Navigating Home Health

Navigating Home Health

By Lauren Thomas

“I think Medicare covers this service”, is a common statement made to home healthcare companies when arranging care for a loved one.  Today with so many types of home health care, the services available to you and your family can be confusing, and challenging to understand.

Medicare is the federal health insurance program for: People who are 65 or older, certain younger people with disabilities, and individuals with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). There are different parts of Medicare that each cover specific services.

  • Medicare Part A known as Hospital Insurance covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B known as Medical Insurance covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Part D is known as prescription drug coverage.

Medicare doesn’t pay for: 24-hour-a-day care at home, meals delivered to your home, custodial or personal care (help bathing, dressing, and using the bathroom) or homemaker services.

If Medicare doesn’t cover everything an individual needs to return home safely there are two additional options for in-home support: Personal Care/Assistive Care or Private Duty Nursing.

Personal Care or Assistive Care is ideal for an individual needing help at home with everyday activities like bathing, dressing, meal preparation, house hold support such as housekeeping and more. This service is available up to 24 hours a day, 7 days a week and does not require prior approval from a physician like Medicare. This service is paid for out of pocket and charged an hourly rate ranging from $20-26 per hour or by Long Term Care Insurance. Many individuals with family members diagnosed with Alzheimer’s disease, Parkinson’s disease, or early on-set dementia find this service to be most helpful while helping loved ones age in place.  Personal care is designed to be a more long-term option for individuals that need on-going and daily care to remain in their homes safely.

Private Duty nursing is for individuals in need of long-term care at home provided by LPN’s or RN’s and is for individuals with chronic illness, injury, or disability. Private Duty Nursing care is home-based skilled nursing care for those individuals that may have had a traumatic brain injury, or may be dependent on a ventilator or require tracheostomy in order to stay at home. You will need physician’s orders for this service similar to Medicare services.

You may be asking yourself how you can help a loved one navigate the types of home health care. There are several things you can do to help yourself or a loved one. The first thing to do is your research! Visit which is the website that outlines information on what Medicare Covers, how it works, and offers helpful resources.

The second thing to do is be prepared! When you or loved one are hospitalized, or in need of some home health care you need to be prepared to ask questions!  Many medical professionals do not have a clear understanding of the types of home health care services available. Important questions to ask your physician include, “do you feel I will need daily in-home support upon discharge?” or “besides the services Medicare covers, do you suggest I look into personal care”? Your physician or social worker should be able to put you in contact with a home healthcare professional that can assist you with making these decisions. Together a home healthcare expert can help navigate the discharge process, create an in-home care plan and arrange for services. It’s important to understand that not every home health care company offers every service. In the greater Charlotte area, many companies only provide Medicare services or Assistive Care services but not both. Interim Healthcare and BAYADA Home Healthcare are two companies that can provide both the services covered by Medicare and Assistive Care. Often, a “one-stop shop” is the best option for someone needing multiple services.

The third thing to remember is that you have the right to choose your home health care agency! Don’t be afraid do your own research, ask questions, and know your options. You are the expert when it comes to deciding what’s best for your family.

Home health care is a wonderful service with many options to meet various needs. It can be difficult to navigate these services so it’s important to research, ask questions, understand which type of healthcare you or your loved one needs, and know your rights.