Medical Home Health Care: Temporary, Skilled, and Insurance-Covered
Medical home health care is considered a “skilled” service typically initiated by a physician’s order following a hospital stay, surgery or rehabilitation. These services are focused on recovery and rehabilitation for the patient, with a goal of restoring independence and function within a defined period and avoiding readmittance to the hospital or rehab facility.
Key characteristics of medical home health care include:
- Skilled Professionals: What’s known as “skilled” professionals includes nurses, physical therapists, occupational therapists, speech therapists, and sometimes medical social workers.
- Insurance Coverage: Care administered by these professionals is typically covered by Medicare and private insurance for qualifying situations. However, it is important to note that this coverage is temporary, as it is considered to be rehabilitative, meaning there is an expectation that the patient will only need such care for a set amount of time.
- Focus on Recovery: Skilled services are goal-oriented, meaning the intent to achieve an outcome, such as wound care, physical rehabilitation, or speech therapy. By definition, there is a start and a presumed end to the care administered.
- Time-Limited: The timeline of skilled care usually lasts four to eight weeks, with possible recertification by a doctor if progress justifies continued treatment. Each recertification is typically that same four-to-eight-week window — again, with the expectation that the imminent need is temporary in nature.
A typical medical home health visit might involve a nurse administering medication, a therapist assisting with exercises, or limited personal care, such as bathing assistance once or twice per week. However, these services are often brief and not designed to meet daily, long-term needs of the patient.
Non-Medical Home Care: Ongoing, Personalized Support
Non-medical home care provides assistance with daily activities (ADL) to help individuals remain in their homes comfortably and safely. Unlike medical home health care, these services are not covered by medical insurance, requiring payment through private pay, long-term care insurance, or certain state and veterans programs. [ link to payment options article ]
Key characteristics of non-medical home care include:
- Focus on Daily Living: Home care professionals in this category serve the day-to-day needs of the individual, including help with bathing, dressing, meal preparation, medication reminders, light housekeeping, transportation, and companionship, among other services.
- Flexibility: Care plans offered by non-skilled home care professionals should be designed to adapt to the senior’s ongoing needs, whether they require a few hours of help weekly or around-the-clock live-in assistance. Each program should be tailored to the specific needs of each individual in need of care.
- Long-Term Solution: Unlike medical home care, there is no fixed timeline for care; in fact, it often continues as long as needed and can evolve as the client’s care needs may evolve as they age or improve over time.
- Caregiver Matching: Agencies (like ours) often work to carefully match caregivers with clients to ensure compatibility, across a range of metrics and considerations. It shouldn’t just be about putting a caregiver in a home; it should be a matter of carefully vetting a senior’s needs and identifying the most appropriately matched caregiver that will meet the full range of physical, emotional, logistical and overall needs of mom or dad.
Non-medical home care is ideal for those who need assistance beyond what family can provide but who don’t require skilled medical services. In the best-case scenario non-medical home care complements medical home health care by providing additional support between therapy or nursing visits.
Common Misconceptions about Home Care
Many families assume that all home-based care is covered by insurance, which is not the case. Medical home health care has strict qualifications and time limits, whereas non-medical care is typically private pay or may be covered by long-term care insurance. Certain individuals may also qualify for Veteran’s assistance or State funding through the Connecticut Home Care Program for Elders.
Another common misunderstanding is thinking that medical home health professionals provide comprehensive daily support, such as meal preparation, housekeeping or transportation. These tasks fall under non-medical care, and are therefore not covered by insurance, nor are they services that will be fulfilled by the skilled nurses visiting the home to administer medical care, in most cases.
For most individuals, the best solution is a combination of medical and non-medical care. For example, a client recovering from surgery might receive physical therapy from a skilled medical provider while a non-medical caregiver assists with daily needs like dressing, meal preparation, and transportation to doctor appointments. This coordinated and comprehensive approach ensures complete and holistic care.
Making the Right Choice for You and Your Loved One
Understanding your loved one’s needs is the first step in determining the right type of care. If recovery from an illness or injury is the primary goal, medical home health care is definitely appropriate. For ongoing support with daily living, non-medical home care is the answer to most of the questions you are facing when considering how to best care for your loved one.
To further help you understand and pursue your options, our agency offers free consultations to help you assess your situation and guide you toward the best solution.
Navigating these options can feel daunting, but educating yourself on the differences between medical and non-medical care can lead to better outcomes for your loved one. Whether you’re planning for short-term recovery or long-term support, knowing these distinctions can help you make confident, informed decisions.
