Home Health Care: Limitations of Medicare Coverage

Nothing is more discomforting than not knowing if you or a loved one will receive the adequate care for a full and safe recovery after hospitalization. When a patient is re-admitted to the hospital, it costs the patient, the government and the hospital additional expenses. More importantly, it causes the patient and their family emotional distress.

Neither Medicare nor traditional medical insurance cover many of the home healthcare services that can help reduce otherwise preventable injuries and hospital re-admissions. These services, usually referred to as long term care, or “custodial care,” include companion services, general supervision for health and safety and long term home help with personal care and hygiene, meal preparation, transportation and errands.

Seniors, especially, require a variety of support services for a safe and full recovery after being discharged from a hospital. However, as reported by Today’s Seniors, “Many excellent home healthcare agencies are not certified by Medicare. But, it isn’t because they aren’t good enough. Instead, their nursing care plans only provide services that aren’t paid for by Medicare, but which their clients need in order to remain in their own homes.”

The problem that exists for and must be addressed is ensuring one’s own or a loved one’s safety and recovery when in such a vulnerable condition, whether it be after hospitalization, illness or injury. Without the proper care, the patient often suffers preventable incidents resulting in additional and more costly care needs and reduction in independence.

Although Medicare does cover some home care, the patient must meet all of the following conditions:

  • The patient must be homebound and under a doctor’s care
  • The patient must need skilled nursing care, or occupational, physical or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)
  • The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient
  • The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”
  • The home health care agency providing the services must be certified by the Medicare program

Additionally, a recovering patient undergoing therapy must show continual improvement in order for Medicare to cover their home health care. If the patient doesn’t meet strict guidelines, Medicare considers the home care custodial. At that point, when often faced with a major change in their needs due to the incident or illness that occurred, the patient becomes responsible for the cost of care.

This is where a private-duty home healthcare agency can be of great assistance. Private-duty agencies such as EasyLiving’s services are designed to pick up where Medicare and other entities’ services leave off, ensuring your loved one’s continued wellbeing and independence. Sometimes a little bit of help from EasyLiving’s home caregivers can provide an alternative to assisted living or a nursing home. Our caregivers provide our clients with support while they recuperate, whether it means coming in throughout the week to provide housekeeping and transportation, or staying with someone around the clock after surgery. While the client receives therapy or skilled nursing services, our caregivers assist as the person regains strength, ensuring proper nutrition and medication compliance so that the other services received have the chance to really work.