Does Medicare Pay for Home Health Care?

Home health care is an alternative to traditional in-hospital care that’s growing in popularity. Care at home offers convenience, ease of access and peace of mind for many families in the US. However, like all other health care options, cost is often a consideration. Not all families can afford to pay in full for home health care services out of pocket. Seeing as in-hospital treatments are normally covered by Part A of a Medicare plan, you might think that you have to opt for hospital care to qualify for cover. But does Medicare pay for home health care under some circumstances? The good news that there are home health care services you can access through your Medicare plan.

What Does Medicare Cover for Home Health Care?

Medicare is a government health plan funded through tax money. Most people contribute to Medicare during their working years. In the same way you contribute to social security tax, part of your income tax goes towards Medicare cover. Cover provided by Medicare can is divided into four categories; Part A, Part B, Part C and Part D.

Most Americans are only eligible to claim Medicare benefits are the age of 65, or after retirement. However, there are exceptions. Certain people with severe disabilities can be eligible for Medicare benefits even before retirement age.

What Does Part A and B of A Medicare Plan Cover?

Upon retirement, American tax payers normally qualify for Part A Medicare cover automatically without the need to pay monthly premiums. Part A covers hospital care or the cost of being in a medical facility.

Although this cover is useful, it’s not a comprehensive health care plan that will pay for all your health care expenses. Additional costs such as visits to the doctor, medical tests, medical equipment and certain procedures are covered by Part B of a Medicare plan. Unlike Part A, there is a monthly premium of approximately $144 for Part B Medicare cover.

What Does Medicare Pay for Home Health Care?

Provided you have both Part A and B cover, you can claim for from Medicare for any of the following home health care services:

  • Part-time or intermittent nursing services
  • Part-time or intermittent home health aides
  • Physical therapy
  • Occupational therapy
  • Medical social work

Considering all the home health care services covered by Medicare, you can claim for almost any home health care service available. The only drawback is that you can’t claim for home health care benefits indefinitely. There are some requirements candidates must fulfill in order to claim home health care from Medicare.

Who Qualifies to Claim for Home Health Care Benefits?

As mentioned, there are some requirements to claim home health care through Medicare. Some of the main requirements for claiming are as follows:

  • The home health care treatment must be part of a plan prescribed by a doctor or qualified medical professional.
  • Necessary services can’t be claimed for indefinitely. This means that you can only claim for a set duration of time as prescribed by a qualified health care professional. When the prescribed treatment time expires, eligible candidates need to reapply for care and obtain an extended treatment recommendation from a heath care professional.
  • Home health care services can’t be administered full-time. This means that Medicare won’t pay for 24/7 home health care services.
  • Eligible candidates must be certified as being home-bound by a doctor. To qualify as home-bound, a patient mustn’t be able to leave home without a wheelchair, walking frame or another person to assist. The patient must be able to prove that leaving home requires a considerable amount of effort.
  • The home health care services have to be administered by a home health care agency that’s registered with Medicare.

Lastly, it’s a requirement that Medicare must approve any home health care costs you wish to claim for. You need to make sure that Medicare will pay for your treatments before receiving care from a qualifying home health care agency.

Medicare won’t pay for home health care services if they aren’t administered through a registered home health care agency. Furthermore, Medicare won’t pay if you only require minor household services like cleaning, cooking and shopping. All household tasks must be performed by qualified health aides and they must be part of a prescribed health care plan.

What Kind of Home Health Services Can You Claim For?

Although the above describes what you can claim, you might still feel a sense of confusion. Does Medicare pay for the home health care you need? To clear up confusion, here are some examples of eligible candidates who can claim:

  • Patients who are recovering at home post-surgery qualify for necessary nursing services, such as wound care at home.
  • Patients recovering from a stroke can qualify to receive care from a health aide during the recovery process.
  • Recovering stroke patients, amputees and disabled persons can qualify for rehabilitation, such as physical and occupational therapy.
  • Diabetic patients can qualify for complex wound care after an injury.
  • Elderly patients suffering from temporary illnesses, infections and injuries can qualify for nursing care and health aide services.

Health aides can deliver a variety of services to patients. Qualified home health aides often perform daily tasks such as cooking and cleaning duties on behalf of patients. Home health aides also assist in helping patients with movement impairments move around. Patients with memory problems often need to be reminded to take their prescribed medications, which is another task home health aides can help with.

