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Home Health & Medicare:
Can I qualify for home health
under Medicare?
Medicare pays for health care in a patient’s residence only if
all four of the
following conditions are met:
- The patient must need intermittent skilled nursing
care, physical therapy, speech therapy, or continuous
occupational therapy.
- The patient must be homebound. (See explanation
below)
- The patient is under the care of a physician who
determines the need for home health care and
subsequently sets up and periodically reviews a home
health plan of care. A patient cannot have home care
without a physician’s order.
- The home health agency serving the patient is
approved for payment by the Medicare program.
Home Health & Medicaid:
Can I qualify for home
health under Medicaid?
Medicaid pays for health care in a patient’s residence
only if:
- The patient qualifies for state Medicaid program.
- The patient must need intermittent skilled nursing
care or therapy. Certain limitations apply.
- The patient is under the care of a physician who
determines the need for home health care and
subsequently sets up and periodically reviews a home
health plan of care. A patient cannot have home care
without a physician’s order.
- The home health agency serving the patient is
approved for payment by the Medicaid program.
Home Health & Private Insurance:
Will private insurance cover
home health?
Private insurance coverage for health care in the
patient’s residence varies from policy to policy. To
determine your policies coverage, please contact your policy
provider.
Homebound (According to the
Medicare Manual, Section 2051.1):
Patient’s may be considered homebound if absences from
the home are infrequent or for periods of relatively short
duration or attributable to the need to receive medical
treatment. Generally speaking, a beneficiary will be
considered homebound if he/she has a condition due to an
illness or injury which restricts his/her ability to leave
his/her place of residence except with the aid of supportive
devices such as crutches, canes, wheelchairs, and walkers,
the use of special transportation, or the assistance of
another person, or if he/she has a condition which is such
that leaving his/her home is medically contraindicated.
Hospice Coverage:
When should a decision
about entering a hospice program be made -- and who should make
it?
At any time during a life-limiting illness, it is
appropriate to discuss all of a patient’s care options,
including hospice. By law the decision belongs to the
patient. Understandably, most people are uncomfortable with
the idea of stopping an all-out effort to “beat” their
disease. Hospice staff members are highly sensitive to these
concerns and are always available to discuss them with the
patient, family, and physician.
Should I wait for our
physician to raise the possibility of hospice, or should I raise
it first?
The patient and family should feel free to discuss
hospice care at any time with their physician, other
healthcare professionals, clergy or friends.
Can a hospice patient who
shows signs of recovery be returned to regular medical
treatment?
Certainly. If improvement in the condition occurs and the
disease seems to be in remission, the patient can be
discharged from hospice and return to aggressive therapy or
go on about his or her daily life. If a discharged patient
should later need to return to hospice care, Medicare and
most private insurance will allow additional coverage for
this purpose.
Must someone be with the
patient at all times?
In the early weeks of care, it’s usually not necessary
for someone to be with the patient all the time. Later,
however, since one of the most common fears of patients is
the fear of dying alone, hospice generally encourages
someone to be there continuously. While family and friends
must be relied on to give most of the care, hospices do
provide volunteers to assist with errands and to provide a
break and time away for major caregivers.
Is the home the only place
hospice care can be delivered?
No. Although most hospice services are delivered in a
personal residence, some patients are cared for in nursing
homes or hospice centers.
How does hospice manage
pain?
Hospice nurses and doctors are up-to-date on the latest
medications and devices for pain and symptom relief. In
addition, physical and occupational therapists assist
patients to be as mobile and self-sufficient as possible,
and they are often joined by specialists schooled in music
therapy, diet counseling, and other therapies. Hospice
believes that emotional and spiritual pain are just as real
and in need of attention as physical pain, so it addresses
these, as well. Counselors, including spiritual caregivers,
are available to assist family members as well as patients.
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