Home health care through Medicare provides skilled services with specific coverage limits.

Home health care through Medicare provides skilled services with specific coverage limits.

Your father is being discharged from the hospital, and the case manager mentions that he’ll get home health care services. You nod, but you’re not entirely sure what that means. Who will come to the house? How often? What will Medicare pay for?

Understanding how Medicare-covered home health care works helps you prepare and fill in any gaps in your parent’s care.

 

Who Qualifies Under Medicare?

Medicare Part A and Part B cover home health care services when certain conditions are met. In general, your parent must:

  • Be under the care of a doctor, with a plan of care that the doctor reviews regularly
  • Have a face-to-face visit with a doctor or allowed provider related to the need for home health
  • Need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy
  • Be considered homebound, meaning leaving home takes a considerable and taxing effort
  • Receive services from a Medicare-certified home health agency

Being homebound doesn’t mean your parent can never leave the house. They can still attend medical appointments, religious services, adult day care, and occasional short outings like a trip to the barber.

 

What Services are Covered

When your parent qualifies, Medicare may cover:

  • Part-time or intermittent skilled nursing care
  • Physical therapy, occupational therapy, and speech-language pathology
  • Part-time home health aide services, when your parent is also receiving skilled care
  • Medical social services
  • Certain medical supplies used during visits

Durable medical equipment, such as a walker or hospital bed, is covered separately, and your parent may pay a share of the cost.

 

What Medicare Doesn’t Cover

Medicare home health care has limits that surprise many families. It doesn’t cover:

  • Round-the-clock care at home
  • Meals delivered to the home
  • Homemaker services like shopping, cleaning, and laundry when unrelated to the care plan
  • Personal care, such as bathing and dressing, when that’s the only care needed

In other words, Medicare covers short, skilled visits, not ongoing daily help. That’s where non-medical home care often fills the gap.

 

The First Visit

After the referral, a nurse or therapist from the home health care agency will schedule a first visit, often within a day or two of discharge. During this visit, they’ll assess your parent’s health, review medications, check the home for safety, and talk about goals. They’ll explain how often visits will occur and who will be coming.

It helps to have a family member present for this visit. Have a list of medications, discharge paperwork, and questions ready. Ask for the agency’s phone number, including the after-hours number, and post it near the phone. Find out who to call if a visit is missed or if your parent’s condition changes between visits. Many home health care agencies have a nurse available by phone at night and on weekends, and knowing that ahead of time can save a stressful search later.

 

What Visits Look Like

Visits are typically scheduled a few times a week and last about an hour. A nurse may check vital signs, manage wounds, teach your parent about a new medication, and monitor for complications. A physical therapist may work on strength, balance, and walking. An occupational therapist may help your parent learn safer ways to bathe and dress.

Between visits, your parent should follow the care plan, such as doing exercises or taking medications on schedule. Family members or caregivers often help with this. Keep a notebook where everyone can record how your parent is eating, sleeping, and moving, so the nurse has useful information at each visit.

 

How Long Services Last

Medicare covers home health in 60-day periods, and services can continue as long as your parent continues to qualify and the doctor recertifies the need. Many people receive services for a few weeks until they reach their goals. When your parent no longer needs skilled care, home health care will end, and the agency should give written notice before services stop.

If you disagree with the decision to end services, you have the right to a fast appeal. The notice will explain how.

 

Filling the Gaps

Because Medicare home health provides short, intermittent visits, many families find their parent needs more help than those visits provide. That’s especially true right after a hospital stay, when your parent may need help showering, getting to the bathroom, preparing meals, and getting through the night.

Non-medical home care can fill those hours. Caregivers can help with bathing, dressing, meals, housekeeping, and companionship, and they can encourage your parent to follow the therapy plan. When home health care ends, home care can continue for as long as your parent needs it.

 

Planning Ahead

If your parent is heading home from the hospital, ask the discharge planner whether they ordered home health care and which agency will provide it. Then think about what help your parent will need between visits. Arranging both types of support before discharge can make the transition home smoother and safer. Knowing what Medicare home health care covers, and what it doesn’t, puts your family in a better position to plan.

 

 

 

If you or an aging loved one is considering Home Health Care in Syosset, NY, please contact the caring staff at Brookville Homecare today. 516-802-7722