Home health care helps individuals improve their health, regain independence, and become as self-sufficient as possible.

What is home health care?

Home health care includes a wide range of medical care and support services provided in a home setting. It is for individuals who are recovering from a hospital stay and need clinical, nursing, social, or rehabilitation treatment and assistance in daily activities. Home health care is provided by licensed healthcare professionals who provide medical treatment or rehabilitation. Professional caregivers may also be involved to attend to non-medical daily assistance or custodial care. These home aides are usually supplied through a home health or home care agency.



Home Health Care vs. Non-Medical Home Health Care (Home Care)

Home health care is often confused with non-medical home health care, more commonly known as home care.

Home Health Care

Home health care services are medical in nature and assist patients recover after a hospital stay or illness. These services allow the patient to remain safely at home and avoid unnecessary returns to the hospital. Care may include wound care, injections, intravenous therapy, or skilled nursing. This care is provided by registered nurses (RNs), licensed practical nurses (LPN’s), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs).

Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility.

Non-Medical Home Care

Home care services, sometimes referred to as social care or custodial care, are non-medical in nature and are typically used on an ongoing basis to help aging individuals complete day-to-day tasks in their own home. These services are provided by non-medical professionals such as caretakers, instead of nurses or doctors. For terminally ill patients, home care may include hospice or palliative care.

Types of care may include help with bathing, eating, cleaning the home, and preparing meals. These services help the person to stay at home versus living in a facility. In-home care is often a lower cost solution to long-term care or assisted living facilities.


How to Select a Home Health Care Agency

There are four main steps to selecting a home health care agency.

1) Understand Your Medical Needs

Meet with a medical professional to make sure that home health care is the best follow up care option for you or your loved one. Home health care is best for patients who require medical follow-up care but can remain in the home setting. If the patient has significant medical needs or requires medical equipment that is only available at a hospital, a skilled nursing facility or inpatient rehabilitation may be a better option. If the patient has a specific need (home infusion therapy, wound care, etc.), you can narrow down your search by evaluating home health agencies based on what specialty care they can provide.

2) Verify Your Insurance Coverage

When selecting a home health agency, it’s important to consider your payment options and understand what your insurance policy will and will not cover. repisodic.com allows you to contact providers to verify whether or not they accept your insurance.

3) Compare Facilities Based on Quality Measures

After you’ve identified agencies within your insurance network, you can compare them based on quality measures. Quality measures are strong indicators of the quality and level of care and rehabilitation you will receive through an agency. Different qualities to compare are how often the home health team began their care in a timely manner, how often patients got better at walking or moving around, how often patients’ wounds improved or healed after an operation, and what percent of patients who would definitely recommend this home health agency to friends and family. repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.

4) Talk to the Agency and Staff

You have the right to choose a home health agency that gives you the care and services you need. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency. Ask the agency how different situations are handled and how the patient care plan and needs will be addressed with their services.

Checklist of Things to Consider

Medicare.gov has a list of suggested things to consider when selecting a home health care agency.

Before Beginning Your Care:

  • Is the facility Medicare/Medicaid certified?
  • Offers the specific health care services I need, like skilled nursing services or physical therapy?
  • Meets my special needs, like language or cultural preferences?
  • Offers the personal care services I need, like help bathing, dressing, and using the bathroom?
  • Offers the support services I need, or can help me arrange for additional services, like a meal delivery service, that I may need?
  • Has staff that can provide the type of care my doctor ordered and start when I need them?
  • Is recommended by my hospital discharge planner, doctor, or social worker?
  • Has staff available at night and on weekends for emergencies?
  • Explained what my insurance will cover and what I must pay out-of-pocket?
  • Has letters from satisfied patients, family members, and doctors that testify to the home health agency providing good care?

After Beginning Your Care:

  • The staff is polite and treats me, and my family members, with respect.
  • The staff explains my plan of care to me and my family, lets us participate in creating the plan of care, and lets us know ahead of time of any changes.
  • The staff are properly trained and licensed to perform the type of health care I need.
  • The agency explains what to do if I have a problem with the staff or the care I am getting.
  • The agency explains what to do if I have a problem with the staff or the care I am getting.
  • The agency responds quickly to my requests.
  • The staff checks my physical and emotional status at each visit.
  • The staff respond quickly to changes in my health or behavior.
  • My home is checked and suggestions are made to meet my special needs and to ensure my safety.
  • The staff have told me what to do if I have an emergency.
  • My privacy is protected.


How to Pay for Home Health Care

Insurance coverage and network participation are two of the most important factors to consider when choosing a home health agency. Because home health care is medical care, it is covered by health insurance, including Medicare, Medicaid, and private insurers. A patient’s individual insurance policy determines what specific home health and home care services are covered and paid for.

Home Care and Other Non-Medical Assisted Living Services

In general, non-medical home care services are NOT covered by Medicare or other private insurance programs. Although there are many misconceptions around Medicare’s benefits for home care, Medicare does not pay for non-medical care at all. It’s safe to assume that in almost all cases assistance for non-medical care provided in the home is not covered by insurance programs.

Medicaid, an insurance program for low income persons, will pay for non-medical home care, home health care, and other in-home supports to help individuals remain living in their homes. However, because Medicaid rules are state-specific, the coverage and eligibility will vary by location. Refer to your local Medicaid office if you think you or yourself qualifies for Medicaid home care.

Medicare Home Health Care Insurance Coverage

Home health care, when considered medically necessary, is covered at least in part, by Medicare and other health insurance programs. All people with Medicare Part A and/or Part B who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need either: Intermittent skilled nursing care (other than just drawing blood) OR Physical therapy, speech-language pathology, or continued occupational therapy services.
  • The home health agency caring for you must be Medicare-certified.
  • You must be homebound, and a doctor must certify that you’re homebound.

Private, Commercial and Employer-Sponsored Insurance Home Health Care Coverage

These plans vary widely in their coverage and policies for home health care. The majority of plans typically provide some sort of coverage for medically necessary home health care, similar to Medicare coverage policies. Private insurance companies will typically only pay for home health care services for providers that are considered “in-network.” Some policies will cover services from providers that are “out-of-network”, but they usually do not cover as much of the cost and can leave patients with additional out-of-pocket costs. That’s why it’s so important for patients to check if a home health agency is part of their insurance network.

To Summarize

Health insurance payment options and programs that cover home health care services are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for. repisodic encourages all patients to consult with their insurance company or administrator for final determination of what post-acute care or home health care their policy covers.


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