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Who Qualifies for Homecare?
Medicare Requirements to Qualify:
- Homebound – “it is a taxing effort to leave the home.”
- Acute exacerbation of an illness or a major change in condition requiring the services of a “skilled professional”, i.e. hospitalization, changes in medications requiring instructions, new injections ordered by MD, change in ambulation status.
- Your primary physician must order the homecare services and approve the homecare plan of care set up by you and the skilled professional.
- Homecare services are “short term and intermittent.” There needs to be a goal to the care being provided.
- Skilled Nursing: A nurse will visit for:
- Assessment of your medical condition, wound, etc.
- Teaching of a specific task needed to manage your medical condition at home or regarding your medications and medical diagnoses and how to manage them.
- Hands-on-Care – wound care, administration of injectable medications, and catheter care. “Wound care cannot be long term or for chronic non-healing wounds.”
- Physical Therapy: Provides instruction on strengthening exercises, post-operative care, gait training, breathing and cardiac rehabilitation.
- Speech Therapy: Language and swallowing therapy.
- Occupational Therapy: Training in Activities of Daily Living.
- Medical Social Work: Planning for long-term care needs, evaluation of Medicaid eligibility, short-term counseling.
- Home Health Aide: Assistance with personal care needs and the therapy home exercise program (can only be provided if there is a Nursing, Physical Therapy or Speech Therapy need).
Other Payors of Homecare and What They Cover
- Managed Care Insurance Companies: These companies follow the same criteria as Medicare, although services are provided based on prior authorization by the Insurance Company.
- Medicaid: Covers Certified Homecare Services in addition to services from Long Term Agencies. Homemaker services are provided through the Department of Social Services with approval from your Medicaid Caseworker. Services do not need to be short-term and intermittent, and you do not need to be homebound.
- Private Pay: If you do not qualify for services as discussed above, you can choose to pay privately through a Licensed Agency.
Your Doctor can call Visiting Nurse Services in Westchester Admissions Department at (914) 682-1480, Ext. 621.
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