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Who is Eligible for Home Health Care Under Medicare?
Medicare is a federal health insurance program that serves
as a vital support system for people aged 65 and older. Patients may be
eligible for Medicare earlier if they have certain disabilities, End-Stage
Renal Disease or ALS. Among Medicare’s unique benefits is home health
care, which provides skilled nursing, therapies and other care services to
those with specific health needs.
Basic Eligibility for Medicare Home Health Care Benefits
To be eligible for Medicare home health care benefits, the
patient must meet several key criteria to help determine if the patient’s
condition and home environment warrant home health care benefits.
Patients may be eligible for home health if they meet the
following criteria:
Being Homebound
A patient is homebound if they are unable to leave their
home or must go through considerable effort when doing so, or that leaving home
is not recommended because of their medical condition. Homebound status is
determined by the patient’s primary care physician based on physical
limitations, such as disabilities, surgery recovery, severe illness or
cognitive impairment.
Demonstrating a Medical Need
In addition to being homebound, the patient must require
intermittent skilled nursing care or skilled therapy services.
Physician Approval/Face-to-Face Encounter
The patient’s physician must authorize home health care
services and review the patient’s care plan regularly.
The patient must have the required face-to-face encounter
with their physician within the timeframes required by Medicare. The encounter
must also be related to the primary reason you need home health care.
Choosing Medicare-Certified Home Health Agency
The agency providing care must be certified by
Medicare.
Common Conditions Among Patients Requiring Home Health Care
Home health care services cater to a wide range of
conditions commonly experienced by patients aged 65 and above. These
conditions often require comprehensive care by an interdisciplinary
team.
A few of the conditions commonly found among patients of
home health care include:
A home health care plan tailored to a patient's needs can
effectively address these conditions, providing the necessary support to
promote well-being, independence and quality of life for patients while helping
to avoid unnecessary hospitalizations.
Circumstances That May Lead to Discharge from Home Health
Care
Several circumstances may negate a patient’s basic
eligibility and lead to the termination of home health care. These factors
include:
Types of Care Covered Under Medicare Home Health Care
Medicare home health care provides a wide range of
skilled nursing, therapy and support services to address the medical
and therapeutic needs of eligible patients depending on their needs.
Skilled nursing care includes:
Therapy services include:
Additional dependent services are available once the patient
has a qualifying need for skilled nursing or skilled therapy services,
including:
Services Not Included in Medicare Home Health Care
It’s important to be aware of services not included in
Medicare’s home health care benefit. Although some of these may be necessary
for your needs, you don’t want to be in a situation in which you expect to have
certain services covered but end up with a significant medical bill. Uncovered
services include:
Supplemental Services Outside of the Medicare Home Health
Care Benefit
Although Medicare covers core home health care services,
certain services not covered by Medicare might be essential to a patient’s
well-being. These home and community-based services may vary according to the
patient’s location and program requirements. Patient eligibility is determined
through a patient assessment with approval from a patient's primary care
physician or social worker. Services like these include:
These non-medical services are generally funded through
out-of-pocket payments or community resource programs. Patients eligible for
Medicaid or Veterans Affairs (VA) benefits may receive additional support. To
find out more, contact your insurance plan or a home health care agency that
connects patients with these external resources.
Costs for Medicare Home Health Care
Understanding associated costs is crucial for patients and
their families when deciding to elect Medicare home health services.
It’s always important to fully understand the cost of benefits from your agency
of choice, but the following key points are a great place to start:
No Out-of-Pocket Costs for Medically Necessary Services
For eligible patients, Medicare covers the costs of all home
health care services deemed necessary by the physician, ensuring that these
patients do not have to pay out of pocket.
Transparency in Medicare Coverage
The home health care agency is responsible for informing the
patient of all costs associated with Medicare coverage. This level of
transparency allows patients to plan and manage their healthcare expenses.
Partial Responsibility for Medical Equipment
When a patient requires Medicare-covered medical equipment,
Medicare may be responsible for covering 20 percent of the cost.
Work with medical equipment provider to receive an estimate to help anticipate
and manage out-of-pocket expenses.
Next Steps for Home Health Care
If you or your loved one has been diagnosed with a severe or
chronic illness, open communication and timely action can significantly impact
the quality of care and support. Take these recommended next steps if you think
home health care is the right choice:
1. Facilitate open communication.
If possible, encourage your loved one to communicate their
wishes and desires with you and other family members and caregivers. Ensure
everyone involved is aware of your or your loved one’s preferences and goals
for care.
