What is Home Care and Who is Eligible for These Services?

Courtesy Visiting Nurses Association of  North Texas

When illness requires medical care, often treatment can be done in the home instead of in hospitals. Home care nursing began in the 1880s when public health nurses traveled to patients’ homes to care for the ill, teach family members how to provide care, suggest ways to improve health, and comfort the dying. The arrival of the trained nurse eased the family’s burden of caring for the sick at home.

Today, home care plays an even greater role in the health and well being of patients of all ages and is an integral part of America’s health care system for the elderly. We are seeing less time spent being hospitalized for complicated health issues; therefore, requiring skilled care to remain on-going in the patient’s home.

Highly trained nurses and other health professionals, using advanced health care technologies and skills, make it possible for patients to receive care at home that once required traveling to clinics and hospitals. Cardio-vascular disease, lymphedema, dysphasia, diabetes, Parkinson’s, and other diseases can be treated by skilled home care professionals.

Through the use of telehealth home monitors, nurses are able to electronically check up on patients at home between visits, reducing the need for emergency room admissions and hospitalizations. Electronic clipboards allow nurses to chart vital patient health data during home visits. Data relayed to patients’ physicians permits them to make decisions and give directives for their care.

These and other new technologies make it possible for many patients to be cared for in their homes, reducing the burden on hospitals and nursing facilities. And home care is less expensive than other forms of health care. The average charges to Medicare per day in a hospital and skilled nursing facility are estimated at $1,500 and $475, respectively. The average charge to Medicare per home care visit is estimated at $150.

As a cost-effective means of providing high-quality health care and supportive services in the dignity and comfort of a patient’s home, home care also helps keep families together.

Many patients, though, are unaware that home care services, including hospice, are Medicare and Medicaid covered benefits. Many private insurance policies also cover these services. Medicare pays for in-home care for patients who are homebound and under the care of a physician. These services include skilled nursing; physical, occupational, and speech therapies; and personal care assistance, as well as medical supplies and equipment. Except for hospice care, health services received in the home are covered only for short periods of time and not on an on-going basis. Most often, the care is provided to patients recovering from acute illness, injury, or surgery. The services must be authorized and periodically reviewed by the patient’s physician, and be provided by a Medicare-certified home health agency.

Many individuals purchase Medigap insurance to cover expenses not paid by Medicare. Medigap insurance usually pays for certain personal care services when the policyholder is receiving Medicare-covered skilled home health services. The patient’s physician must order the services as part of a plan of care. As with Medicare, Medigap insurance is not designed to cover long-term care.

Medicare also covers in-home hospice services for terminally ill patients who have a life expectancy of six months or less and are ready to embrace comfort care instead of curative care. Services include palliative care nursing, medications, medical social work, equipment and personal care assistant. Hospice care must be authorized by the patient and the patient’s physician.

Medicaid also covers home care services, which can be of longer duration than what is provided by Medicare. Skilled nursing, rehabilitative therapies, and medical social services, in addition to medial supplies and equipment must be authorized by the patient’s physician. In Texas, Medicaid also covers the same range of hospice services that Medicare does.

Coverage of home care services by private insurance varies from policy to policy. Home care services are typically covered for acute needs on a short-term basis. Usually there are deductibles and co-pays made by the patient for the services. Long-term care insurance policies are also available for purchase to cover extended home care, if needed. Most private insurance plans also cover comprehensive hospice care. Individuals should review their health insurance plans to be certain what home care services they are eligible for.

Community-funded care, paid for by charitable donations and state and local taxes, may also provide home health and supportive services. Based on eligibility criteria, including the patient’s financial circumstances, all or part of needed home care services may be covered. Information about community-funded care can be obtained from hospital discharge planners, social workers, local offices on aging, and the United Way.

Visiting Nurse Association is a non-profit Home Health and Hospice Agency and can be reached at 214-689-2355 to make a referral.