Doctor Ordered Home Care

What is Home Health Care?

Home health care is doctor-ordered care that can be given in the home. Home health care is usually less expensive, more convenient and just as effective as care given in a hospital or skilled nursing facility. The goal of home health care is to treat an illness or injury, helping an individual to get better, regain independence, and become as self-sufficient as possible.

In general, home health care includes intermittent home visits to provide skilled nursing care or other skilled services like physical therapy, occupational therapy, and speech therapy services. Services may also include medical social services, dietician services or assistance from a home health aide. Nightingale Homecare, like other home health care agencies, works closely with each client’s physician to determine which of these services is required and is responsible for providing all of the services needed.

In order for Medicare or other insurance to cover home health care, there are generally four requirements that must be met.

1. Care must be ordered and overseen by a physician
2. The individual must have been seen by a physician for the condition requiring home care no more than 90 days prior to the start of home care services or no later than 30 days after the start of home care services
3. 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 taxing effort
4. The care needed is “skilled” and not “custodial”.

Skilled care is care that can only be delivered by a trained professional. For example care of a complicated wound or the development of a home exercise program to be implemented after a hip replacement.

Custodial care is care that can be given by a non-professional. Generally, it is the help given to an individual to allow him or her 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. It is provided to make sure daily activities are completed safely. While Medicare will cover custodial care given by a Home Health Aide during the time that someone is receiving skilled care, ongoing custodial care is not paid for by Medicare. Many individuals utilize long term care insurance policies to meet custodial care needs, or they pay privately for this type of care.