What Won’t Medicare Cover?

Although Medicare will generally cover almost any home health care services, they won’t cover 24/7 home health care. Severely disabled patients often need 24/7 assistance, with a nurse permanently available. However, this won’t be covered by home health care.

Chronic home health care also isn’t covered. This means that if you have an elderly loved one who is permanently dependent on a health aide, Medicare is unlikely to cover your costs.

Home Health Care Cost vs Traditional Care Costs

Seeing as not all persons in need of home health care can claim from Medicare, the cost of at-home health services compared to traditional options is an important consideration.

For instance, how does home health care costs compare to nursing home expenses? While many people think that home health care is a much more expensive option, it isn’t always the case. In fact, hiring a home health aide to care for an elderly loved one for 40-44 hours a week can cost as little $5000 monthly. Compare that cost to a nursing home, which can cost almost $7000 a month, by comparison.

Keep in mind that home health aides aren’t qualified nurses and can’t administer skilled health care services. A health aide won’t be able to deliver complex wound care. Your health aide also won’t be able to deliver medications through an IV or to tube feed a patient, as these all require the skills of a nurse. If your loved one requires any of the above-mentioned health services, traditional treatment might still be a cheaper option for you.

That said, home health aides are qualified to help patients with daily activities like cooking, cleaning and moving around. Patients who need help getting dressed and eating can also rely on a health aide for care.

So, when choosing whether to opt for home health care vs traditional care, consider what kind of care your loved one needs. If your loved one needs a lot of medical assistance, home care costs might end up being more expensive. But if you have an elderly loved one with dementia who simply requires supervision to stay safe alone at home, home health care can be cheaper than other options.

Rozanne WildsDoes Medicare Pay for Home Health Care?
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Wound Care At Home: Home Health Care Options

Everyone has had a cut or two at some point. Usually, it’s no big deal. You simply clean it and put a band-aid on. In a few weeks, it’s like it never happened. However, some wounds are more serious than this, requiring more attention for the wound to heal properly. A wound is a break in the skin caused by anything, from a surgical incision to an injury. While some wounds can heal quickly and easily on their own, others are the opposite. Fortunately though, taking care of a serious wound at home doesn’t have to be stressful. You can get assistance with your recovery thanks to professional wound care at home services provided for by professionals known as wound care nurses.

Wound Care Nurses

Home health care providers aim to offer patients flexibility on their journey to recovery. One way they do this is through providing wound care for patients permitted for home care by their doctors.

Certified wound care nurses are specialized in the treatment and care of complex wounds, making them ideal for wound care at home. Yes, family may be able to help, but wounds like those acquired from surgery need to be treated by professionals, as their complex nature can make them a bit tricky to manage.

As a home-based patient, your wound care nurse will assess, treat and create plans of care that will enable you to heal efficiently.

Well-rounded Care

Assessments are done before starting patient care. Assessments don’t only look at the wound itself, but take on a holistic view of the patient’s circumstances. Factors like wound characteristics, as well as the kind of family support available to the patient, are considered.

This ensures that the care plan fully compliments the patient’s unique situation. Even though wounds can be similar, every patient has their own journey to recovery and home care nurses understand this.

Wound care at home is a collaborative effort that includes a team of healthcare providers all working together to care for a patient.

Types of Wounds

Open and Closed Wounds

Wounds can either be open or closed. Open wounds are characterized by exposed body tissue due to a break in the skin while closed wounds occur underneath the surface of the skin (for instance, bruises), meaning the underlying body tissue remains unexposed.

Open wounds are more complex and need to be handled carefully to avoid any complications that may hamper the wound’s healing process.

Chronic Wounds

Chronic wounds – as their name suggests – are wounds that take a longer than usual time to heal, especially compared to acute wounds, which are quick to heal. Since chronic wounds take a lengthy period of time to heal, they require skilled intervention to be treated.

Causes of chronic wounds include:

  • Reopened surgical wounds
  • Pressure ulcers – caused by broken-down skin from excessive pressure in a bony area
  • Arterial/venous ulcers – caused by poor blood circulation, resulting in leg or feet injuries
  • Diabetic ulcers – caused by a loss of circulation as well as feeling
  • Sharp objects

Examples of chronic wounds include the following:

  • Surgical incisions
  • Animal bites
  • Gunshot wounds
  • Chemical, thermal and electrical burns

Chronic wounds often take a lot of care to heal and there’s a risk of serious infection if these wounds aren’t treated properly.

