A Cursory look at Home Health Care&Medical Home Care, Any Difference?

In general, home health care includes intermittent home visits to provide nursing care or other skilled services like physical therapy, occupational therapy, and speech therapy services. In order for Medicare or other insurance to cover home health care, there are generally four requirements that must be met.

  • Care must be ordered and overseen by a physician
  • The patient must have been seen by a physician for the condition

Services may also include medical social services, dietician services or assistance from a home health aide. Nightingale Homecare is a leading home health care agency serving Phoenix, Sun City, Peoria, Mesa, Tempe, Glendale, Scottsdale, Paradise Valley, Chandler, Gilbert and all of Maricopa County, AZ. Nightingale works closely with each patient’s physician to determine which of these services is required, and is responsible for providing all of the in home care needed.

requiring home health care no more than 90 days prior to the start of home health care services or no later than 30 days after the start of home health care services

  • The individual must be “homebound”, meaning that leaving the home to receive care is unsafe, requires the assistance of other people and/or requires considerable and exhausting effort
  • The care needed is “skilled” rather than “custodial” (see below for clarification these terms)

Note that skilled care is only provided by trained professionals. As an illustration, skilled nursing care is required for a complicated wound and skilled therapy care is required for the development of a home exercise program to recover from a hip replacement operation.

On the other hand, Custodial care is one that can be provides by a non- professional (i.e. nursing assistant or home health aide). Generally, it is the help given to an individual to complete daily activities, such as bathing, dressing, preparing meals, eating, using the toilet, walking, etc. This type of care is not provided with the goal of helping someone heal from an illness or injury, but to ensure daily activities are completed safely. While Medicare will cover a limited amount of custodial care given by a Home Health Aide during the time that someone is receiving skilled care, extended or ongoing custodial care is not paid for by Medicare.

Many individuals require greater assistance than Medicare or other insurance providers will cover under the home health care benefit. They may need someone to be with them round-the-clock while they recover from an illness, or they may need care for a longer period of time than Medicare will cover – perhaps even until the end of life, when necessary. In these cases, individuals usually utilize long term care insurance policies to meet custodial care needs, or they pay privately for this type of care. For many seniors, the unlimited options provided by home care services is more preferable than going into the unfamiliar surroundings of a skilled nursing facility.

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