Home Health: Common Terms, How to pay for Home Health, Licensing and Questions to ask
Home health services are unique in comparison with other forms of care. Typically, a physician orders the services as a continuation of care. These services are generally provided so the patient may be in their home while receiving care, as opposed to a long -term facility like a nursing home. The individual’s treatment plan (as assigned by the doctor) may include physical and occupational therapy, the monitoring of recovery, injections or wound care. Upon completion of the rehabilitation, the patient may resume normal function around the house after they’ve recovered.
- Home Health: Common Terms, How to pay for Home Health, Licensing and Questions to ask
- Short-term or long-term care?
- Is Home Health the same as Home Care?
- How is Home Health different?
- What to look for in an agency
- What does the certified team of aides do?
- The services provided by the nursing team in Home health
- Laws and Regulations
- How much does Home Health cost?
*Take note that home health services are different from other types of care. Generally, when people think of senior care they immediately imagine a nursing home. This is definitely not the case. Nursing homes are far from your only option when providing care for a loved one.
Definitions of types of care
Home Care: Caregiver assistance related to activities of daily living, including: mobility, eating, toileting, bathing and personal hygiene, dressing and grooming or cognition support. These services are typically not covered by medical insurance and do not require a physician’s order.
Home Health: includes skilled nursing services, physical therapy, occupational therapy, speech language therapy and medical social services. A home health care agency may choose to be Medicare certified to be reimbursed for their services. Home health agencies may also teach you how to care for yourself. Services ordered by a physician, covered by Medical Insurance and typically provided following a hospital or skilled rehab stay.
Rehabilitation & Therapy: treatment for an injury, illness, or pain with the goal of restoring function, including nursing and therapy services. Rehab is ordered by
a physician and services are provided by nurses and physical, occupational, and speech therapists. Examples include working with a physical therapist to help you walk and with an occupational therapist to help you get dressed.
Respite Care: short term relief for family caregivers to take a break from the caregiving responsibilities and allows for a healthier and better quality of life for both the caregiver and care receiver. Respite services include: companionship, personal care, recreational activities and security. Respite care can be provided as short stay or for a longer period that allows the family caregiver to go on vacation or a business trip. Longer duration respite care is generally found at select senior housing communities although some Companion services may provide this service in the home.
Hospice Care (Palliative Care): emphasizes comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family. The goals of hospice are to keep the patient as comfortable as possible by relieving pain and other symptoms. Hospice care, is typically offered in the last six months of life and covered under Medicare Part A .
Short-term or long-term care?
Home health services are generally short-term (temporary), depending on the doctor’s orders. Not all home health services require around the clock care like patient’s and residents receive in a nursing home. However, there are situations in which the caregivers continue the home health services beyond the doctor’s order.
Is Home Health the same as Home Care?
Home care professionals assist with activities of daily living (ADLs). These in-home aides may assist with personal care and health monitoring, similar to the care an individual would receive in a long-term facility or community, in the comfort of their own home. Typically, this is non-medical care. However, caregivers may work with patients to craft a plan to fit their needs.
How is Home Health different?
Senior Home Health is a level of care designed for individuals who need care while recovering after surgery and other acute health conditions. Home health is there to assist in faster recovery, and allows a patient to discharge from the hospital earlier and reduce future hospital admissions.
These home health services are approved and prescribed by the individual’s doctor. Within the home health plan is a detailed description of the type (or types) of medical care your loved one will receive. It will show you the plan for what types of care professionals will be delivering the care and the schedule they will be working.
What to look for in an agency
Most commonly, your loved one’s doctor will prescribe a home healthcare agency. Being serviced by the agency your physician has chosen is not set in stone and you may choose to use a different home health agency if you choose. Healthcare is about choice – whether it be an assisted living facility or memory care or a residential care home or a nursing home – your loved one’s comfort is the prime objective. If you know someone, a friend or family member who has received home health care and they were satisfied with their trained professional team, you can inquire into that agency.
Who is the home health team?
- Home health aides
- Certified nursing aides
- Physical therapists
- Occupational therapists
What does the certified team of aides do?
