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Home health care refers to services that are provided in the home to help a person with a medical condition. These services can be “specialized” (provided by a nurse, physical therapist, occupational therapist, or speech therapist) or “non-specialized” (provided by a home health aide, social worker, or volunteer).

Home health care is for people who are homebound. If you are able to leave the home for necessary medical care, your insurance company may not cover home care services. Being homebound is defined as:

-Due to illness or injury, the patient requires the help of supportive devices such as crutches, canes, wheelchairs, or walkers; the use of special transport; or the assistance of another person to leave their place of residence.

-Leaving the patient’s home is medically contraindicated.

-The individual must be unable to leave home or leaving home must require considerable and exhausting effort.

However, there are some exceptions. You may still be considered home if you only leave home temporarily for medical care, such as attending a senior day program, going on dialysis, or receiving chemotherapy/radiation therapy. Occasional absences from home are also allowed, such as a trip to the barbershop, a walk around the block, attending a wedding, funeral, or other infrequent or one-time events, while receiving home care under inmate condition. In the home.

Specialty services are usually covered by insurance. Non-specialized services are only covered if and when you have a specialized need for which you are receiving care. Skill needs include nurse medication monitoring, vital signs, patient/family education, and teaching, wound care, and physical, occupational, and speech therapy. Unqualified needs include assistance with activities of daily living (ADL) such as bathing, dressing, and eating.

Skilled home care is generally provided short-term and on a temporary basis. Many people are referred to home care after hospitalization or a new medical diagnosis to aid in the transition between hospital and home and to provide a vital link between home and the medical team that provides patient care. Homecare providers are the eyes and ears of the medical team in the field. They inform the medical team of findings, signs, symptoms, and concerns and can help identify problems that may affect the patient’s well-being between office visits.

Infusion Therapies
Home infusion is a type of home health care that involves giving intravenous (IV) therapy. These can be intravenous antibiotics, chemotherapy, pain control, fluids, or nutrition services. Home infusion providers administer central lines (eg, PICC catheters, Hickman catheters) and provide supplies and teaching for the management of these catheters in the outpatient setting.

Insurance companies vary widely in coverage for home infusion services. It is important that you clearly communicate with the infusion provider about your infusion coverage, as well as any out-of-pocket expenses associated with infusion care BEFORE starting treatment. For example, Medicare does not cover home IV antibiotics or central line care. Some insurance companies will not provide services in the home if the same service can be provided in an outpatient setting or in the doctor’s office.

Another important thing to know about infusion care is that a nurse will not come out to administer every dose of treatment. The patient or caregiver is expected to learn to manage intravenous needs at home independently. Also, the same rules for home care do not always apply to home infusion cases. You won’t necessarily be hooked up to a large IV pole to navigate the entire house. Many home infusion pumps now fit in a backpack and allow you to continue living an independent life outside of the hospital or infusion center, regardless of the need for IV therapy.

Durable Medical Equipment
Durable medical equipment is any type of device that helps the patient at home and improves their quality of life. Examples of DME include walkers, wheelchairs, toilets, wheelchairs, toilets, shower chairs, electric scooters, oxygen, and hospital beds.

As with infusion and home care services, payment for medical equipment by insurance companies varies widely. Any request for equipment submitted to the insurance company for payment must be medically necessary. Your healthcare team must order the equipment and is responsible for providing the equipment company with all the necessary documentation to facilitate payment. You may be responsible for a monthly rental fee for some types of equipment. Most insurance does not cover two types of assistive devices; that is, you cannot get a walker and a wheelchair covered by the insurance company at the same time.

You can buy some DMEs privately, such as canes, shower chairs, adult diapers, and toilets at local drug stores or online. This can also be profitable, as you may pay less to buy the equipment instead of paying monthly rental fees.

How can I access these services?
Home health, infusion, and DME needs are coordinated by your healthcare team. If you think that you or a member of your family could benefit from home care services, be sure to ask a team member to help facilitate the referral. Ask your friends, family, and neighbors for the names of agencies they have used for in-home services in the past; you can request a specific service provider.

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