How Do I Qualify for Home Health Care?

Among patients recovering in a hospital or skilled nursing facility, going home is a goal that is both common and completely understandable. With home health care services, patients are able get the quality medical care that they need while enjoying the comforts of their own home. There are emotional and mental benefits to receiving health care in familiar surroundings, and this cost-efficient form of health care tends to be more affordable while remaining just as effective as the care delivered to patients housed in a medical facility. However, there are rules about who can utilize this type of care. Understanding how to qualify for home health care allows patients who might benefit from this type of care to make arrangements to get the services that they need.

How do I qualify for home health care?

What does home health care involve? As the name makes clear, it entails health care services that are delivered by skilled providers in a patient’s home. These services are generally delivered under a care plan established by a doctor and coordinated by a home health agency. They can include intermittent skilled nursing care, speech-language pathology services, physical therapy, occupational therapy, and other similar services. Medicare will cover home health care services for eligible patients. In order to qualify for home health care services, a patient must meet certain requirements:

Why must a patient be under the care of a physician to qualify for home health care?

Orders from a doctor are needed to begin home health care. Treatment will follow a care plan created by the patient’s doctor, and the doctor will need to review the treatment plan regularly to verify that the services are appropriate for the patient’s health situation.

Why must my doctor certify that I need home health care services?

For a patient to qualify for home health care services, a doctor must determine and certify that they need one or more of the following services:

  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Continued occupational therapy services

Why must a home health provider be certified to deliver services?

Although there are many people who are called on to provide care for someone recovering at home, only qualified and vetted professionals are allowed to deliver services approved by Medicare. Medicare will only pay for home health care services that are delivered by a Medicare-certified provider.

Must I be homebound to receive home health care services?

In addition to needing the services offered by home health care providers, patients must be certified as homebound by their doctor. What does it mean to be homebound? To meet this requirement, the patient must be able to show that leaving their home unassisted requires extreme, taxing effort or that their condition makes it unsafe or dangerous for them to leave their home for an extended period. However, patients who are deemed homebound are not strictly confined to their homes. They may attend adult day care programs. They may also leave home occasionally for short periods to do things like attend religious services or receive medical care.

When can a home health care agency help me?

There are many situations in which home health care can provide valuable assistance to patients. Individuals who are homebound and under a doctor’s care may benefit from home health care if one or more of the following conditions apply:

  • The patient has an unstable or complex health situation that requires professional monitoring.
  • The patient has a history of multiple hospital admissions.
  • The patient has been readmitted for a diagnosis treated by hospitalization within the last three months.
  • Wound care for an injury, a surgical incision, pressure sores, or other wounds is required.
  • The patient has difficulty following the doctor’s recommendations at home without professional supervision.
  • Additional patient or caregiver education is necessary.
  • Injections or intravenous or nutrition therapy are needed.
  • The patient has a potentially terminal, life-threatening, or seriously incapacitating diagnosis.
  • Skilled nursing, physical therapy, occupational therapy, or speech therapy is required to improve or maintain the patient’s health.
  • The patient has been recently diagnosed or is still acclimating to new or adjusted medications.
  • The patient was previously fairly independent, but they have recently experienced a significant decline in their ability to function.
  • The patient is returning home from a stay in a hospital, skilled nursing facility, rehab center, or assisted living facility and requires continued care.

The delivery of top-notch home health care services can be an incredibly positive experience. These services allow patients to get the health care that they need to thrive while enjoying the familiar comfort of their own home and community.

If you or a loved one is considering home care, or you’re wondering how to qualify for home health care, don’t hesitate to meet with a provider to discuss how this service can provide for your needs. Or, take our quiz to find out which service could improve your quality of life today. Finally, if you’d like to explore more services and benefits, you can visit Phoenix Home Care to learn how to get started on your journey to a happier, healthier you!

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