Understanding In-Home Services

Maybe you or a loved one could use some help in the home. There are a lot of services that can assist someone who wants to continue to age in place (at home) and needs a bit of assistance. Plenty of questions probably pop up next. Should home care or home health be explored? What is private duty care? The next question may be, “How do I pay for that?” These questions do not always have a simple answer. Today, home care and home health are used interchangeably. However, they can mean different types of services, and it varies as to whether Medicare provides coverage.  

Home care is more of an umbrella term that can represent both health and social services. One type of home care is private duty care that includes non-medical companion or caregiving-type services. This could be personal care, meal preparation, companionship, housekeeping, etc. Home health is care provided by a licensed professional, such as a registered nurse or physical or occupational therapist. Often a home health professional is teaching a patient about how to manage their health, illness, medication, etc. 

The terminology is not the most important piece to consider though. An individual should think about what types of activities require assistance. Is mobility assistance needed? Does someone need help managing medications or injections? Is assistance needed after surgery? Once this is under consideration, talk with the doctor and the health insurance provider. This is where the distinction can be made as to payment for in-home services.

If the doctor determines a home health order can be prescribed, they will identify the types of services needed, such as skilled nursing care or therapy. Additionally, the doctor prescribing the home health order would need to confirm that the individual is “homebound” or has trouble leaving the home without aid. The next step to choose a Medicare certified home health agency. The home care team along with the doctor, will create an individualized plan of care that the doctor will continue to oversee. The doctor or medical team will regularly review this care plan. Keep in mind, home care is intermittent care to evaluate, monitor, and provide education on disease and medication management. Medicare will not cover 24/7 care.  

Medicare does not cover non-medical services if it is the only type of care needed. The most important step is to have an on-going conversation with the doctor to discuss concerns and needs. Another essential step is to check with the insurance provider to see if there are any programs that can meet the person’s needs. 

Coverage can vary depending on the type of service, and there can be different eligibility factors. Also, coverage may differ depending on the type of insurance, such as a Medicare Advantage plan, Medigap plan, Medicaid, VA, private insurance, or long-term care insurance. 

If you are interested in learning more about home health care services, visit the UPMC Home Healthcare website at UPMCHomeHealthcare.com.

For more information, visit https://upmc.com/services/seniors/.

Please note that more information on the eligibility criteria and type of services eligible for Medicare coverage is available on Medicare’s website. To find a Medicare certified home health agency, individuals can find the ‘Care Compare’ webtool on Medicare’s website. To contact Medicare, their phone number is 800-MEDICARE.

Source: Medicare.gov