Given the enormous volume of information written about home care services, I continue to be amazed at the frequency with which skilled home health care is conflated with non-medical home care, as if they were similar concepts. Some authors even use the terms interchangeably. Nothing could be more off the mark. In this article, I would like to make clear some of the key distinctions between these two kinds of home care.
Skilled home health care is virtually always provided by Medicare-certified agencies and is covered by Medicare and commercial health insurers. The services consist of intermittent visits by skilled professionals, usually a nurse and/or a rehabilitative therapy professional-physical therapy, speech therapy or occupational therapy. Visits take place intermittently over a limited period of time lasting no more than a few weeks, usually initiated after a hospital or nursing home discharge. In conjunction with skilled services, a home care aide may visit once or twice a week for a brief visit to provide in-home assistance with personal care, such as bathing.
Medicare covers skilled home health care under the following conditions (commercial insurers usually adopt the same criteria): 1) The services must be prescribed by a physician; 2) They must be provided by a Medicare-certified home health agency; 3) The patient must be home-bound, a requirement that is loosely defined; 4) The patient must need the care of one or more of the professionals mentioned above, as certified by a doctor.
Now, the eligibility criteria and insurance coverage of home health care have certain implications for consumers that are not always explained. Of all, the patient and family rarely have any role in choosing the agency they prefer. That decision is in the hands of the doctor in conjunction with the hospital or nursing home. Sure, a patient can express a preference for a particular provider if he or she has had a previous experience with home health care, but this is unusual in practice. Medicare has begun to make comparative information available on the internet through the Home Health Compare database. This may help to shift some control back to the consumer over time, because it permits patients and families to obtain quick information within the limited time frame permitted by discharge planning.
The second implication for consumers is that the frequency of home visits and the duration of home health services is also largely out of the control of families and patients. It is the home health agency, governed by the physician's orders and Medicare's eligibility requirements, that makes those determinations. And, just to be sure that the home health agencies can't profit unreasonably from more and more services, Medicare typically pays them by the episode of care, not by the volume of services they perform.
Non-medical home care is a completely different animal. Companies that provide such in home caregiver services employ unskilled personnel, variously called certified nurse aides, home caregivers, home health aides, home companions and other designations. The caregiver services they perform include help with personal care, such as bathing, toileting, dressing and mobility assistance, as well as general companionship, safety supervision and various household tasks. Typically each visit is several hours in length, and many highly impaired care recipients require live-in or round-the-clock care. Conceptually, non-medical home care can be thought of as "assisted living at home." The care recipient is usually referred to as a client, reflective of the consumer-controlled nature of non-medical home care. Unless the client meets the low-income criteria to qualify for Medicaid, this type of home care is almost always paid out of pocket or by long-term care insurance. Clients select the company that provides the care and can fire the company if dissatisfied.
Here is a summary of the key factors that characterize skilled home health care:
Requires a doctor's prescription
Nursing, therapists, social workers
Patient must be house bound
Performed by a Medicare-certified agency
Limited visit frequency and duration of services
Consumer usually not in control
No sustained presence in the home
Covered by Medicare or health insurance
Providers paid by the episode of care
Accountability to doctor and insurer (Medicare), not just to patient
And here are the ways non-medical home care is different:
No doctor's prescription required
Home companions, nurse aides, home caregivers
Irrelevant whether client is house bound
Agency does not need to be Medicare-certified
Length of visits and duration of care determined by client and family
Consumer in control
Sustained presence is central to the service: "assisted living at home"
Not covered by Medicare or health insurance
Providers paid by the hour or by the day
Accountability to the client and family
Everyone needs care at some point in their lives; from little babies to centenarians and everyone in between. Most of the time when we need care, our friends and families provide it. Some people require more care than family and friends are able to provide. Often in these instances the person requiring the care (care recipient) may be a new mother, have a disability, be frail aged, have a severe illness or a mental health issue. Depending on the needs of the person, particular home care supports will be put in place to assist them to manage or live at home. Many people who receive home care would need to live in a nursing home, hospital or institution if that support was not available. Other terms such as 'home health care' and 'domiciliary care' are often used interchangeably with home care - but can refer also to care provided by a health professional.
Homecare - What is it?
There is a wide range of services and supports that fall under the banner of home care. In short, the type of care provided is what the person is unable to do for themselves. Listed below are some of the main ones with a brief description:
- Personal Care - Refers to all care that addresses the personal hygiene of the care recipient. Personal care support can include; assistance to shower or bath, to dress, to use the toilet, to change continence aids, to shave, apply lotions and cosmetics, brush hair and brush teeth.
- Domestic Assistance - refers to all housekeeping and cleaning tasks. Services can include; cleaning the house, doing the dishes and laundry.
- Transportation- This can be driving the person to appointments and can also include accompanying them if required.
- Shopping- This can involve driving the person to the store and assisting them to do their own shopping, or the home care worker can do the shopping with a list.
- Respite- This type of support involves remaining with the care recipient while the usual carer has a break.
- Nursing Care- refers to the home care that needs to be provided by a registered nurse. Can include: medication monitoring, wound dressing, injections and nursing assessments.
- Case management - Case management involves a comprehensive assessment and the development of a care plan in conjunction with a case manager. Case management can be long or short term depending on the needs and requirements of the care recipient.
- Social Support - refers website to services that focus of the social needs of the client. This type of service can include companionship, visiting and community access.
Homecare - Who pays?
Depending on the country you live in there may be government funded programs that assist in paying home care costs. Some health insurance can cover some of these costs - check with your insurer for more information.
There is also a wide variety of home care agencies that can provide you with a home care worker for a fee.
Homecare - Who provides it?
In most instances friends and family of the care recipient are able to provide them with home care. In those cases where family and friends can not do so, or where the care recipient prefers; a professional care giver will provide the care. Professional care givers can also be referred to as: support workers, carers, community workers, personal care aides and assistants and nursing assistants. The terminology will vary between countries. The level of skill and qualifications required for professional care work will also vary depending on country. It's best to check with your care provider to find out the minimum requirements in your area.
Given the enormous volume of information written about home care services, I continue to be amazed at the frequency with which skilled home health care is conflated with non-medical home care, as if they were similar concepts. The care recipient is usually referred to as a client, reflective of the consumer-controlled nature of non-medical home care. Given the enormous volume of information written about home care services, I continue to be amazed at the frequency with which skilled home health care is conflated with non-medical home care, as if they were similar concepts. Other terms such as 'home health care' and 'domiciliary care' are often used interchangeably with home care - but can refer also to care provided by a health professional.
In those cases where family and friends can not do so, or where the care recipient prefers; a professional care giver will provide the care.