Health Affairs estimates that 4 million older American adults cannot leave their homes without assistance. This means that for a significant number of people, accessing health care is a serious challenge. A recent study shows that Medicare beneficiaries are seriously underutilizing the home health care options available to them through the program, which can offer life-changing and life-saving benefits.
What Are Home Health Care Services?
There is a wide range of home health care services available depending on an individual’s needs. These include:
- Doctor care
- Nursing care
- Physical, occupational and speech therapies
- Medical social services
- Home health aides
- Basic assistance (homemaker) care
Are Home Health Care Services Covered by Medicare?
Medicare Parts A and B cover certain home health services, including both part-time and intermittent skilled services. Part A covers home health care for people following a hospital stay or a stay in a skilled nursing facility. Part B provides home health care for homebound adults who need skilled nursing care.
A Medicare beneficiary is considered homebound in the following situations:
- Because of an illness or injury, they have trouble leaving their home without help, such as a cane, wheelchair, walker or crutches, special transportation or another person’s assistance.
- Their physician recommends staying at home.
- Leaving their residence takes a major effort.
The program covers medically necessary part-time or intermittent skilled nursing care and health assistance, durable medical equipment and medical supplies for use at home.
Medicaid also covers long-term services and supports (LTSS), which include medical and personal care services that aid with activities of daily living (ADLs). These are the kinds of services an assisted living facility typically provides, available in your own home.
An Underutilized Resource
In a study of Medicaid beneficiaries currently taking advantage of home health care services through the program, 30 percent receive some home-based clinical care, while 80 percent receive home-based long-term services and supports (LTSS).
The same study identified three levels of home clinical care and LTSS usage among older adults:
- Low Care and Services (46.6 percent). The largest group of participants received little home-based care. These individuals tended to be younger with fewer chronic conditions and functional impairments.
- Home Health Only with LTSS (44.5 percent). While this group used some home health services, such as assistance with ADLs, they received little home-based clinical care.
- High Clinical with LTSS (8.9 percent). Only a few participants had extensive home-based clinical care. In addition to tending to be older, they were more likely to have dementia and live alone.
Finding only about 9 percent of participants receiving high levels of clinical care and LTSS points to a significant gap between the number of older Americans who could benefit from these services and the number taking advantage of them.
How Do I Know If I Qualify for Home Health Care Services Benefits?
There are resources available to provide you with the information you need to decide whether home health care services are right for you, and the benefits for which you qualify. Medicare’s Home Health Services Coverage Page is a great place to start.
Our knowledgeable and compassionate elder law attorneys have a depth of experience counseling and representing elders and younger individuals with disabling illnesses and their families. Please reach out to see how we may be able to help you.