Home Health Agencies

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What are Home Health Agencies?

Home health agencies provide part-time and intermittent skilled nursing care at your home, provided you’re unable to leave home without assistance or risk of injury. They also provide physical, occupational and speech therapy in home if required.

Certain home health agencies may also offer some level of non-medical personal care, such as help with bathing and dressing. However, these services must be accompanied by a need for skilled nursing care in order to be covered by Medicare.

Home Health Agencies vs In-Home Care Services

Unlike in-home personal care providers, which focus on activities of daily living (ADLs), housekeeping and companionship, home health agencies provide skilled medical care by licensed nurses and therapists. As such, home health agencies tend to serve people with more immediate health needs than non-medical home care providers.

Another key difference is that home health agencies are not a continuous, long-term care solution. Medicare coverage limits home health care to a maximum of 8 hours a day and 28 hours a week over a 21 day period.

Home Health Agencies In-Home Care Agencies
Medical care - Part time skilled nursing care
- Physical therapy
- Occupational therapy
- Speech therapy
No
ADLs assistance (help with dressing, bathing, eating, etc.) Limited / only covered by Medicare when accompanied by a need for skilled nursing care Yes
Household chores Limited / not covered by Medicare Yes
Cooking / meal preparation / meal delivery Limited / not covered by Medicare Yes
Transportation / accompanying to appointments Limited / not covered by Medicare Yes
Cost Varies based on type of medical care $21/hour on average*
Payment options - Medicare (if eligible)
- Medicaid (if eligible)
- Veterans benefits (if eligible)
- Personal funds (if required)
- Private health insurance (policy dependent)
Personal funds (if required)
- Medicaid (if eligible)
- VA benefits (if eligible)
- State programs (if eligible)
- Long-term care insurance (if you have it)

*https://www.genworth.com/aging-and-you/finances/cost-of-care.html

What services are included in home health care?

Home health agency services typically include:

  • Skilled nursing care for a maximum 8 hours a day / 28 hours a week for 21 days
  • Wound care
  • Blood draws and injections
  • IV / nutrition therapy
  • Medical testing
  • Administering medications and medication management
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Some level of assistance with activities of daily living (ADLs)*

Additionally, some home health agencies may also provide the following non-medical services, which are not covered by Medicare:

  • Light housekeeping
  • Appointment reminders and scheduling
  • Transportation and escorting to appointments
  • Friendly companionship

*In order to be covered by Medicare, this must be accompanied by a need for skilled nursing care.

What services are not included in home health care?

Home health care does not provide stand-alone personal care and help with activities of daily living (ADLs). These services must be accompanied by a need for skilled nursing care in order to be covered by Medicare, and the level of non-medical care offered by home health agencies varies greatly by provider.

How much does home health care cost and who pays for it?

The costs for home health care vary greatly depending on where you live, the home health agency itself, and the amount of care required.

How To Pay

People use the following methods, or most often a combination of the following methods, to pay for home health care services:

Medicare

Home health care is covered by Medicare if its deemed medically necessary and the individual qualifies as “homebound.” To be considered homebound, you must be unable to leave home without assistance or risk of injury.

Medicaid

Medicaid covers or partially covers both non-medical and medical home care for older adults whose income and assets fall below a certain threshold. The coverage is provided through Home and Community Based Services (HCBS), Medicare waiver programs, or both, depending on the state. Wait lists are common.

Private Health Insurance and Managed Care Plans

Many private health insurance and managed care plans include a certain level of coverage for short-term home health care. Benefits vary depending on the policy.

Insurance

Many private health insurance and managed care plans include a certain level of coverage for short-term home health care. Benefits vary depending on the policy.

Personal Savings / Income

Many people use personal funds for any remaining costs that aren’t covered by Medicare, Medicaid, Veterans Benefits, private health insurance or state programs.

Veterans Benefits

Veterans can receive short-term skilled nursing care at home through the VA’s Skilled Home Health Care (SHHC) program.

How to find the best home health agencies for your loved ones.

Make sure the agency offers the type of care you need. If your loved one has diabetes, choose an agency that specializes in diabetes care and education. If your loved one is recovering from a joint replacement, choose an agency that specializes in physical therapy. Don’t assume every agency provides the same services.

Look for Medicare- and Medicaid-certified agencies. Not only does this allow you to pay for services through Medicare and Medicaid (if eligible), but it also ensures the agency meets certain quality standards.

Find home health agencies near you. Choosing a home health agency with an office located close to your neighborhood makes it easier to coordinate scheduling and meet with management when necessary.

Avoid large online referral brokers. These companies share your contact information and earn commission for placing you with certain agencies. With Care Listings, you can do your own research and submit care requests without worrying about a broker’s ulterior motives.

Review quality ratings and patient surveys. Each quarter, Medicare-certified home health agencies are given a rating based on clinical quality measures and, if available, a rating based on the results of patient surveys. Review these star ratings for the current year and past years to get a more complete picture of the agency’s overall quality.

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