Home Health Care
- Home Health Care ==========================
The following information on home care services is summarized from the National Association for Home Care, courtesy of William D. Cabin, J.D., M.A., director of Regulatory Affairs/Research.
Home health care is professional, caring services at home. It is best suited for individuals — from babies to the elderly — who do not need 24-hour, round-the-clock supervision and monitoring.
Home care includes a variety of services:
HEALTH SERVICES include personal care, nutrition services, medical and skilled nursing care, counseling, administration of prescription drugs, lab work and tests, and therapy treatments such as intravenous, speech, and ostomy therapies.
HOMEMAKING SERVICES are services to help the family or individual with housekeeping, food shopping, meal preparation, laundry, temporary child care, and other errands and tasks that are necessary when someone is very ill.
SOCIAL SERVICES include services for helping family members cope with problems associated with the care of a sick person and also for coordinating home care with other community programs.
HOSPICE SERVICES provide physical, social, and emotional care for the terminally ill and their families. Services include pain-management for the patient, home care so that families can maintain as normal a routine as possible, and continued care for the family through the bereavement period.
SUPPORTIVE SERVICES include the following: -adult day care
-respite care
-pastoral counseling
-household tasks
-meal delivery
-visits and phone calls
-transportation
-equipment lending, rental, and sales
Who Provides Home Care?
Several types of organizations provide home care. These include temporary nursing and medical services, medical equipment companies, community and non-profit service organizations, and homemaker-home health agencies.
Who Pays for the Services?
Home care costs are paid by a variety of sources. They are sometimes paid by the individual or family, but insurance programs cover some of the costs. Benefits and requirements vary greatly, however, depending on the home care agency and insurance carrier. Some agencies charge on a sliding scale.
Listed below are a few of the major payment sources and what they cover:
MEDICARE For persons 65 and over, this federal health program pays for home health services, some kinds of homemaking services, and agency-provided medical supplies and equipment if the patient meets these requirements:
-The patient is homebound and under a physician’s care. -The services are intermittent.
-The illness or condition is one that in general responds favorably to treatment.
-The services are provided through a Medicare-certified home health agency.
MEDICAID This program is administered by each state for persons with low incomes. Eligibility requirements vary from state to state.
HEALTH INSURANCE POLICIES Coverage varies, but it is generally limited to physician-directed medical services, therapy, and medical equipment.
VETERAN’S ADMINISTRATION Veterans with a 50 percent or more disability related to military service are eligible for home health care coverage. Services must be authorized by a physician.
WORKER’S COMPENSATION Any person injured on the job is eligible for home care services.
OLDER AMERICAN ACT FUNDS AND SOCIAL SECURITY BLOCK GRANTS TO STATES Services covered by these sources include homemaker-home health aid services and home-delivered meals.
HEALTH MAINTENANCE ORGANIZATIONS (HMOs) These and other group health plans sometimes include home care services. Coverage is usually limited to physician-directed medical services and therapy.
CHAMPUS This program covers skilled nursing care and other professional medical home care for dependents of active military personnel, retirees, and their dependents or survivors.
SOCIAL SERVICE ORGANIZATIONS Groups that operate with private charitable funding, such as the United Way, offer a wide range of services. These agencies may require some payment or donation.
How Are Home Care Services Billed?
If the cost of home care is to be reimbursed by an agency, the agency will bill its insurance source directly. The patient or responsible party will receive a bill only when a portion of the bill is not paid by the insurer, as in the case of deductibles. Accurate record keeping is extremely important. Home care expenses qualify as medical expenses for federal income tax, and within certain limits, they are tax deductible.
Guidelines for Choosing a Home Care Agency
Finding a good home care agency requires research. Quality of care and caliber of personnel should be the first priorities. The following questions are important ones to consider:
-How long has the agency been serving the community? -Is the agency’s reputation good?
-Is the agency accredited?
-Is it certified by Medicare?
-Is there a written statement describing the agency and its services?
-How does the agency hire its employees and how does it treat them?
-Does the agency conduct an evaluation of the needs of the client and family? What is included in such an evaluation? -Is the care plan written out? Is it specific? Can it be reviewed by the patient and family?
-Is family involvement included in the plan? -Are the financial arrangements specific and written? -Is there regular professional supervision and follow-up? -What arrangements are made for emergencies? -What arrangements ensure patient confidentiality? -Will the agency continue its services if Medicare or other reimbursement sources are exhausted?
Quality of service is reflected to some degree by accreditation, which is a voluntary procedure conducted by non-profit professional organizations. The three agencies listed below accredit groups providing home care services:
-The Joint Commission on Accreditation of Hospitals -The National League for Nursing/American Public Health Association
-The National Homecaring Council