A Common Scenario: Medicare Home Health Care or Private Duty Home Care?

A Common Scenario: Medicare Home Health Care or Private Duty Home Care?

No one said the “Golden Years” would be easy but thank goodness Brevard County has a wealth of senior resources to get us through! One valuable resource to seniors in our area is the availability of home health care and we have quite a selection to choose from. As discussed in the previous article, check out FloridaHealthFinder.gov for a complete list of licensed agencies and take time to review the information provided.

This article will focus on two types of home health providers – Skilled Home Health and Private Duty Home Care – and the differences between each that might make one a better fit than the other. Though, you can have both at the same time! We’ll get there…

Woman and Man from Home Health Care

Let’s start with a common scenario.

Seniors would rather age in their own homes than move to a senior living community. When seniors exercise that choice, with it comes certain compromises in health, nutrition, medication awareness, and safety. The perfect storm of these compromises can result in what will be referred to as a “qualifying event.” More specifically, a fall resulting in an injury that requires hospitalization and possibly surgery and a short-term skilled rehab stay.

Skilled Home Health Care

After a short-term rehab stay, whether the senior individual returns home or relocates to a senior living environment that offers more oversight, there is often a doctor’s order for Skilled Home Health Care. The skilled home health care may be providing nursing care for a post-surgical wound and, most likely, continued therapies that were received while in skilled rehab.

Therapies Available from Home Health

Physical Therapy

Occupational Therapy

Speech Therapy

These services will be provided through a Home Health Agency that provides licensed providers in each of these areas and progress according to a written plan of care will be reviewed periodically with the doctor.

These services will be limited to the duration as approved by Medicare or insurance, whoever is paying the bill. If additional therapy services are desired after a Medicare or insurance benefit has been exhausted, the senior individual can contract to receive services on a private pay (out-of-pocket) basis with a provider who is licensed to provide these services on a private pay basis.

Elderly person walking with walker Home Health Care worker Stock Photos - Page 1 :  Masterfile

Medicare Part B Might Be an Option

If additional therapy services are wanted, ask your Skilled Home Health Care provider for a referral for Medicare Part B services, if appropriate. Sometimes you can even keep the same therapist while using the benefits of your Part B Medicare coverage. This will keep you from paying privately for therapy and may satisfy the time you needed to fully recover.

In most cases, the senior can successfully complete therapies and no longer need nursing care for a post-surgical wound but still need a little… something. If they have returned home, this is almost guaranteed, and even if they have returned to a senior living environment with more oversight, additional assistance while recovering from a qualifying event like a fall is a good idea.

Private Duty Home Care

Private Duty Home Care through licensed agencies or registries provides certified nursing assistants or home health aides to assist clients wherever they reside with activities of daily living (ADLs) such as bathing, dressing, grooming, medication reminders, and toileting. A private duty licensed nurse (LPN or RN) can also fill a pill box for a senior living at home. Companions/Homemakers can do light housekeeping, meal preparation, and transportation but may not provide hands-on assistance with ADLs according to the limits of their agency license. This extra assistance can often make a huge difference in the day of a senior individual recovering from a fall.

Who Pays for Private Duty Home Care?

Private Duty Home Care is a private pay situation. If you have a long-term care insurance policy, you may want to check the requirements of coverage to file a claim. If applicable, VA Aid & Attendance provides limited reimbursement for Private Duty Home Care – see a local elder law attorney that specializes in VA benefits for full details.

Do You Have Insurance or Other Benefits?

Without the benefit of long-term care insurance or VA Aid & Attendance, Private Duty Home Care can be expensive, so it is important to evaluate what your needs are and make inquiries to a couple of agencies. If you only need assistance with housekeeping and meal preparation, a Companion/Homemaker would be appropriate, and they may be less expensive than a certified nursing assistant or home health aide providing hands-on assistance. Minimum hours of service will apply for most agencies, so be aware of what each agency’s minimum requirements are when calculating the cost on an ongoing basis.

It's Never Too Early to Plan!

The “Golden Years” can be rough, but most situations can be worked out with the forethought of a plan.  Take time to consult with an elder law attorney and create a financial plan to prepare for out-of-pocket costs that arise as you age. When you have a plan, you take pressure off yourself and your family. Knowledge is power! Take the time to explore options before you encounter a crisis.

(This piece was originally written when I was a guest blogger for Amy B. Van Fossen, PA)

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