By Britt Hemsell, Senior Living Advisor at Ruby Care | Contributor
When a family member starts requiring assistance at home, one of the primary questions that arises is: “Should we opt for Home Health or Home Care?”
While these terms may seem alike, they represent distinct types of services that can coexist within the home environment. Grasping the nuances between them is pivotal in ensuring proper care, minimizing hospital readmissions, and making certain that your loved one receives the appropriate support when they need it.
Having navigated this issue with my family on numerous occasions, I aim to clarify the distinctions between these two services based on my experiences, while also detailing what aspects Medicare or insurance may cover.
Home Health
Home Health encompasses medical services rendered in a home setting by licensed healthcare professionals. This care is prescribed by a physician and is usually eligible for coverage under Medicare, Medicaid, or private insurance, provided certain conditions are satisfied. Detailed coverage information is available in the CMS Medicare & You Handbook.
Home Health Services Include:
– Skilled Nursing (Registered Nurse/Licensed Vocational Nurse)
– Physical Therapy (PT)
– Occupational Therapy (OT)
– Speech Therapy
– Medical Social Work
– Wound Management
– Medication Management
– Post-operative Monitoring
Medicare Eligibility Criteria
According to the Centers for Medicare & Medicaid Services (CMS), a patient must meet these criteria:
– Be under a physician’s care
– Require intermittent skilled services
– Be classified as homebound
– Receive services from a Medicare-certified agency
Common Scenarios for Home Health Services:
– Following hospitalization
– After a fall
– Post-surgery (e.g., hip replacement, cardiac procedures)
– With a new medical diagnosis
– In cases of deteriorating chronic illness
Generally, Home Health services are temporary and goal-oriented, with the patient’s progress reassessed approximately every three months by their physician.
Think of it this way: “We are addressing or stabilizing a medical issue.”
Home Care
Home Care, often referred to as Personal Care or Companion Care, is a non-medical form of assistance provided within the home.
This service focuses on daily living activities and safety, collectively known as Activities of Daily Living (ADLs). Unlike home health services, home care is not classified as medical treatment and typically does not fall under Medicare coverage.
Home Care Services Include:
– Assistance with bathing and dressing
– Meal preparation
– Medication reminders (not management)
– Light cleaning duties
– Transport to appointments
– Companionship
– Supervision to prevent falls
Home Care is:
– Primarily paid privately
– Occasionally covered by long-term care insurance
– Available in either short-term or long-term arrangements
– Not contingent upon being homebound
Consider this: “We are enhancing daily living and ensuring safety.”
Exception: Medicare provides limited respite care hours for those with dementia, subject to approval through the CMS GUIDE Model. For further information on financing Home Care, see our blog on How Am I Going to Afford Assisted Living or Home Care When I Need It?.
The Importance of Understanding These Distinctions
Through my interactions with families, I often hear comments like: “We believed Medicare would cover daily assistance.”
Medicare does not extend coverage for ADL support (like help with bathing or supervision) unless skilled services are also being rendered, and even then, only intermittently. This confusion can lead to added stress during challenging transitions.
Grasping these differences empowers families to:
– Organize their financial planning
– Avoid caregiver exhaustion
– Decrease hospital readmission rates
– Preserve dignity at home
When to Explore Home Health Services
– Following hospital discharge or a rehab stay
– If there are newly developed wounds or adjustments in medications
– When there is a decline in strength, balance, or speech
– At a physician’s recommendation for in-home therapy
When to Consider Home Care Services
– When a loved one lives alone
– When there are concerns regarding memory
– If meals are frequently missed
– When personal hygiene is declining
– If family caregivers are feeling overwhelmed
– When there is an increased risk of falls
– If feelings of loneliness and isolation exist
Ultimately, the goal is more than just keeping someone at home; it’s about ensuring they are safe, supported, and able to thrive.
At times, that may involve a combination of services, making adjustments as needs evolve, or, when necessary, considering community living arrangements. This is where my team at Ruby Care Senior Living Advisors comes in to guide you through transitions when they are required.
Nevertheless, clarity is essential from the outset.
If you’re uncertain about what your loved one requires, ask:
– Is this situation medical in nature?
– Or is it about daily living support?
– Will this assistance be needed temporarily or for the long haul?
These inquiries often bring the clarity needed to make the right choice.