Physical therapists work to help individuals regain strength and mobility after an injury. They may help with range of motion and muscle movement, relieve pain and improve general strength. The physical therapist will implement specialized exercises and teach how to do them with detailed instructions. Along with teaching rehabilitative exercises, they will be willing to answer any questions or concerns.
Registered Nurses (RNs)
RNs perform certain medical assistance, like changing dressings, managing catheters, injections, managing medications for patients. These nurses will make evaluations of the individual when visiting.
Certified Nursing Aides
These aides are certified to visit the home and provide medical care. They may help with ADLs as well. They are trained and certified to assist with mobility devices, administer medications, help with braces, massage and help with simple dressing of wounds.
With specific training, some certified nursing aides may operate medical equipment such as oxygen ventilators. Training and certifications will vary by state.
Home Health Aides
Home Health Aides come to the home and perform medical care. They may assist with activities of daily living (ADLs): preparing meals or bathing, getting dressed and even some light housekeeping as needed. These are trained professionals who can generally administer medications and may assist with mobility devices and other tasks.
The services provided by the nursing team in Home health
- IV transfusion
- Diabetes management
- Catheter care
- Tracheotomy care
- Post-op rehabilitation
Typically, visits scheduled a few times a week with different disciplines of the home health team.
Laws and Regulations
Licensing and certifications for Home health agencies must be in compliance with state and local standards. In order to receive Medicaid and Medicare, agencies must meet certain standards set out by the Centers for Medicare and Medicaid Services (CMS).
Each state has their own guidelines and regulations regarding the operations and licensure of agencies and certifications for nurses and aides.
How much does Home Health cost?
The good news is that typically home health is covered by Medicare. Generally plans are setup to be reimbursed by Medicare or other insurance when applicable.
In the case of having to pay for services, generally the cost is between $20 to $80 per week. This depends on the services and which health professionals are required: Home health aides are going to be less expensive than therapists and certified nurses.
How to pay for Home Health and available coverage
Generally Medicare reimburses the cost of Home health services. Medicare typically covers your loved one when recovering from an illness or an accident or a surgery.
*Medicare covers the specific ailment. When treatment is completed Medicare coverage stops.
Medicare is not a long-term care solution.
Medicaid programs are put in place on a state-by-state basis. Each state will have their own regulations regarding the coverage of care. Some individuals at a certain low-income level may qualify for Medicaid Home and Community Based Service Waivers.
Veteran Aid and Attendance:
This benefit is available to some military veterans or surviving spouses.
- A veteran may qualify for as much as $2,050 each month.
- A veteran with a sick spouse may be eligible for $1,600 per month.
- If a veteran has passed, their surviving spouse can qualify for $1,300 per month.
- Most health insurance companies typically cover some services for acute medical needs.
- Do be aware, long-term coverage vary by plan. Not all long-term insurance will assist with home health services as the needs of the person tend to be temporary.
Families which can afford to do so may pay for care with private funds. Private pay can be a combination of retirement funds, personal savings, pension payments and family members may contribute funds toward a loved one’s care as well.
Questions and Inquiries about Home Health
- How long has the agency been serving this community?
- Does the agency have any printed brochures describing the services it offers and how much they cost?
- Is the agency an approved Medicare provider?
- Is the agency currently licensed to practice (if required in the state where you live)?
- Does a national accrediting body certify the quality of care?
- Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?
- Is there a care plan in place that outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?
- How closely do supervisors oversee care to ensure quality?
- Will agency caregivers keep family members informed about the kind of care their loved one is getting?
- Are agency staff members available around the clock, seven days a week, if necessary?
- Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?
- How does the agency ensure patient confidentiality?
- How are agency caregivers hired and trained?
- What is the procedure for resolving problems when they occur?
- How does the agency handle billing?
- Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?
- Will the agency provide a list of references for its caregivers?
- Who does the agency call if the home health care worker cannot come when scheduled?
- What type of employee screening is done?
Home Health resources and links
The Center for Medicare & Medicaid serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes.
Medicaid agencies are available all throughout the United States. Find out if you are eligible with this link.
AARP will provide you with a full list of home health providers in the United States.