Medical Home Health or Non-Medical In-Home Care? By Mark Wecker

When people see my Always Best Care name badge, they’ll often ask what I do. My short answer is, “I am the director of business development for home care agency.”

“Oh, you mean like, ‘Home Health’?” they inquire.

“Well, it depends on what you mean by ‘Home Health.’”

It can be confusing. Terms like “home health” and “in-home care” are not synonymous, yet they are often mixed up. Similarly, the term “nursing home” is often used when people really mean “assisted living.” Entering the world of senior care requires a primer.

When a loved one has a traumatic event that leads to admission to the hospital, family members are thrust into a strange universe where they have to navigate a new language and unfamiliar rules. This adds to the stress of supervising their loved one’s care while managing their own personal affairs. Some family members have spent years shouldering the demands of being the primary caregiver for an aging spouse, parent, or relative. Either way, it is not uncommon for family caregivers to feel overwhelmed, isolated, and confused about the services available to their loved one.

Following is a basic overview of the differences in levels of care; it is not intended to be an authoritative guide. You may wish to visit for more information.

Patients who have been hospitalized due to major surgery or injury may be transferred to a Skilled Nursing Facility (or SNF) for rehabilitation provided by a team that includes Registered Nurses, Licensed Vocational Nurses, Physical Therapists, Occupational Therapists, and Speech-Language Pathologists. Medicare may cover basic skilled nursing care at a SNF, provided that the patient had a “qualifying hospital stay.” This means a person has to be admitted as an inpatient to the hospital for a minimum of three consecutive days, not including the day of discharge, and not on “observation status,” in order for Medicare to pay for care at a SNF.

On the other hand, not every patient who is ill or incapacitated will necessarily wind up in the hospital or be transferred to a SNF. A doctor may write an order for home health care, which provides intermittent skilled nursing care (typically two or three days a week) at home in order to treat an illness or injury for a limited period of time (four to six weeks is the average, though it could be more). Examples of care include: wound care, intravenous injections, nutrition therapy, physical therapy, occupational therapy, and speech therapy. To qualify, the doctor must certify that home health care is medically necessary, that the patient is homebound and has a condition that is expected to improve. If the patient meets these requirements, Medicare will cover skilled home health services. But Medicare will NOT pay for long-term custodial care, such as 24-hour care, personal care, or homemaker services.
A typical home health care visit lasts no more than an hour. What about the other 23 hours a day? Who is there to assist with Activities of Daily Living? For example, what if mom or dad needs help transferring out of bed or a chair? What about walking from bedroom to dining room, or simply getting to the commode? Grooming and dressing? (Have you ever tried zipping up pants or buttoning a sweater with only one hand? What if you can’t remember how to use a zipper or button?) What if mom has only been eating peanuts for lunch because she is too weak to go to the market or preparing meals is too difficult for her? What if dad needs verbal cues to use the bathroom throughout the day? And, what if complying with prescription medications has become too confusing and overwhelming – especially after a hospitalization? Who’s reminding mom and dad to take their pills on time, every time? Qualified caregivers through a reputable in-home care agency are insured, bonded, and trained to provide these services.

As noted above, custodial care is not covered by Medicare or Medicare supplemental insurance. The patient or family will pay privately for these services out of pocket. A long term care insurance policy will reimburse for the cost of custodial care provided at home or at an assisted living facility, but fewer than 10% of Americans have this type of insurance coverage.

Navigating care options for a loved one can be confusing, but you don’t have to do this alone! Always Best Care South Bay is dedicated to reducing the confusion, isolation, and stress related to senior care. Solutions are as easy as A-B-C and just a phone call away:

A. Non-Medical, In-Home Care – companionship, personal care, and end-of-life comfort care – provided by thoroughly screened, bonded and insured caregivers, backed by our expert care management team.

B. FREE Assisted Living Finder Services – we have prescreened over 180 Residential Care Facilities for the Elderly in the South Bay and personally escort families to the most appropriate living options that match their loved one’s criteria, including budget, geographic area, and level of care.

C. FREE Family Support Services – including monthly caregiver training for families who have a loved one with dementia, as well as caregiver support groups affiliated with the Alzheimer’s Association.

For more than 5 years, it has been our privilege to serve the South Bay from Manhattan Beach to Long Beach, enabling older adults to lead safe, independent and more dignified lives. Please give us a call if you or someone you know has a loved one who needs care. We are happy to answer any questions you may have. Please call our office at (310) 792-8666.

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