Understanding In-Home Services

UPMC Senior Services

Maybe you or a loved one could use some help in the home. There are a lot of services that can assist someone who wants to continue to age in place (at home) and needs a bit of assistance. Plenty of questions probably pop up next. Should home care or home health be explored? What is private duty care? The next question may be, ‘how do I pay for that?’, or ‘does Medicare cover in-home services?’ These questions do not always have a simple answer. Today, home care and home health are used interchangeably. However, they can mean different types of services, and it varies as to whether Medicare provides coverage.

Home care is more of an umbrella term that can represent both health and social services. One piece of home care is private duty care that includes non-medical companion or caregiving-type services. This could be personal care, meal preparation, companionship, housekeeping, etc. Home health is care provided by a licensed professional, such as a registered nurse (RN) or physical or occupational therapist (PT or OT). Often a home health professional is teaching a patient about how to manage their health, illness, medication, etc.

The terminology is not the most important piece to consider though. An individual should think about what types of activities require assistance. Is mobility assistance needed? Does someone need help managing medications or injections? Is assistance needed after surgery? Once this is under consideration, talk with the doctor and the health insurance provider. This is where the distinction can be made as to payment for in-home services.

If the doctor determines a home health order can be prescribed, they will identify the types of services needed, such as skilled nursing care or therapy. Additionally, the doctor prescribing the home health order would need to confirm that the individual is ‘homebound’ or has trouble leaving the home without aid. The next step is to choose a Medicare certified home health agency. The home care team along with the doctor, will create an individualized plan of care that the doctor will continue to oversee. The doctor or medical team will review this care plan, at least, every 60 days. Keep in mind, home care is intermittent care to evaluate, monitor and provide education on disease and medication management. Medicare will not cover 24/7 care.

Medicare does not cover non-medical services if it is the only type of care needed. The most important step is to have an on-going conversation with the doctor to discuss concerns and needs. Another essential step is to check with the insurance provider to see if there are any programs that can meet the person’s needs.

Coverage can vary depending on the type of service, and there can be different eligibility factors. Also, coverage may differ depending on the type of insurance, such as a Medicare Advantage plan, Medigap plan, Medicaid, VA, private insurance, or longterm care insurance. If care would not be available, individuals could explore local programs that assist with in-home services:

Area Agency on Aging offices provides care coordination to older adults to help individuals live as independently as possible at home. To learn more, visit aging.pa.gov

Community Life is an all-inclusive program tailored to meet the health care needs of lower-income seniors who continue to live at home. To learn more, contact 866-419-1693. This is an example of a Living Independence for the Elderly (LIFE) program. Visit palifeprograms.org for more information about comparable programs.

Living-at-Home provides care coordination for ongoing in-home care for older adults to 23 Pittsburgh area neighborhoods. To learn more, contact 412-723-6200.

If you are interested in learning more about home health care services, visit the UPMC Home Healthcare website at UPMCHomeHealthcare.com.

If you have questions about community resources or would like to discuss a situation that is close to you, please reach out to us! Our phone number is 866-4308742, our e-mail is UPMCSeniorServices@UPMC.edu, and our website is SeniorServices.UPMC.com. Join us on Facebook for posts on topics like this at Facebook. com/Groups/UPMCSeniorServices.

Please note that more information on the eligibility criteria and type of services eligible for Medicare coverage is available on Medicare’s website. To find a Medicare certified home health agency, individuals can find the ‘Care Compare’ webtool on Medicare’s website. To contact Medicare, their phone number is 800-MEDICARE. n

Source: Medicare.govx