Why Is Wound Care Essential?

The importance of proper wound care cannot be stressed enough. Poor care can lead to serious complications and even infections, which can put your health at risk.

Prevent Infections

If the appropriate precautions of wound care are not followed, chances are you’ll develop an infection.

Infections are caused by an increase in bacteria in the wound and, if left untreated, wounds can become worse, which delays the healing process.

Signs of infection can include:

  • Redness or swelling around the wound
  • An unpleasant odor from the wound, even after it’s been cleaned
  • The wound or area surrounding it feels warm
  • The wound changes color
  • Pus buildup in the wound
  • Wound pain that’s getting worse
  • Fever
  • Feeling nauseous and vomiting

If either you or a loved one has some of the above symptoms with a chronic wound, it’s crucial to seek out medical help as soon as possible.

Control Surgical Site Infections

A surgical site infection is an infection that develops in the part of the body where surgery was performed. Site infections can either only involve the skin or can be more serious, affecting the tissues underneath the skin such as your organs and even implanted material.

Minimize Risk of Sepsis

Sepsis – also known as blood poisoning – is a blood infection caused by bacteria. Because the infection is in the blood, it can spread throughout the body, making it very dangerous if it’s not controlled as soon as possible. Sepsis is potentially fatal and will normally lead to death if left untreated.

Avoid Septic Shock

Sepsis that is left untreated evolves into what’s known as septic shock, a life-threatening condition that needs to be attended to immediately. Approximately half of all patients who develop septic shock die.

Facilitate Speedy Healing

Efficient wound care is directly linked to a faster healing process. So, if you neglect your wound, it will take longer to heal, delaying your recovery and leaving you vulnerable to complications.

Reduce Scarring

A good care plan can help to reduce scarring as the wound heals. Knowing what to do and what not to do can go a long way in minimizing scars during the healing process.

Benefits of Professional Wound Care At Home

Some wounds are more complicated than others. Sometimes, a patient or their caregiver might not have the expertise to adequately care for the wound.

Yes, family may be able to help, but difficult wounds like those acquired from surgery need to be treated by someone who knows what they’re doing. This is why wound care nurses are so beneficial for patients recovering at home.

Hospital Quality Care at Home

Wound care nurses are highly skilled, making them super reliable in delivering the best care to their patients. This affords patients the ability to still enjoy the highest standard of quality care even at home.

Reduced Risk of Readmission

Having a professional assist helps to minimize any risks of infection that you might otherwise become exposed to. Wound care nurses involved in your healing process can significantly reduce the risks of any wound-related complications, which reduces the risk of readmission to the hospital.

Diabetic Patients

People living with diabetes usually have to deal with wounds that don’t heal completely or that take a long time to heal. This leaves them at higher risks of getting infections and developing other complications.

Professional wound care at home is very beneficial for diabetic patients. Nurses can ensure that the right precautions are adhered to and appropriate care is taken in treating the wound. Furthermore, they can help patients manage their healing in conjunction with their condition (not just diabetes) in the best possible way.

Wound Care Nurse Services

Wound care nurses offer a multifaceted service to their patients. The following are things wound care nurses can assist with:

  • Changing the dressing
  • Treating wounds that are not healing as they should
  • Helping the patient with pain management
  • Advising patients on a suitable diet plan and lifestyle to assist wound healing

Dietary advice can be especially helpful for slow-healing wounds in diabetic patients. Wound care nurses can provide an all-round service to their patients. Nurses also provide education to patients and their families on wound care and techniques, along with ways to prevent complications.

Something to Consider

With all the benefits and convenience that it brings, you can rest assured that professional wound care at home is certainly something that will help you enjoy a smoother recovery process.

Wound care can be a lengthy and complicated process, which is why it’s so important that it’s done properly.

Re-admittance to hospital due to complications from a poorly managed wound must be avoided. While many wounds are easily manageable without the aid of a professional, more challenging wounds can heal better with the help of a qualified home care nurse.

Rozanne WildsWound Care At Home: Home Health Care Options
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