General Caregiving Article

Home Health Care Options and Resources: Simple Answers to Complex Questions

As our country’s population continues to age and healthcare costs rise rapidly, home health care has become an increasingly popular alternative to institutionalization for those who require medical care in their homes.  Anyone with an acute illness, long-term health condition, disability, or terminal illness, regardless of his or her age, may qualify to receive home health services.

Furthermore, many more relatively healthy individuals, primarily older Americans, who wish to remain at home but require or prefer assistance with personal care and household management, will choose to hire a caregiver to provide these non-medical home care services.  As of 2001, more than 20,000 providers were delivering various home care services to about 7.6 million individuals nationwide.

The sheer number of resources available to Americans who need these services makes for seemingly unlimited choices.  But with many choices can sometimes come confusion about where and how to begin to look for answers.  This article will cover the funding for three basic types of home care and will provide some answers to some important questions about home health care.

Types of Home Health Agencies

Medicare-certified Agencies

Medicare is an entitlement program funded entirely at the federal level and focusing on the older adult population.  Medicare provides health insurance to people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end stage renal disease.  Since President Lyndon B. Johnson signed Medicare into law as amendments to Social Security legislation in 1965, Medicare-certified agencies have come to comprise the vast majority of home health agencies in the United States.

Medicare-certified agencies are allotted one lump sum of money per patient—based on the patient’s specific diagnosis and needs—and it is the agency’s responsibility to rehabilitate the patient in the least number of visits necessary.  During these visits, a licensed nurse will typically perform wound care, administer intravenous therapies, train a patient or family member on a new procedure or equipment, provide diabetic or medication management, perform blood draws, or offer other similar short-term medical services.  Therapists may also make home visits to assist patients in their rehabilitation efforts.  Other staff members that may comprise a home health team can include Medical Social Workers, Registered Dieticians, and Home Health Aides.

Medicaid-certified Agencies

Medicaid-certified agencies, however, offer a different type of home health.  Medicaid (known as Medi-Cal in the state of California, MassHealth in Massachusetts, and TennCare in Tennessee) is the United State’s health insurance program for individuals and families with low incomes and limited resources, including parents, children, seniors, and people with disabilities.  Established in 1965 through Title XIX of the Social Security Act, Medicaid is jointly funded by each state and the federal government, and is managed by the state.

Like Medicare agencies, Medicaid-certified agencies may also provide intermittent skilled nursing visits and therapy services.  However, most Medicaid agencies focus on providing private duty nursing, also known as extended hourly or shift nursing care.  In other words, Medicaid will reimburse agencies at an hourly rate to provide skilled nursing care to patients who have ventilators, tracheostomies, and/or feeding tubes, since these patients have a high level of acuity and therefore usually need constant care.  Even if an individual can afford to buy into a commercial health insurance plan, Medicaid will often still pay for home care services for patients with these needs.

Typically, patients requiring Medicare- and Medicaid-covered home health care will be referred to a provider through a Discharge Planner at their hospital or through their physician, thus eliminating the need for much, if any, legwork on the part of the patient or family members.

Non-medical Agencies

Also known as custodial care or attendant care, and sometimes also referred to as private duty nursing, non-medical home care is available primarily to older adults who are not ready to move out of their homes, but require some assistance in order to remain independent.  The term “home care” can also be used to distinguish custodial care from skilled nursing care, which is referred to as “home health care”. 

Home care recipients generally need assistance with Activities of Daily Living (ADLs), a term that encompasses bathing, dressing, transferring, using the restroom, eating, and walking. (5)  Some clients may also require help preparing meals, running errands, and performing other household duties including cleaning. 

Those individuals who earn a living providing non-medical home care are usually referred to as caregivers.  Some “caregivers” are licensed Home Health Aides who have been trained and licensed to provide these non-medical services, but most caregivers are unlicensed and simply have relevant experience. 

Non-medical home care is not covered by Medicare, Medicaid, or commercial health insurance plans.  The cost of these services may be covered by long term care insurance, but are primarily paid out-of-pocket. 

Find Answers to Questions about Resources and Funding

If you are unsure as to whether or not you qualify for home health services, or if you do not have the resources to fund these services independently and have questions about where to turn for financial assistance, you may contact the U.S. Administration on Aging Eldercare Locator hotline at 1-800-677-1116.  This hotline will provide you with contact information for your local Area Agency on Aging, which can also help you to find local providers and services to meet your needs.