MEDICARE

If you are over 65 or older, you qualify for Medicare. Many people incorrectly think that Medicare will pay for all of their health care needs when they are older, but this is not necessarily true. When it comes to home health care, Medicare will only pay for skilled-type services. These are services that can only be provided by a skilled, licensed clinician like a nurse or a therapist.

If you have been hospitalized, and still have the potential to improve as you are discharged home, your doctor may prescribe a home health care assessment. Many hospitals have their own home care company but you can choose any company as your home care provider. Within a day of returning home, a nurse or physical therapist will come to your home to complete an assessment of your needs. This information is submitted to your doctor and he/she will approve services appropriate for your needs. For example, if you need nursing care, a nurse may visit you two or three times per week. Your home health care nurse may also educate you or a family member about how you can begin to perform your own nursing care (as appropriate).

Every Medicare approval period, or “episode”, lasts up to 60 days, as long as you are working hard and making progress. You may even be approved for an additional 60 days if needed. If you get better sooner, or no longer need this specialized assistance, your services will be discontinued.  Aside from hospitalization, other common reasons one begins receiving Medicare home health care is if they have a new diagnosis, or if their condition has suddenly declined.

Other services available during your episode(s), depending on your health care needs, may be physical therapy visits to help you regain your strength and mobility, or a social worker to help you access community resources, or an occupational therapist to ensure you can perform all of your own self-care safely.

You may even qualify for a few Home Health Aide visits. Your Home Health Aide can help you bathe until you can do so on your own or with help from a trained family member. None of your clinicians can help you with ongoing safety and supervision, or to do your laundry (for example) if you cannot go up and down steps when you return home; Medicare pays for skilled services only.

Medicare will pay 100% for the services described above if you qualify. If you need a walker to move around safely Medicare may only pay 80%, so you’ll have to pay the remaining 20% out-of-pocket or through a supplemental insurance if you have one.

A unique and specialized program for which Medicare pays 100% is Low Vision Therapy by FamCare Adult Day Care and Health Centers. If your aging parent suffers from low vision as a result of macular degeneration, glaucoma or other common disease that affects vision, he or she may qualify for this service which also happens in your home. Available exclusively through FamCare Adult Day Care and Health Centers in St. Louis and surrounding counties, Low Vision Therapy combines visual retraining therapy with home modifications to achieve an average 60% improvement in visual acuity within eight weeks!

Our, ‘Do I Qualify for Medicare Home Health Care?’ checklist is a helpful tool for understanding if Medicare home health care is an option for you:

Do I qualify for Medicare Home Health Care?

Medicare home health care services are for clients for whom it is a taxing effort to leave home, who have had a recent decline in condition, and need skilled nursing or therapies to get better. It is NOT long-term care. Our Medicare services include skilled nursing, physical, occupational and speech therapies, social worker services and Home Health Aides (for baths only).

What are the Warning Signs you or your loved one needs help?

• Problems Taking Medication Correctly

• Supervision needed

• Falls

• Decline in health

• Hospitalization

• Missing meals

• Missing appointments

• Incontinence

• New diagnosis (such as CHF, COPD, or diabetes)

• Won’t leave home

• Poor hygiene

• Concerns about safety

• Planned hospitalization or surgery (knee or hip replacement, bypass, etc.)

To qualify for Medicare home health care, you:

• Must be Medicare-eligible (65+, disabled or kidney disease)

• Must need skilled nursing and/or therapy

• Must have potential to improve as a result of care

• Must be under a physician’s care

• Must be homebound, which means:

  • Unable to leave home w/o assistance

  • Away from home only for short intervals

  • Any absence requires a taxing effort

  • Patient can attend religious services, go to healthcare appointments and grooming appointments

If you checked any Warning Sign(s), and all of the qualifiers, please call FamCare Adult Day Care and Health Centers to get started!

MEDICAID

Unlike Medicare, you must qualify financially for Medicaid. Another way to remember this is that Medicare is a federal program designed primarily for seniors, while Medicaid is managed state by state and is designed for individuals with very low incomes and/or disabilities. First, one must qualify financially by earning approximately $800 or less/month as an individual, or $1100 or less/month for a family. To receive in-home services through Medicaid, one must also qualify by needing assistance with some of their activities of daily living like bathing, dressing, going to the bathroom and/or walking. There is an approval process that takes approximately 30 days from the time you apply for in-home services, until you begin receiving them. FamCare helps clients who are new to the in-home services program as well as clients who have received these services for many years. If you are receiving Medicaid in-home services and you also qualify for Medicare, then if you are hospitalized you may receive Medicare home health care to help you regain your strength and improve as much as possible before resuming your Medicaid in-home care to maintain your current independence level at home.

VA

The Department of Veterans Affairs pays for two main types of home care. The first is Fee-based services and the second is through the Aide and Attendance pension. If you are a veteran who was active duty status for at least one day during which our country was officially at war, you may qualify for this pension which reimburses you for part of your home care expenses.

HEALTH INSURANCE

Your health insurance policy may pay for skilled services prescribed by your physician, similar to Medicare. If you have medical insurance and Medicare, your insurance must pay before Medicare may pay any remaining portion.

LONG-TERM CARE INSURANCE

One may elect to enroll as early as when he or she is in their 40s, paying a monthly premium. Policies vary greatly from the cost of monthly premiums, to the amount of paperwork required to access benefits, to approved services (including skilled care, assisted living, caregiver visits or a combination). One big challenge is to accurately choose the policy appropriate for your anticipated long term needs.

If you have long-term care insurance, we will help you understand and access your benefits.

WORKER’S COMPENSATION INSURANCE

This insurance will pay for your medical needs as a result of a work-related accident or injury. FamCare offers a specialized Worker’s Compensation Program (link to brochure pdf.)

REDUCED FEE PROGRAMS

FamCare Adult Day Care and Health Centers works with _____ as a provider for their Reduced Fee Program. Funded through the _____ and available for persons of any religious denomination, this program helps qualified individuals “pay what they can afford” per hour for home care. One must meet financial and clinical qualifications; there may be a waiting list to receive care.

SELF PAY

After examining every other funding option: Medicare, Medicaid, VA, Medical Insurance, Long-Term Care Insurance, Worker’s Compensation and Reduced Fee Programs, clients may pay out-of-pocket for some or all of their home care services. FamCare Adult Day Care offers discounted Value Packages to meet your home care needs as affordably as possible.

Now, you’ve got the basics of home care funding. When you’re ready, call FamCare for information on how to pay for home care specifically tailored to your aging parent’s needs