When it comes to choosing health benefits, our focus naturally turns to hospital and routine outpatient care services. The former is essential when serious health issues arise, while the latter will hopefully help us maintain our good health and address minor issues before they become major ones. But there is an additional area that is especially important for seniors, and it’s home health care.
Let’s look at the types of coverages this benefit may include, as well as the critical role it plays in maintaining seniors’ overall independence and happiness long-term. But first, here’s a quick overview of why it should be top-of-mind as you plan your health coverage going forward.
When Home Health Care Is Needed
Seniors may find they require in-home care because of a sudden injury or illness, or as a result of gradual health changes over time.
For example, after a hip replacement surgery, physical therapy will be required to ensure a full and successful recovery. Or, after hospitalization for an illness, the patient may return home but still needs part-time skilled nursing care. To recover at home is not only better psychologically, but it’s also less expensive than an extended hospital stay.
For some, in-home assistance is needed to help with day-to-day tasks they can no longer manage on their own. This could range from bathing and grooming to managing medications and transportation to medical appointments.
The reasons for needing in-home care can vary widely. However, the overall mission is to use professional service providers to enable seniors to remain safely in their preferred, familiar living spaces.
Different Levels of Home Health Care
So now that we know why in-home care becomes necessary, let’s examine some of the types of care provided.
- Medicare-Certified Home Health Care – The services provided under this category include occupational therapy, physical therapy, speech-language pathology, intermittent (part-time) skilled nursing care, medical social services, and part-time care from home health aides.
Typically these services are provided on a short-term basis to seniors who are recuperating from an injury, a sickness, or a recent stay in the hospital. This type of care must be declared medically necessary by your physician, and he or she will also need to certify that you are homebound.
- Private Home Nursing Care – While the previous category addresses short-term needs, this type of care is provided to those with chronic or long-term conditions. These may range from diseases like ALS or MS to patients who have spinal cord or traumatic brain injuries.
Examples of some of the services nurses provide include ventilator, feeding tube, tracheostomy, and catheter care, along with the monitoring and administration of other key health measures.
This type of care must be prescribed by a physician.
- Daily Living Assistance Care – For those seniors who live on their own and prefer to keep it that way, sometimes a different kind of care is needed. The kind that’s non-medical in nature and a caregiver can provide.
Some services seniors may receive with this coverage include assistance with personal care, such as bathing and dressing. In addition, aides can help with healthy meal planning, medication management, and transportation to doctors’ appointments.
This type of assistance doesn’t require a prescription, but needs to be deemed medically appropriate by a licensed healthcare professional.
The ABCs of In-Home Care
So now that you know the types of home health care available, how do you make sure you’re covered for the services you’ll eventually want or need? The answer is to know what the Medicare coverage options are so you can select the best plan available.
Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). It will cover the Medicare-certified Home Health Care services if you meet the eligibility requirements.
However, Original Medicare doesn’t cover Daily Living Assistance Care if this is the only type of care you require. That’s where Medicare Part C, also known as Medicare Advantage comes in.
Medicare Advantage plans are supplied through private insurance companies that Medicare must approve. Medicare Advantage plans are required to offer the same hospital and medical insurance coverages that Original Medicare does. (This includes home health care services.) Additionally, Medicare Advantage plans can offer extra benefits ranging from vision and dental to non-skilled in-home care and more. These additional benefits could mean the difference between staying comfortably in your house and having to move somewhere new.
The At-Home Advantage
So what types of in-home services could this Medicare Advantage coverage include? We touched on a few previously, including:
- Daily personal care (bathing, grooming, getting dressed)
- Medication management
- Transportation to doctors’ appointments.
Home health aides may also show seniors how to prepare healthy meals and assist them with eating. For seniors who have asthma or related conditions, selected house cleaning services may be included.
In addition, Medicare Advantage benefits may cover the purchase and installation of certain safety equipment, such as raised toilet seats, shower stools, grab bars, and wheelchair ramps.
In-Home Caregivers and Respite Care
Since several of the in-home services may be performed by a non-medical professional, many Medicare Advantage plans allow seniors to turn to either a professional caregiver or a relative of their choice.
In both cases, there will be times when the main caregiver will need time away. Medicare Advantage providers understand this and offer respite care as part of their coverage. Here’s a brief look at the three types of respite care provided.
- Short-Term Stay at Nursing Home or Assisted Living Facility – This option is especially helpful when a senior is convalescing and their condition makes returning home too soon impossible. Senior living facilities typically have short-term rooms available for this type of use.
- In-Home Respite Care – When a trusted caregiver is away, some plans enable seniors to stay at home and bring in a professional to address their needs for an allotted time.
- Adult Day Care – This form of respite care nurtures the emotional needs of seniors, as well as the physical. By interacting with others and socializing, it helps them to form new connections in a safe and supervised environment.
As you plan your future health care needs, think about your home and how much you value living there. From the independence and security it provides, to the joy of being near the neighbors and friends. The choices you make now could enable you to have many more years of happiness there.