2. Contact an agency for connections to resources.
A reputable agency can facilitate access to necessary
resources. In addition to offering access to essential services, the right
agency can provide comprehensive support for a seamless care experience.
3. Consider agencies with a full continuum of care.
A full continuum of care provides a comprehensive range of
healthcare services that address an individual’s care needs across different
stages of illness or recovery.
Choose an agency that offers a full continuum of care so you
or your loved one can smoothly transition from one program to another, if
necessary. This approach ensures they receive consistent, uninterrupted care
tailored to their care needs.
Severe or chronic illnesses create many challenges, but navigating Medicare home health care benefits shouldn't be one of them.
Contact Amedisys Home Health Care in the South Alabama Area with locations in Bay Minette: 251-580-8236, Brewton: 251-809-1717, Citronelle: 251-866-3261, Foley: 800-763-6382, Mobile: 251-380-0492 and Monroeville: 866-334-0260.
Estate Plan Check-UpsEffective estate planning is personal, and its more than just deciding who to leave your assets to once you die. Effective estate planning is a comprehensive process that encompasses pre-need planning: health care decisions, financial management, and maintaining a delicate balance between independence and security. Like your preventive doctor visits, you should regularly check in on your estate plan to ensure it fits your current needs, considers and plans for potential future care needs, and will give effect to your wishes now and in the future. Generally, estate planning involves creating a last will and testament, possibly a revocable trust, possibly an asset protection trust or a supplemental needs trust for a loved one who is unable to manage finances or may be vulnerable to abuse or exploitation. Estate planning also involves important advanced directives, such as a durable financial power of attorney, a health care power of attorney, and a living will. Creating an estate plan, or getting my affairs in order, tends to be an item on our to-do lists, for us to get done and move on to the next thing. However, while it may not be something you have to look at every month, or even every year, once your initial estate plan is completed, it is something that needs to be reviewed with some regularity.Most people get an annual physical when they are healthy, not when they are sick. They do this because they want to proactively spot any issues that could cause them to become ill in the future. The same concept can and should be applied when it comes to reviewing and updating your estate plan. Your estate plan may be healthy now, but you want to make sure that it stays that way by checking it regularly, to ensure it fits your needs and family circumstances, protects and provides for you now, and accomplishes your goals and wishes in the future. Editors Note: This article is for informational purposes only and is not intended to be legal advice. This article was submitted by Ashley Day, Esq. Ashley Day Law, LLC. Reach her at 251-277-3377.
Greetings,In our last bi-monthly newsletter, I mentioned we had nominated one of our caregivers Jane, as the Caregiver of the Year for Visiting Angels nationwide. We were notified at the end of January, she was selected to move onto Round 2 of nominations! This round, we must submit video testimonials about Jane from the client, family members, office staff, and our owner Karen. By the time you read this, we will have submitted the video testimonials and will hear back by March 21st if Jane is a semi-finalist for this prestigious award. The winner of this years Caregiver of the Year award will be announced at the Visiting Angels 26th Annual Conference being held in June and will receive $5,000. There are many team members deserving of consideration for Caregiver of the Year, yet Janes exceptional qualities really stand out. Id like to share an excerpt from the written nominations highlighting Janes contribution.Jane has worked with our team for almost three years. She is dedicated to her work and committed to her clients. She is always on time and never calls out, no matter the weather conditions. The dignity of those in her care is a top priority for Jane while maintaining a positive attitude. Shes willing to go-with-the-flow in any circumstance. For example, when her client resists wearing oxygen and doesnt remember why they need to wear it, Jane knows how to navigate the situation with grace and patience. On the other hand, she holds her ground with difficult clients, and even though it may be uncomfortable, she handles it with respect and kindness.Nominating a caregiver of the year is not just a process, its an opportunity to acknowledge and celebrate the extraordinary dedication and compassion of someone whose role is to serve others. Being a part of this journey of recognition has been rewarding because it highlights the invaluable contributions of caregivers nationwide and the importance of acknowledging their efforts. Its been a reminder of the power of appreciation and the significance of recognizing individuals who demonstrate excellence in their work. Im pleased to be a part of a nationally known and locally owned company, like Visiting Angels, who understands the importance and joy of recognizing others. In the end, nominating a caregiver is about acknowledging the countless acts of kindness and the immeasurable impact caregivers have on the lives of others. Whether or not Jane wins nationwide, she is our Visiting Angels of Medford, MA Caregiver of the Year 2023, and that is something to celebrate! I look forward to giving you another update regarding the award in May. All for now,Abby
