How It Works
Home-based Care Frequently Asked Questions
Who can benefit from home health care?
If you or a loved one is having any of the following difficulties, you (or your family member) may benefit from home healthcare:
- Do you have difficulty leaving your home?
- Have you fallen in the past 60 days?
- Do you have trouble maintaining your blood sugars (diabetic patients only)?
- Have you had difficulty standing or walking in the past 60 days?
- Do you feel sad, nervous or uneasy?
- Do you have open sores on your body?
- Have your ankles been swollen more than usual?
- Have you had any recent changes to your medications and/or diagnosis?
- Do you have shortness of breath or high or low blood pressure?
Who is eligible to receive care under the Medicare home health benefit?
What services are covered under the Medicare home health benefit? Medicare covers in-home skilled services, as long as you are eligible to receive the services and they are considered reasonable and necessary for the treatment of your illness or injury.
Skilled Nursing Care
Skilled nursing services are covered when they are given on a part-time or intermittent basis. Home health nurses provide direct care and teach you and your caregivers about your care. They also manage, observe and evaluate your care. Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse is not considered skilled nursing care.
Home health aide services must be part of the care for your illness or injury. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care, physical therapy, occupational therapy or speech-language pathology services from a home health agency.
Physical Therapy, Occupational Therapy and Speech-language Pathology
Medicare covers therapy services that are reasonable and necessary in the home. The therapy services must be a specific, safe and effective treatment for your condition. The therapy services must be complex or your condition must require services that can safely and effectively be performed only by qualified therapists. The amount, frequency and duration of the services must be reasonable, and one of the three following conditions must exist:
- It is expected that your condition will improve in a reasonable and generally-predictable period of time.
- Your condition requires a skilled therapist to safely and effectively establish a maintenance program.
- Your condition requires a skilled therapist to safely and effectively perform maintenance therapy.
Medical Social Services
These services are covered when given under the direction of a doctor to help you with social and emotional concerns related to your illness. This might include counseling or help finding resources in your community. Medical Supplies Supplies, like wound dressings, are covered when they are ordered as part of your care.
What isn’t covered under Medicare home health benefits?
Medicare doesn’t pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services like shopping, cleaning and laundry when this is the only care you need, and when these services aren’t related to your plan of care
- Personal care given by home health aides like bathing, dressing and using the bathroom when this is the only care you need
Is the patient involved in the decision making about their treatment?
VitalCaring believes you have the right to:
- Be informed and participate in planning and treatment. This includes being notified in advance of the disciplines that will furnish care and the frequency of visits proposed to be provided.
- Refuse a portion of the treatment without relinquishing other portions; however, you will need to be fully informed of, and understand any, adverse consequences of such a decision.
- Request a change in caregiver without fear of reprisal or discrimination.
- Have your family or guardian exercise your patient rights if you are unable to do so.
- Be treated with mutual respect and dignity, for both you and your caregiver.