The key to qualifying for some paid services is whether your
loved one is 'homebound'
by Jennifer J. Salopek, AARP,
October 11, 2019
En español | Medicare, the government's medical
insurance for disabled people and retirees 65 and older, isn't designed to pay
for 24-hour care for a loved one at home.
But with a doctor's orders and plan of care,
you can get costs covered for several necessary services if you are caring for
a loved one who is homebound because of a chronic illness or injury.
Covered services include part-time or
intermittent home health services from home health aides; medical social workers, who
help with emotional concerns and with understanding a disability or illness;
occupational therapists, who help people do the daily activities they need to
live life more easily; physical therapists, who help restore movement in those
who might have weakened while being hospitalized; speech-language pathologists,
often used after strokes to help restore communication and swallowing; and
skilled nursing care.
What 'homebound' is
• A person has trouble leaving home without help because of an illness or
injury.
• Or a patient's medical condition means that leaving home is not
recommended.
Attending adult day care or religious
services, or infrequently going out for medical treatment or special occasions,
is OK under Medicare rules.
Care can’t be
full time
These services are limited to fewer than seven
days a week or less than eight hours a day for up to 21 days.
Medicare also covers medical supplies and up to 80
percent of the cost of medical equipment, such as a wheelchair or walker, if a
doctor certifies that it is medically necessary.
Home health care has many benefits: It is
usually less expensive and more convenient for patients and can shorten their
stay in a hospital or skilled nursing facility. It also can help them
recuperate faster.
"Not only can home health care help to
avoid accidents and falls, but it can increase your loved one's happiness,”
says Gretchen Jacobson, associate director at the Kaiser Family Foundation.
In 2017, 3.4 million people took advantage of
these benefits. Medicare beneficiaries have no copayments for approved
benefits.
How to qualify
for benefits
To ensure that your loved one can take maximum
advantage of Medicare home health benefits, review these important
requirements:
Patients must be under a doctor's care, and the doctor must issue a plan of care
that certifies the patient needs one or more of the services listed above. In
addition to certifying that need, a plan of care specifies the type of health
care professional who should provide the services, how often the services will
be provided, any needed medical equipment, and the results the doctor expects.
The doctor and the home health team review and
recertify the plan of care at least once every 60 days.
Patients must see their doctor in person less than 90 days before or 30 days
after home health services begin.
A Medicare-certified agency must deliver Medicare home health services. Agency
personnel will coordinate the services the doctor orders.
For help finding a certified agency near you,
Medicare offers a tool called Home Health Compare on its website.
Types of
services provided
Different kinds of home health care
professionals deliver different services.
Registered nurses or licensed practical nurses under the supervision of a registered nurse deliver
skilled nursing care.
This includes:
·
Changing
wound dressings
·
Giving
injections, intravenous drugs or
tube feedings
·
Teaching
about prescription drugs and
diabetes care
Some of the tasks home health aides do
include:
·
Assessing
pain
·
Checking
blood pressure, breathing, heart rate
and temperature
·
Checking
the safety of the home
·
Ensuring
medications are being taken
correctly
·
Monitoring
food and drink intake
·
Teaching
patients and
caregivers about the plan of care and how to carry it out
Professional therapists provide specific kinds of services, including
physical therapy, speech therapy and occupational therapy.
Social workers provide medical social services.
"Your doctor or other health care
provider may recommend you get services more often than Medicare covers,"
Medicare's website says. “Or they may recommend services that Medicare doesn't
cover. If this happens, you may have to pay some or all of the costs. Ask questions
so you understand why your doctor is recommending certain services and whether
Medicare will pay for them.”
Medicare home health benefits do not cover
full-time skilled nursing care. They also do not cover drugs, housekeeping,
meal delivery or transportation.
To find out whether an item, service or test
is covered under home health benefits, access Medicare's search tool or download
Medicare's What's Covered app from the Apple App Store or Google Play.
"Most family caregivers aren't familiar
with Medicare,” says Amy Goyer, AARP family caregiving expert. “It's important
that caregivers learn what it covers and what it does not. Part of our role as
caregivers is to advocate for our loved ones."
Jennifer J. Salopek has been a freelance
writer for 19 years. Her health care pieces have appeared in major outlets
including The Washington
Post. Follow her on Twitter @jsalopek.
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