You want the best for your loved one, ensuring they live independently and comfortably while remaining safe. It’s easy to become overwhelmed when trying to take care of personal responsibilities while simultaneously caring for an elderly or disabled loved one. Fortunately, home care services can ease your load and calm your mind by helping your loved one live their best life.
Perhaps it is you and not a loved one in need of assistance because of an illness, injury, or chronic condition. You may be among the many who think home care services are only for the elderly.
Home care services are designed to help seniors, people with disabilities, and those with acute or chronic health conditions live safely in their homes. Home care providers often include personal aides, nurses, physical therapists, and others.
Services may include:
- Assist with activities of daily living (ADLs) – toileting, bathing, dressing, personal hygiene, transferring, walking, and eating
- Perform household tasks – cooking, shopping, cleaning, laundry, pet care, and errands
- Meal delivery
- Pick up and manage prescription medications
- Companionship and life enrichment activities
- Physical therapy and other rehabilitative services
- Fall risk reduction by ensuring the home is free of safety hazards
- Transportation – medical and nonmedical
- Short-term nursing care – help with recovery from illness, injury, or hospitalization
- Long-term nursing care – help with chronic health conditions or disabilities
Having a qualified person provide your loved one with needed services may sound like a dream come true, and it can be. But determining whether your loved one is eligible for any of the above services and whether insurance covers them are crucial questions.
Who is Eligible for Home Care Services?
While anyone is eligible to receive personal care services, Medicare and most private insurance plans do not cover such services, so recipients would be personally responsible for payment. Sometimes, personal care services may be covered under a long-term care insurance policy, Medicaid, a private health policy, Veteran’s benefits, or Worker’s comp.
Most home care medical services are covered by private health insurance, Medicare, Medicaid, Veteran’s benefits, or Work Comp benefits if the individual meets eligibility requirements. If the patient does not have coverage under any of these entities, they would need to pay personally for services.
Medicare
All individuals with Medicare part A, part B, or both who meet the following criteria are eligible for certain medical home care services. Medicare eligibility criteria include the following:
- You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
- A doctor must certify that you need one or more of the following:
- Intermittent skilled nursing care (other than drawing blood).
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe, and an effective treatment for your condition. The amount, frequency, and time of the services must be reasonable, and they need to be complex, meaning only qualified therapists can do them safely and effectively.
- To be eligible, either: 1) your condition must be expected to improve in a reasonable and predictable time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- A doctor must certify that you’re homebound (or homebound but attend adult day care).
It’s important to understand that Medicare will not reimburse for personal care provided by a medical home care professional delivering any of the above services.
Medicaid
Medicaid provides health insurance for low-income individuals. The program covers nonmedical home care, like help with ADLs and household tasks, home health care, and other in-home care to help people remain safely in their homes.
Medicaid eligibility and coverage may vary from state to state. Check to determine state-specific Medicaid eligibility requirements and the home services typically covered by Medicaid.
Private Health Care Policy
As mentioned, Medicare and most private insurance policies do not cover personal home care services. Many private health insurance policies cover some medical home healthcare services, with eligibility and coverage guidelines similar to those of Medicare. It’s essential you talk to a health insurance representative to verify eligibility and coverage.
Veterans Benefits
The Veteran’s Administration provides the following services to veterans and their caregivers in the veteran’s home, nursing home, assisted living facility, adult day care, or group home:
- Home health aides
- Physical therapy
- Assistance with activities of daily living
- Homemaker services
- Skilled home healthcare
- Pain management and palliative care
- Remote monitoring
- Respite care
- Caregiver assistance
Work-Comp Benefits
Although worker’s compensation plans may vary, they typically cover medical expenses, including ongoing care, lost wages, and other work-related injury or illness costs.
Some policies specifically cover home care, while others need to be clarified. Request a copy of your company’s worker compensation plan and talk with a work comp representative to verify home care coverage and whether documentation is required to secure those services.
Long-Term Care Insurance
Many long-term care insurance policies cover home healthcare services in the policyholder’s home, assisted living facility, adult day care, or nursing home. Some policies include payment for home modifications needed to ensure the policyholder’s safety and accessibility. If your loved one has a long-term policy, check directly with the insurance carrier for the terms of coverage.
At Home Harmony
At At Home Harmony, our dedicated team of caregivers, advanced practitioners, registered nurses, and pharmacists works tirelessly to provide a safe, healthy, and happy environment for our patients and their loved ones.
In addition to our expert medical practitioners and our impeccably trained and compassionate care aides, we offer innovative services, including:
- Up-to-date in-home technology, covered by Medicare, to monitor chronic conditions (like high blood pressure, diabetes, heart failure, and others) so our nurses can track your loved one’s health and respond quickly to condition changes.
- Personalized in-home pharmaceutical services, including medication management, pre-sorted pill packs, and expedited delivery.
Medicare covers all At Home Harmony medical and pharmaceutical services, and we participate with all major Medicare Advantage and Prescription Drug Plans and commercial plans. Our pharmacists actively work with all prescription plan providers to limit out-of-pocket costs.
Home care services offer a host of benefits to those in need of care and their families. We all value our independence, and most of us want to remain in our own homes as long as possible. Whether it is you or a loved one in need of home care, the right services can provide peace of mind to your family and the quality of life you all deserve.
Contact At Home Harmony today to learn how we can help you and your family enjoy your lives to the fullest.