What ex­actly can be counted home health care?

The Kent Island Bay Times - - Senior Satellite - By MIKE ZIMMER

Home health care is a wide range of health care ser­vices that can be given in your home for an ill­ness or in­jury. Home health care is usu­ally less ex­pen­sive, more con­ve­nient, and just as ef­fec­tive as care you get in a hospi­tal or skilled nurs­ing fa­cil­ity (SNF).

In gen­eral, the goal of home health care is to pro­vide treat­ment for an ill­ness or in­jury to help you get bet­ter, re­gain in­de­pen­dence and be­come as self-suf­fi­cient as pos­si­ble. Home health care may also help you main­tain your cur­rent con­di­tion or level of func­tion or to slow down de­cline.

Medi­care pays for you to get health ser­vices in your home if you meet cer­tain el­i­gi­bil­ity cri­te­ria and if the ser­vices are con­sid­ered rea­son­able and nec­es­sary for the treat­ment of your ill­ness or in­jury. Who’s el­i­gi­ble? If you have Medi­care, you can use your home health ben­e­fits if:

1. You’re un­der the care of a doc­tor, and you’re get­ting ser­vices un­der a plan of care es­tab­lished and re­viewed reg­u­larly by a doc­tor.

2. You need, and a doc­tor cer­ti­fies that you need, one or more of the fol­low­ing:

. In­ter­mit­tent skilled nurs­ing care (other than draw­ing blood) . Phys­i­cal Ther­apy . Speech-Lan­guage Pathol­ogy Ser­vices

. Con­tin­ued Oc­cu­pa­tional Ther­apy

. Home Health Aide Ser­vices (only if you are re­ceiv­ing Skilled Care) . Med­i­cal So­cial Ser­vices . Med­i­cal Sup­plies such as wound dress­ings when your doc­tor or­ders them as part of your care

3. The home health agency car­ing for you is ap­proved by Medi­care.

4. A doc­tor cer­ti­fies that you are home­bound. To be home­bound means:

. You have trou­ble leav­ing your home without help (like us­ing a cane, wheel­chair, walker, or crutches; spe­cial trans­porta­tion; or help from an­other per­son) be­cause of an ill­ness or in­jury, or leav­ing your home isn’t rec­om­mended be­cause of your con­di­tion.

. You are nor­mally un­able to leave your home, but if you do it re­quires ma­jor ef­fort.

You may leave home for med­i­cal treat­ment or short, in­fre­quent ab­sences for non-med­i­cal rea­sons, like an oc­ca­sional trip to the barber, a walk around the block or a drive, or at­ten­dance at a fam­ily re­union, fu­neral, grad­u­a­tion, or other in­fre­quent or unique event. You can still get home health care if you at­tend adult day care or reli­gious ser­vices.

5. As part of your cer­ti­fi­ca­tion of el­i­gi­bil­ity, a doc­tor, or cer­tain health care pro­fes­sion­als who work with a doc­tor such as a nurse prac­ti­tioner, must doc­u­ment that they have had a face-to-face visit with you within re­quired time frames and the visit was re­lated to the rea­son you need home health care.

If you only need skilled nurs­ing care, but you need more than “in­ter­mit­tent” skilled nurs­ing care, you don’t qual­ify for home health ser­vices. To de­ter­mine if you are el­i­gi­ble for home health care based on a med­i­cally pre­dictable re­cur­ring need for skilled nurs­ing, Medi­care de­fines “in­ter­mit­tent” as skilled nurs­ing care that is needed or given ei­ther: . Fewer than 7 days a week. . Daily for less than 8 hours each day for up to 21 days. Medi­care may ex­tend the three-week limit in ex­cep­tional cir­cum­stances if your doc­tor can pre­dict when your need for daily skilled nurs­ing care will end.

If you are ex­pected to need full­time skilled nurs­ing care over an ex­tended pe­riod of time, you would not qual­ify for home health ben­e­fits.

Mike Zimmer is pres­i­dent of Bay State In­sur­ance Agency Ltd. in Centreville. He is avail­able to an­swer your ques­tions or speak to groups re­gard­ing Medi­care, Medi­care Ad­van­tage, Medi­care Sup­ple­ments, Medi­care Part D (Pre­scrip­tion Plans) and Home Health Care In­dem­nity Plans. He may be reached at 410-758-1680.


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