home health care PT working with home care worker and client

Home Health Care v Home Care: What's the Difference?

Mar 30, 2021

What is home health care?

The term “home health care” is typically used to refer to skilled care provided in the home, usually under Medicare. Here’s what may be included:

  • Skilled nursing care such as changing wound dressings, feeding through a tube and injecting medicine, provided on a part-time or intermittent basis. Your combined home nursing and personal care cannot exceed eight hours a day or 28 hours a week, except in limited circumstances. If you need full-time or long-term nursing care, you probably will not qualify for home health benefits.
  • Home health aides to assist with personal activities such as bathing, dressing or going to the bathroom if such help is necessary because of your illness or injury. Medicare covers these services only if you also are getting skilled nursing or therapy.
  • Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk in the aftermath of an illness or injury or to help keep your condition from getting worse.
  • Medical social services such as counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care and help finding community resources if you need them.
  • Medical supplies such as catheters and wound dressings related to your condition when your home health agency provides them. This might also include durable medical equipment from the home health agency, such as walkers or wheelchairs, but for those Medicare does not pay the full cost. You usually are responsible for 20 percent of the Medicare-approved amount.

Qualifying for Home Health Care and What Home Health Care is NOT

Home health care is not intended to be ongoing (“long term care”) or “custodial”. This is the type of care many elders and those with chronic conditions need to stay safely at home. Medicare home health care is not intended for this purpose. Here’s more about what is required to qualify for Medicare home health:

Medicare covers skilled nursing care when the services you need require the skills of a nurse, are reasonable and necessary for the treatment of your illness or injury, and are given on a part-time or intermittent basis (visits only to draw your blood aren’t covered by Medicare). 

“Part-time or intermittent” means you may be able to get home health aide and skilled nursing services (combined) any number of days per week as long as the services are provided:

  • Fewer than 8 hours each day 
  • 28 or fewer hours each week (or up to 35 hours a week in some limited situations)

These are the home health care qualification criteria:

  1. You are homebound. That means you are unable to leave home without considerable effort or without the aid of another person or a device such as a walker.
  2. You have been certified by a doctor, or by a medical professional who works directly with a doctor (such as a nurse practitioner), as being in need of intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy.
  3. That certification arises from a documented, face-to-face encounter with the medical professional no more than 90 days before or 30 days after the start of home health care.
  4. You are under a plan of care that a doctor established and reviews regularly. The plan should include what services you need and how often, who will provide them, what supplies are required and what results the doctor expects.
  5. Medicare has approved the home health agency.
  6. Medicare can pay the full cost of home health care for up to 60 days at a time. That period is renewable, meaning Medicare will continue to provide coverage if your doctor recertifies at least once every 60 days that the services remain medically necessary.

Download Guide to Medicare Coverage

Important to Know: Home Health Aide Services

It may seem a bit confusing when we talk about home care services, yet you see that home health aide services are covered by Medicare. However, Medicare doesn’t cover home health aide services unless you’re also getting skilled care. Skilled care includes:

  • Skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy

Medicare will pay for part-time or intermittent home health aide services (like personal care), if needed to maintain your health or treat your illness or injury. In other words, it is part of the “package” of services needed for acute treatment. Many clients need further home care support while receiving home health services. Additionally, many will need ongoing support which is not the intention of Medicare home health.

Here are some examples of what Medicare doesn’t pay for:

  1. 24-hour-a-day care at home
  2. Meals delivered to your home
  3. Homemaker services, like shopping, cleaning, and laundry
  4. Custodial or personal care like bathing, dressing, and using the bathroom when this is the only care you need. Medicare will not pay for an aide if you only require personal care and do not need skilled care.

That’s where home care comes in!

What is home care?

Home care includes the types of care many of us think of when we think of what people need as they age at home. These services may be short term, provided to support someone after a hospitalization, during an illness, or to assist a family caregiver. Many times they are ongoing. Home care is customized to the client’s needs and budget and usually includes a range of services. 

For some clients, a home caregiver comes in to prepare meals and help with household tasks a few times/week. A caregiver might help with personal care, like bathing and dressing. Essentially, home care services assist with ADLs and IADLs (Activities of Daily Living, like bathing and getting up and down from a chair and Instrumental Activities like managing medications, bills and household chores). Home caregivers also provide support and companionship. Live-in home care services may be provided around the clock for someone needing continual supervision and assistance.

Who needs home care?

Home care is a critical link. When someone returns home from the hospital, they may need physical therapy. A nurse may come in to provide wound care or teach the person how to manage their treatment. But without the support of home care services, that patient is likely to suffer a setback and end up back in the hospital. 

For example, most patients are weak after a hospital stay. They may be prone to falling or injury without someone to assist with bathing and dressing. Top notch surgery or the best medications won’t do much if a person can’t take those medications properly or get enough nutrition. They may need rides to follow-up treatment and help getting all the things they need.

Even without a hospitalization, most elders with chronic conditions need some help at home. Home care services fill the gaps that have too often been unaddressed by acute healthcare solutions. We need to implement both a clinical plan of care and address social issues that get in the way of people getting and staying healthy. 

Clients who typically need home care, include those with:

  • Chronic medical conditions
  • Medicare home health care but limited additional support, when being discharged from the hospital or facing a changing condition
  • Family at a distance or who cannot provide physical/daily support
  • Loneliness and/or depression
  • Struggles with ADLs and IADLs— meal preparation, baths/showers, medication management, transportation, etc.
  • Memory issues and cognitive problems
  • Multiple past falls or high fall risk

Results of Home Care

With a coordinated care plan, elders can expect better health and wellbeing. Most importantly, home care gives them the choice to age at home even if they face challenges. With just a little household support, many clients could age in place at home longer. Too often, avoiding help causes a crisis that leads to needing even more help.

Medical practitioners can expect improved results, including better treatment outcomes and fewer hospitalizations. Families will feel less stress and gain peace of mind.

If you're worried about a loved one or want to be sure you/your loved one can remain safely at home for the long run, call us anytime at 727-447-5845 or 813-333-5020, or click below:

Get help at home

 

Topics: Home Care

tete-check-img

Telehealth Checklist

Get a printable checklist to use for your telehealth and other medical appointments to stay on track and get the best results.

Get My Free Checklist
el_logo@2x

Your Trusted Experts in Aging Wisely.

Find a location near you