Medicare Home Health Services for Seniors: An Overview

Feb 28th, 2010 | By Sharon Shaw Elrod MSW EdD | Category: Social Security & Medicare

One of the services offered senior citizens by Medicare is Home Health Services, covered under Parts A and B.  Medicare recipients must qualify for services, and they must be recommended/ordered by the individual’s primary care physician or specialty care physician. 

Services covered under the Home Health rubric include part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

It is common, for example, for an elderly person to need assistance upon discharge from a hospital or in-patient rehabilitation stay.  That individual’s physician, sometimes in concert with family members and the patient him/herself, would determine the in-home need and complete paperwork that refers the patient to home health care.  Other common situations include the slow physical decline elderly people experience; when that decline includes inability to care for oneself on a daily basis—but nursing home care is not yet required—the physician may recommend home health care for just those tasks the senior is unable to perform.

These four conditions must be met before home health services can be prescribed and covered by Medicare:

  1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
  2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech-language pathology services or continue to need occupational therapy; and
  3. You must be homebound, or normally unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious services. A need for adult day care does not keep you from getting home health care for other medical conditions; and
  4. The home health agency caring for you must be approved (“certified”) by the Medicare program.

Let’s take a look at a hypothetical example:  Wanda is 84; her husband died two years ago and she lives in her own home with her small dog.  She falls one evening and breaks her hip; following hip surgery and a month of rehabilitation in the hospital, she chooses to return home but needs assistance with light housekeeping and meal preparation; she also can no longer drive so she needs physical therapy at home; and she needs a walker because her physical strength was impaired with the long hospitalization.  Wanda’s physician discusses her needs with her and her family, and recommends home health care.  Services begin in Wanda’s home the day she returns from the rehab center.

Medicare.gov website says this about home health care:  “These services are provided by a variety of health care professionals in your home. The home health staff provides and helps coordinate the care and/or therapy your doctor orders. In support of your doctor’s orders, home health staff develop a care plan, which is a written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well being. You have a right to participate in planning your care and treatment. The home health staff keeps your doctor up-to-date on how you are doing and updates your care plan as needed. Home health agencies cannot make changes to the care your doctor orders for you without your doctor’s knowledge and permission.”

For more information about home health services covered by Medicare Parts A and B, check out this Internet web site.



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