What is Home Health?
Home Health provides skilled services, including nursing care and physical, occupational, speech and respiratory therapy. The agency will send a licensed professional to assess home health needs and develop a complete care plan. These services are usually short-term, as in the case of a person recovering from surgery or other health issues.
Medicare will cover home health if it is ordered by a physician and the person is homebound and in need of skilled services.
A home health care agency employs the healthcare professionals sent to the home and must be licensed by the state. Many seek additional accreditation to assure consumers that they have met quality standards. Common accreditations are Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Program (CHAP), and The Joint Commission (JCAHO).
Here is a helpful publication about the Medicare Home Health Benefit, published by CMS.
What is the cost and is it covered?
Medicare will cover most forms of home health care if it is ordered by a doctor. Services are usually covered for a 60-day "episode of care." However, if an individual is enrolled in a Medicare HMO, known as a Medicare Advantage Plan, services are authorized on a per-visit basis. Be sure when you interview an agency to ask whether they are certified by Medicare and what services are covered. Long-term care insurance and Medigap plans may also cover some costs of a home health aide.
How to find a home health agency
The Association for Home & Hospice Care of North Carolina (AHHC) offers a Home Care & Hospice Directory where you can search for an agency by county. Home health agencies are licensed by the North Carolina Division of Health Service Regulation.
Whenever anyone on Medicare is discharged from a hospital and is prescribed home health services (i.e. physical therapy following a hip fracture), a hospital social worker or case manager will present the individual with a list of Medicare-certified agencies to consider. When you find an agency, make sure it has been certified by Medicare so that the services qualify. Medicare certification also means the agency has met federal minimum requirements for quality patient care and management.
You can also search online to compare how well home health care agencies perform with Medicare's Home Health Compare tool.
What to Ask
When you interview a home health agency, there are a number of important questions to ask:
- Are you licensed by the state?
- Are you certified by Medicare?
- Do you have any accreditations from professional organizations? If so, please tell me about them.
- Are the workers you send your employees or contracted employees?
- What type of background checks do you conduct on your employees?
- If the worker does not show up when scheduled, will you send a replacement immediately?
- What type of progress reports can I expect from each type of professional providing care?
- Will you send a replacement if the worker is not compatible with the person receiving care?
- What can I expect to pay if services are not covered by Medicare, Medigap, Medicaid or long-term care insurance?
- To whom should I speak regarding care status?
- How do we appeal to Medicare if we think more care is needed?
- Can you put me in touch with someone who has used your services?