Home Care is the fastest growing segment of the senior healthcare continuum and for good reason. Seniors want great healthcare but they also want control. With the negative stigmas surrounding nursing homes, seniors are often choosing care in their own home rather than care in a facility.
Nursing Home care has its place in the healthcare continuum but it is costly. With monthly rates ranging between $8,500 to $15,000 many are opting to spend their healthcare dollars in the comfort of their own home. Medicare has also shifted healthcare dollars by cutting funding to nursing homes and funding pilot programs designed to promote home care innovations.
With so much opportunity comes competition. Thousands of Home Care companies have sprung onto the market hoping to capitalize on the Baby Boomer retirement rush causing confusion for consumers and referral sources.
Every level of the senior care continuum has its place but large caseloads prevent social workers from spending the time it takes to explain how each level works.
In this post we will talk about home care, how it starts and how it works.
How it Starts
Home Care is covered by Medicare Part A. It is approved in 60 day increments called “certification periods”. In order for someone to qualify for Home Care they must be homebound. Homebound is defined by Medicare as an individual who is confined to home because …a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device… according to the Centers for Medicare Advocacy.
A patient doesn’t need to have a qualifying hospital stay in order to begin home care but they do need an order from a doctor. That order can come at any time but must be prescribed specifically to treat a particular diagnosis. Additionally it must be explained to the patient why they are being prescribed home care treatment (called a face-to-face).
Home Care is an excellent tool if used to prevent a possible hospital stay. If prescribed at the first sign of weakness or exacerbation of a chronic illness it can prevent the senior from entering a cycle of hospitalization.
How it Works
After the home care company receives the referral they have 48 hours to open the case. In order to do that a nurse must go to the patient’s home to complete an evaluation. After the case is opened a physical therapist and sometimes an occupational therapist will come out to complete their own evaluations. After all the initial evaluations and paperwork is complete, the treatment team will decide on a schedule (also known as frequency) they will use to provide the physician directed treatment.
As with any other type of short-term health care insurance, coverage only continues if the patient continues to show progress. Coverage ends when the patient achieves their treatment goals or stops showing progress toward them.