Levels of Home Care

There are two types of home care, and it's important to know the difference in making an informed decision to meet your needs. 

Unskilled:

  1. Costs:
    • Primary source of reimbursement is private pay or long term care insurance
    • Services are not covered by Medicare
       
  2. Care services provided:
    • Help is provided by a Certified Nursing Assistant (CNA)
    • Registered Nurse (RN) supervises care and is required by the State
      • Performs assessment of patient
      • Creates a Care Plan
      • RN visits to assess for changes and care provisions by CNA
      • Physician order not required
         
  3. Assistance with daily living:
    • Bathing, grooming, toileting 
    • Dressing and personal care
    • Assistance with mobility
    • Fall prevention
    • Medication assistance
       
  4. Additional tasks:
    • Meal preparation
    • Laundry
    • House cleaning
    • Personal errands
    • Transportation (with waiver)
    • Shopping

Skilled:

Physician order required
Requirements for Medicare eligibility:


To be considered homebound certain criteria must be met to qualify for insurance support. 

  • Unable to leave without assistance of another person or assistive device
  • Considered a hardship to leave home
  • Patients who can drive themselves are not considered homebound
  1. Care includes:
    • Skilled nursing
    • Physical therapy
    • Speech therapy
    • Occupational therapy
       
  2. Must be ordered by a physician and referred to a skilled home health care agency
    • Eligible for intermittent aide services
    • Medical social worker
    • Occupational therapy
    • Some medical supplies if ordered by physician
       
  3. Charges & claim submittal:
    • Skilled home health agency submits all claims to Medicare for home visits covered at 100% approved cost
    • You may be charged for services or costs Medicare does not cover
    • Medicare sends statement of submitted claim and services received
    • If there is a disagreement on amount or services covered by Medicare, you have a right to appeal decision

Medicare does not cover domestic, household or personal care needs when those are the only services needed. Most durable medical equipment is covered at 0%, so there is a 20% co-pay.

Most private insurance pays for home health services and follows Medicare criteria. Each policy is individual on coverage, so contact with insurance representative is advised.