Making Sense of Medicare Requirements for Home Care

home care Phoenix AZ

Receiving care in your home is often preferred over going to a facility to recover from a surgery or illness. It can not only be comforting to be in your own home while you recover, but it is also often necessary. If you have Medicare or another form of insurance, there may be questions you have about what your plan will cover. In order for Medicare or other insurance policies 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, such as the home health care professionals at Nightingale Homecare. For example, skilled care can include care for 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 provided 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.

The Arizona Department of Health Services can be a helpful resource for questions about what Medicare covers.

Many individuals require greater assistance than Medicare or other insurance providers will cover under the home health care benefit. They may need someone to be with them round-the-clock while they recover from an illness, or they may need care for a longer period of time than Medicare will cover – perhaps even until the end of life. In these cases, individuals usually utilize long-term care insurance policies to meet custodial care needs, or they pay privately for this type of care. For many seniors, the unlimited options provided by home care services is more preferable than going into the unfamiliar surroundings of an elder care community or facility.

If you’d like to explore senior care options for yourself or a loved one, the professional in-home care team at Nightingale Homecare is here to help you determine the best care solution for your specific circumstances. Providers of the highest quality home care Phoenix, AZ has to offer, Nightingale Homecare offers a full range of care – from custodial care to highly skilled nursing care and therapy services. Contact us at (602) 504-1555 to learn more.