When is the right time to hire a home care services organization? How much care does your loved one need? Is this a temporary or permanent situation? The answers to these, and other questions, are very personal and vary with each family. However, here are a few considerations that can help you make the right decision.
Medicare and Homebound Criteria
- Medicare defines an individual as homebound if he/she:
- Is unable to leave the home due to an illness or injury,(not just due to weakness and feebleness or old age).
- Experiences a considerable and taxing effort to leave and is absent from the home infrequently, for a short duration, or to receive medical care.
- Requires the assistance of a device, other persons or special transportation.
- Homebound eligibilty is not affected by frequent absences from the home when the reason for leaving is to receive medical care, provided the home health services could not reasonably be provided by the other medical care providers.
- CMS was asked by Congress to refine the definition of
Homebound status, and added the following information:
- The new definition explicitly allows absences from home to participate in “therapeutic, psychosocial or medical treatment in an adult-day-care program that is licensed and certified by a state.” Such violations will not be considered violations of the homebound criteria.
- Additional clarification includes that absences to attend religious services will be considered an “absence of infrequent or short duration,” and allowable under homebound defintion.
- An individual will NOT be considered homebound if he/she:
- Leaves the home frequently for social activites.
- Goes to a day care center for non-medical purposes or to a relative’s house part of the time (except alzheimer’s specific daycare centers).
- Leaves the home against physician’s orders, if this is done frequently or for long periods of time.
- Leaves the home for shopping or business on a regular basis.
- Medicare services are intermittent meaning not everyday. Services are provided by healthcare professionals to help patients through a relatively short term recovery. While there are some situations where services can be continued for several 60 day periods of care, the healthcare professionals are only in the home 2-3 days per week, up to one hour per visit. Families and caregivers are still the primary source of long term care for their loved one at home. One of the most important duties of the home care professional staff is to instruct the “informal” caregivers with all the information and resources they need to successfully manage and care for their loved one at home.
- Home Health Provides:
• Observation & Assessment of Condtion
• Patient & Family Education of Disease
• Management & Evaluation of Patient
• Medication Education & Management
• Dressing Changes
• Home Safety & Emergency Education
• Gastrostomy Care
• Wound Care
• Tracheostomy Care
• Catheter Care
• Enteral & Parenteral Nutrition
• IV Therapy
• Ostomy Care
• Pain Management
• Diabetic Care
• Nutritional Support
• Anodyne® Therapy
- Medicare will pay for home care visits when the following criteria have been met:
• The patient must be enrolled in the Medicare program
during the time the services are provided and be eligible
• A Medicare certified agency must provide services.
• A physician who establishes and periodically reviews the
plan of care at least every 60 days must order the services.
• Services must be provided in the patient’s place of residence.
• The patient must be homebound.
• The services must be medically reasonable and necessary
to the treatment of an illness or injury.
• The patient must need a qualifying skilled service (Skilled
Nursing, Physical Therapy, Speech Therapy on an intermittent
basis or continued care from an Occupational Therapist).
• IF at least one of the qualifying services is needed, Medicare
covers the following services: home health aide services,
medical social services, medical supplies, durable medical
equipment and supplies.
- Your loved one must feel comfortable around, and get along well, with their caregiver. Feel free to let us know if there are any special requirements for your caregiver. We want your loved one to feel at ease with their Home Care Staff.