An Often Misunderstood Option - Medicare Part A Certified Home Care

The call comes – the one every adult child of an elderly parent dreads. Mom has fallen and can’t get up. Amusing when on a TV advertisement but in reality, it is a fear realized for both of you. Now that she is back home and okay what next? Is there anything that will help keep her safe and enable her to live in her own home for even just a little while longer? One underutilized and often misunderstood option is Part A Medicare certified home care. Even the doctors who prescribe it may not fully understand what a great alternative it truly is for the patients who make use of it.

Medicare beneficiaries qualify for the Part A Home Care Benefit by meeting four very simple eligibility criteria. 1) They must be homebound. Medicare language is vague on this topic so that the patient requires “considerable and taxing effort” to leave their home or does so with the “assistance of another”. 2) The need for intermittent skilled services must exist. The services of a nurse, physical, occupational or speech therapist are required to achieve goals set on an initial visit with patient and caregiver input. 3) When ordering home care, physicians must establish and certify a plan of care for the patient’s services. The patient has to stay under the doctor’s care and remain compliant with what the nursing or rehabilitation professionals recommend. 4) The homecare services have to be provided by a Medicare certified agency. Many such agencies exist. How does one know what can be done for Mom and what will it cost?

The great news about Part A Medicare certified home care services is that they are 100% covered. Mom (or Dad in many cases) worked their whole lives paying into the Medicare system and after 65, meeting the above criteria, are able to receive the services now need. Agency staff will be able to verify their Medicare status and at the initial visit, paperwork will be provided that assures that no bill for services will go out to the beneficiary if they are indeed eligible. Unlike Part B therapy services which can also be provided in a patient’s home, there are no co-pay or insurance premiums to be paid and no outpatient cap on therapy services.

Upon an initial visit by either a nurse or physical therapist, a comprehensive assessment of the home, Mom’s physical condition, and her need for services is made. Caregivers are often included in developing the plans of care. Services will be provided on a short-term, transitional basis (usually less than 2 months) with a focus on teaching both patient and caregiver how to address those identified needs, instead of fostering dependency. Subsequent disciplines will evaluate Mom and set goals with her functional independence and safety as the primary objective. Each service will continue to visit her at home at a frequency (often 2-3 times /week) agreed upon while she progresses.

An agency’s home care professionals provide many services to their patients. Nurses are able to provide teaching about newly prescribed medications, heal wounds, and provide education about disease management and safety. Therapists address functional limitations by teaching exercises that improve strength, balance, and coordination. They may recommend additional home modifications or equipment to ensure that Mom is as independent as possible while safe in taking care of herself in her own home. Compromised daily living skills such as bathing or dressing that are so vital to being able to care for herself are addressed by therapy services and may even require a brief period of home health aide service while she is not able to do them for herself. Getting up from a chair or the toilet, walking across the room or apartment complex, or up and down a flight of stairs are very common goals that a physical therapist will focus on in their care plan. Preventing that call from reoccurring – keeping Mom safe and in her own home, where she wants and you need her to be – is the most important objective for all.

About the author: Teri N. Thompson, MPT is the Interim Administrator of Allegiance Home Health Care, Inc. in Troy, MI, a Medicare certified home health agency servicing the Oakland, Macomb and Wayne counties. She is also a physical therapist with more than 15 years home care experience with a clinical focus on geriatric rehabilitation. She can be contacted at tthompson@allegiancecare.comwith any questions.

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