following:

  • Taking the patient's vitals
  • Administering pain medication
  • Completing medical treatments
  • Recording symptoms in a journal

In addition to these simple tasks, a home health nurse helps facilitate communication between the patient's physician and caregivers. Continuity of care is extremely important, and a home health nurse helps keep the lines of communication open, helping teach all involved parties how to properly manage the patient's condition.

What Do Home Health Nurses Do on Their Visits?

The primary function of a home health nurse is to follow the physician's plan of care, administering medically necessary services to treat, prevent, or manage the patient's condition. On each visit, the home health nurse will take the patient's vitals, track symptoms and other details of the patient's condition, and administer any necessary medications or treatments. Home health nurses may also keep a journal for each patient, recording the details of the visit to ensure continuity of care and communication between family, caregivers, and the patient's medical team.

What Is a Home Health Aide?

A home health aide is a professional who provides assistance to patients with special needs, including those who are disabled, chronically ill, or cognitively impaired. They may also provide services for seniors who require assistance in the home.

A home health aide may provide services including checking vital signs, assisting with personal hygiene, administering medication, and employing other elements of a physician-prescribed plan of care.

Home Health Aide vs. Personal Care Aide

The duties of a home health aide and a personal care aide overlap at times, but the key difference is that home health aides typically work for agencies instead of being directly employed by their clients. Home health aides play an important role in the continuity of care, coordinating among caregivers and medical professionals, and tracking the condition and progress of their clients.

While home health aides and personal care aides provide services to the same type of patient, a personal care aide's duties are typically limited to non-medical services. This may include dressing, bathing, cooking, cleaning, running errands, doing laundry, and providing companionship for their clients.

How to Get Home Health Care

There are several ways to apply for home health care, but the first step is to have your doctor evaluate your condition and draw up a home health care plan. Once you have a physician-prescribed plan, you can contact your health insurance company or work directly with an agency to establish service.

Before applying for home health care, make sure you meet all eligibility requirements.

Who Qualifies for Home Health Care?

There are rules for how to qualify for home health care, especially if you want it to be covered by your insurance or Medicare plan. In order to be eligible, you must meet these requirements:

  • Be under the care of a physician who orders home health services
  • Meet the definition of "homebound"
  • Require skilled nursing or therapy services on an intermittent basis

Specific home health agencies may have additional requirements of their own, and you may also need to meet certain qualifications for your insurance plan. Be sure to familiarize yourself with these requirements before applying for home health care.

How to Pay for Home Health Care

Patients and their families can save considerably by choosing home health care over long-term hospitalization or a skilled nursing facility. Still, medical care is expensive. When it comes to paying for home health care, there are several options:

  • Self-pay
  • Public third-party pay
  • Private third-party pay

The first of these options, self-pay, is home health care paid out-of-pocket. You may be able to negotiate the cost of services or arrange for a payment plan with the agency depending on your situation.

Most Americans over the age of 65 are eligible to receive federal Medicare coverage, which may then be used to pay for home health care services. In order to receive reimbursement for services, Medicare requires that the following conditions be met:

  • The patient is an eligible Medicare beneficiary
  • The physician certifies the need for services and creates a plan of care
  • The beneficiary meets the Medicare definition of "homebound"
  • The care must be delivered to the patient's place of residence
  • The patient requires intermittent skilled nursing or therapy services
  • The services are provided by a Medicare-certified agency

If you don't qualify for Medicare, or choose not to use it, you might be able to get home health care covered by a private insurance plan. Many insurers offer a cost-sharing provision for professional in-home care for seniors.

Typically, home health care providers accept Medicare and, in many cases, Medicare will pay for home health care if you are a current recipient and meet certain qualifications.

At Keystone Health, we accept Medicare along with other private insurance plans and self-pay options.

Is Home Health Care Covered by Medicare?

Home health care services are covered by Medicare as long as certain eligibility requirements are met. In order to be eligible for Medicare coverage for home health care, you must meet the following requirements:

  • Be considered "homebound" according to the Medicare definition
  • Require part-time or intermittent skilled care to improve, maintain, prevent, or further slow the progression of an existing condition
  • Be under the care of a medical doctor who prescribes home health care (you must have documentation of an in-person visit with said doctor either three months before starting home health care or within one month of when home health care begins)

Medicare typically covers skilled nursing care and rehabilitative services, which may include physical therapy, occupational therapy, and speech therapy. Depending on your needs, additional services like medical social services, durable medical equipment, medical supplies, and other in-home services may also be covered.

If you have Original Medicare, you may be able to receive home health care at no cost (though you might pay up to 20% of the Medicare-approved cost for durable medical equipment). If you have a Medicare Advantage Plan, you may qualify for additional coverage.

Medicare does not cover non-skilled personal care services such as cooking, cleaning, transportation, and other elements of custodial care.

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