When a loved one is discharged from the hospital or aging parents need help with everyday activities, family caregivers may seek “home care” not realizing that that generic term includes vastly different services, and funding sources. Misconstruing this can result in families paying for services that should be covered by insurance, or forgoing medical care because they mistakenly believe traditional home care providers can deliver it.
What Makes Home Health Different
Home health involves providing medical care directly in a patient’s home. It must be prescribed by a physician in order to be covered by Medicare Part A and B when medically necessary.
The home health team includes skilled, licensed professionals, such as registered nurses, physical therapists, and occupational therapists. The types of services provided reflect that. For instance, a patient who needs wound care, IV therapy, ongoing monitoring following surgery, or nursing assessments would benefit from home health services. A nurse can also give the patient medication.
What Personal Care Actually Covers
Non-clinical personal care exists to keep someone safe at home when they can no longer handle certain tasks. It’s a vague, catchall term, but in a practical sense, it helps to draw lines around what’s provided in order to see what distinguishes it from other home care types.
First, personal care is not clinical. No one’s been ordered the service of a doctor to meet a health need. Medication management is often a necessary part of life for an older adult, but it comes in a pillbox or dosette, ready for the proper patient to administer themselves. That’s a good example of what personal care doesn’t entail.
This is also where families looking to establish a reliable routine should take time to find the right fit. Those exploring home care services Philadelphia providers, for example, need to understand what their chosen agency covers so expectations match reality from day one.
How the Costs and Coverage Break Down
If you need care as a result of an event (such as a fall or surgery) that triggers a medical necessity, and this care has been prescribed by a doctor, Medicare probably covers it. You will have to pay for personal care unless it’s specified as part of your long-term care policy or you qualify for low-income assistance and live in one of the states that use state Medicaid waiver programs for personal care.
So, what’s the difference between the two? The line can be blurry because the same person (e.g., a personal care assistant) may provide both types of care at different times. But in general, medical home care is prescribed by a doctor (e.g., to manage a wound, perform a therapy, or oversee medication), and personal care is deemed necessary by either a doctor or a caseworker if someone needs assistance with fundamental activities of daily living such as getting out of or into bed, walking, bathing, dressing, eating, and using the bathroom.
A Simple Framework For Assessing What’s Needed
A family in planning mode, or responding to a sudden change in a parent’s health, can use a few rough and ready questions to figure out the starting point.
Is the senior coming out a hospitalization, surgery, or acute medical event? That’s home health. You’ll want to talk to the discharge planner before you leave the hospital, they can start the referral and walk you through what Medicare will likely cover.
Is the senior medically stable but having a hard time bathing safely, getting a meal together, or keeping the house in order? That’s personal care. The need here is steady, ongoing help with the basics of daily life, not clinical care.
Is the senior generally in good shape, but you’re starting to see signs of isolation or cognitive issues? That can likely be headed off by using the companion services that often come bundled within personal care.
It’s not an either/or choice. A senior who has had a stroke can be getting visiting skilled nursing and occupational therapy through home health while, at the same time, having a personal care aide come to help them bathe and fix a meal. The two run in parallel, taking care of clinical and daily living needs at the same time.
Making the Right Call
The language used in this area is not very easy to understand. The terms “home health,” “home care,” “home aide” are often used as if they mean the same thing, making it very challenging for families who need to make fast decisions in a crisis.
The best way to think about this is to focus on what you or your loved one needs at the moment. Once you are clear about that, you can understand what type of professional or caregiver can provide that service, and if it is covered by insurance. Most families will require you to access both types of care at different times.
