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Home Health vs Skilled Nursing

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As more seniors choose to age in place, home health agencies have responded by offering skilled services provided by licensed nurses or therapists in clients homes. When prescribed by a doctor, these short term skilled care services can be covered by medicare, some private health care insurance policies, veterans benefits and long term care insurance policies. Utilizing a home health care provider enables an individual to receive highly effective medical treatment, while remaining as independent as possible in the comfort of their own home.

An easy way to look at it is to explore the types of home health care services that medicare will pay for. If you qualify for the home health benefit, Medicare will cover the following types of care:

  • Skilled nursing services and home health services- provided up to seven days a week for no more than eight hours per day and 28 hours per week(medicare can cover up to 35 hours in unusual cases)
  • Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self inject) tube feedings, catheter changes, observation and assessment of a patients condition, management and evaluation of a patients care plan and wound care are examples of skilled nursing care that Medicare may cover.
  • Medicare pays in full for a home health aid if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the medicare home care benefit. An example of a home health aid that would be covered by medicare is if you are needing the aid due to a recent fracture of a bone that is healing that you are also undergoing physical therapy services while at home.
  • Skilled Therapy services including physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength to a body area. Speech-language services include exercises to regain and strengthen speech and language skills. Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long these services require the skill or supervision of a licensed therapist, regardless of your potential to improve. It’s a good point to remember that if for instance you only need occupational therapy that you will NOT qualify for the medicare home health benefit for just that need. However, if you qualify for medicare coverage of home health care on another basis, you can also get occupational therapy. When your other needs for Medicare Home Health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it.
  • Social Services. Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
  • Supplies. Medicare pays in full for certain medical supplies provided by the medicare certified home health agency. Things such as wound dressing materials and catheters.
  • Medical Equipment also referred to as “durable” medical equipment. Medicare will pay 80% of its approved amount for certain pieces of medical equipment such as wheelchairs, walkers and bedside commodes.

There are some certain things Medicare will not cover while under the home health benefit.

  • Medicare will not pay for 24 hour a day at home prescription drugs. To get Medicare to drug coverage you need to enroll in a Medicare part D plan. If you are staying in a facility for your “therapies” or “skilled care” the facility orders your medications and its covered under the Medicare part A while you are in patient.
  • Medicare does not pay for meals to be delivered to your home. If you are at a facility your meals and room are also covered by Medicare part A.
  • Medicare will not pay for you to have a homemaker or other custodial services in your home. Which are provided if you choose to rehabilitate in a skilled nursing facility.

Making the decision whether it is best for a patient to be admitted to a skilled nursing facility versus returning home for therapy and nursing care is one that is made with the assistance of your doctor, Social workers and therapist in the hospital. Along with family input the outcome should be the one that is going to be the best and safest for the patient. There are times when patients need 24 hour care after a hospital stay and they have no one to stay with them and being admitted to a skilled nursing is going to prove the be the best outcome. There are others who may have a spouse or child that can be available on a 24 hour basis for a short period after a hospital stay. It is always good to have some idea of the options that are available to seniors to help them age with dignity and respect.

Written by
Concierge Care Advisors

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