It's important to know that home health care and home care are two different types of support.
Home Health Care:
Home health care involves medical services like physical and occupational therapy, prescription medications, medical tests, health monitoring, and wound care.
You might use home health care if you have significant medical issues, a recent injury, a high risk of falling, or serious health conditions. Here are some situations where you might need home health care:
If you've recently been discharged from a hospital, rehab center, or nursing home.
If you need monitoring after a change in your medication.
If health challenges prevent you from safely traveling to a doctor’s office.
If you have functional decline but might regain independence with physical or occupational therapy.
Home Care:
Home care offers non-medical help with daily activities to keep you independent. This can include assistance with bathing, dressing, grooming, transportation to appointments, meal prep, cleaning, managing finances, and companionship.
You might benefit from home care if:
You need help with daily activities like bathing and dressing.
You’re active but no longer drive and need transportation.
You need or want help with household tasks like cooking, cleaning, and shopping.
You’re feeling lonely or isolated and would appreciate companionship.
Home health care and home care can be short-term following a health event or long-term for ongoing needs.
Who Provides Caregiver Support?
Formal Caregivers: Formal caregivers are paid for their work and have a range of training and skills. For example:
Home care aides may only need a high school diploma, though some states require certification.
Home health nurses typically have a bachelor's degree in nursing and at least two years of experience.
The tasks they perform vary based on their training:
Home care aides might run errands, clean, prepare meals, and help with personal care.
Home health nurses assess health needs, develop care plans with doctors, monitor treatment responses, administer medication, take vital signs, and coordinate care.
Informal Caregivers: Informal caregivers are not paid and often have a personal relationship with the care recipient. These might include spouses, adult children, siblings, friends, or neighbors.
In the U.S., about 44 million people provide care for family members, averaging 24 hours of care each week. Even without specific training, informal caregivers often perform the same tasks as home care aides, and sometimes more advanced tasks like managing medications and coordinating care. Unlike formal caregivers, informal caregivers who live with the care recipient rarely get a day off.
Understanding the differences between home health care and home care, and knowing the types of caregivers available, can help you make informed decisions about the support you or a loved one might need.
Medicare and Home Health Care
Home Health Care Services: Medicare covers home health care because these services are considered medical and are often essential for treating or managing health conditions. Home health care includes:
Skilled Nursing Care: Services provided by registered nurses or licensed practical nurses, such as administering medications, wound care, and health monitoring.
Physical Therapy: Helps patients regain mobility and strength after surgery, injury, or illness.
Occupational Therapy: Assists patients in relearning daily activities and regaining independence.
Speech-Language Pathology: Helps patients who have difficulty speaking or swallowing due to medical conditions.
Medical Social Services: Assistance with social and emotional concerns related to the patient’s medical condition.
For Medicare to cover these services, a doctor must certify that the patient is homebound and requires skilled care. Additionally, the care must be provided by a Medicare-certified home health agency.
Medicare and Home Care
Home Care Services: Medicare does not cover home care services because these are considered non-medical and are typically associated with daily living activities rather than medical treatment. Home care includes:
Personal Care: Assistance with bathing, dressing, grooming, and toileting.
Homemaker Services: Help with housekeeping, meal preparation, laundry, and other chores.
Companionship: Providing social interaction and supervision to ensure safety and well-being.
These services do not require the skills of licensed medical professionals, and therefore, Medicare does not see them as medically necessary for treatment. They are instead viewed as custodial care, which aims to assist with daily living activities.
Understanding the Rationale Behind Medicare's Thinking
The main reason Medicare covers home health care but not home care is due to the medical necessity and skill level involved. Home health care services are:
Medically Necessary: Essential for treating or managing specific medical conditions.
Skilled Care: Requires the expertise of trained and licensed medical professionals.
On the other hand, home care services are:
Custodial in Nature: Focus on assistance with daily activities rather than medical treatment.
Non-Skilled Care: Provided by caregivers who do not require medical training or licenses.
What This Means for You
If you or a loved one needs help with daily activities, you may need to explore other options beyond Medicare. Some alternatives include:
Medicaid: Depending on your state and financial situation, Medicaid may cover some home care services. See an Elder Law Attorney to help you with Medicaid.
Long-Term Care Insurance: These policies often cover non-medical home care services. But be aware of the fine print.
Out-of-Pocket Payment: You might need to pay for home care services yourself if other options are not available.
Final Thoughts
Understanding the distinction between home health care and home care, and the reasons behind Medicare’s coverage policies, can help you better navigate your healthcare needs. While it might be frustrating that Medicare doesn’t cover home care services, knowing the available options can help you plan accordingly and ensure you or your loved ones get the support needed to live comfortably and independently at home.