The landscape of senior care is bracing for a storm. Over the next five years, the sectors of home care and assisted living will face severe headwinds, each for reasons as varied as they are challenging. These obstacles have the potential to reshape the industry and open up opportunities for alternative models like adult day services to thrive.Lets delve into the converging fronts that are forming this perfect storm.Home Care: A Perfect Storm BrewingThe home care industry, which has long stood as a bastion of personalized elderly care, is facing a staffing crisis. This challenge is not merely a forecast but a present reality. A significant driver of this shortage is the tightening of immigration policies.Historically, the home care workforce has been bolstered by immigrants, who often fill these vital roles. However, restrictive immigration laws are rapidly reducing this labor pool, leaving agencies scrambling to find caregivers.In addition, the home care model itself is inherently inefficient and expensive due to its one-on-one nature. While personalized care is highly beneficial for the recipient, its also labor-intensive and does not scale economically.As the costs of providing services rise, so too does the price for consumers, which is exacerbated by the current inflationary environment. Consequently, home care is becoming less accessible for the average family, with costs soaring beyond the reach of many.Assisted Living: The Constraining Grip of EconomicsOn the other side of the spectrum, assisted living facilities, which offer a middle ground between independence and nursing homes, are also in turmoil. New development, which has been the lifeblood of the industrys growth, is coming to a halt.This stagnation is attributed to inflationary pressures, which increase the cost of construction materials and labor, squeezing the margins of developers.Moreover, the rise in interest rates, as a measure to combat inflation, has a two-fold effect: it makes borrowing more expensive for new developments and acquisitions, and it decreases the affordability of these facilities for consumers.With higher costs to finance the development of new facilities, the prices are passed along to residents, many of whom are on fixed incomes and may not be able to afford increased costs.Adult Day Services: The Emerging ContenderIn the wake of these industry hardships, adult day services are positioned to disrupt the status quo. These services offer a compelling model that provides social interaction, care, and supervision during the day, allowing seniors to return to their homes in the evening.This model addresses several pain points of the current care options.Firstly, adult day services are more cost-effective. They do not require around-the-clock staffing or the high overhead associated with maintaining full residential facilities.Secondly, they are less labor-intensive on a per capita basis, mitigating the severity of the staffing crisis facing home care.Furthermore, adult day services can be an attractive option for seniors and their families who are seeking community engagement and medical oversight without relinquishing the comfort of home.The flexibility and lower costs can appeal to a broad range of seniors, making these services a growth sector in an otherwise constrained industry.Charting a New CourseAs the tides rise against home care and assisted living, innovative care models like adult day services may offer a safe harbor for the industry. By providing a more economical and scalable solution, they could potentially address the needs of a growing senior population amid the financial and logistical constraints facing other care options.Stakeholders in the senior care industry must navigate these headwinds with foresight and agility. Those who can adapt and diversify their offerings to include models like adult day services will likely weather the storm ahead.For families, these changes will require a careful consideration of the evolving landscape to make the best decisions for their loved ones.As the clouds gather, it is clear that the industry must prepare for change.The next five years will undoubtedly bring transformation, and within it, the opportunity to reimagine the future of senior care.
Amedisys Home Health in Mobile provides in-home health care for people managing chronic illness or recovering from a surgery or injury. We make visits to patient's homes in cities throughout Mobile County. These include Mobile, Theodore, Semmes, Grand Bay, Saraland, Wilmer, Eight Mile, Irvington, Prichard, Satsuma, Dauphin Island and other communities within about 50 miles of our care center. Call us at (251) 380-0492 to find out if we provide home health care in your area.
Whether youre recovering from surgery or illness, or living with an ongoing condition like diabetes or heart problems, Amedisys Home Health Care in Foley is here to help. We can help you recover, manage your condition and live as independently as possible. Following the plan of care developed with your doctor, our home health care team can deliver the care you need where you need it most: at home.With Amedisys Home Health Care in Foley, youll work with an experienced team that understands the challenges youre facing and is passionate about helping you get better. You and your family will have peace of mind knowing youre being cared for by highly trained, carefully screened home health care professionals.
Whether youre recovering from surgery or illness, or living with an ongoing condition like diabetes or heart problems, Amedisys Home Health Care in Bay Minette is here to help. We can help you recover, manage your condition and live as independently as possible. Following the plan of care developed with your doctor, our home health care team can deliver the care you need where you need it most: at home.With Amedisys Home Health Care in Bay Minette, youll work with an experienced team that understands the challenges youre facing and is passionate about helping you get better. You and your family will have peace of mind knowing youre being cared for by highly trained, carefully screened home health care professionals.