Home Care Services - #25
Take QuizReview available home care services and Medicare requirements.
What are the 5 requirements for Medicare Home Care Services?
- Patient Medicare (Part A) eligibility - age 65 or older and person or spouse worked and paid Medicare taxes for at least 10 years.
- “Homebound patient”Patients must be “homebound” - Leaving home may include:
- Leaving home requires help (e.g., wheelchair, walker, special transport, or help from family or friends
- Leaving home requires considerable and taxing effort
- ”Skilled services” – The care given requires the services of an RN or PT and may include direct patient care to manage, observe, and evaluate a patient’s condition, teaching of patient/caregiver (e.g.,giving IV medications/immunizations,tube feedings, changing dressings, diabetic management)
- “Intermittent services”– Care is not custodial (e.g., care/services end once the skilled need is determined to be either met, or unobtainable).
- Medicare certification of the home care agency
- State government agencies inspect health care providers and if they pass inspection and meet Medicare’s set standards; Medicare approves them as a certified provider.
Available Home Care Services
| Discipline | Diagnostic | Therapeutic | Supportive |
|---|---|---|---|
| Nursing | X-ray / ultrasound | IV medications/infusions/mental status follow up | Medical Equipment |
| Occupational therapy | EKG | Wound care | Mobile meals |
| Physical therapy | Laboratory/phlebotomy | Medication management | Bathing |
| Podiatry | Pulse oximetry | Peritoneal dialysis | Home safety evaluation |
| Psychiatry | Blood pressure monitorying | Respiratory treatments | House cleaning |
| Social work | Podiatry treatements | Laundry | |
| Speech therapy | Ventilator support | Transportation | |
| Home health aide | Hospital bed/commode |
How do I order Home Care Services?
- Home care services must be ordered by the physician and require the physician order and “face to face” Medicare Encounter documentation form to be completed, as well as recertification of care every 60 days. Qualifying conditions must be met, and the home care agency will notify the physician if the patient no longer meets the Medicare home care criteria for care.
- Payment from Medicare occurs only when care is ordered by the physician and the above 5 criteria are met. Supportive care services are not covered by Medicare and are private pay. Medication management and wound care are covered for only a short time, until the patient/family are provided education in how to provide for those care needs.
Geriatric patient in the emergency department, with preparations being made to arrange for home care services at home discharge.
Identify geriatric patients who are eligible for home care services and identify those services that would be started after discharge from the emergency department.
Home care services are an integral part of caring for homebound geriatric patients. In 2006 12% of the population was over 65 years of age.1 In 2030 it is expected that 20% of the population will be over 65 years of age. While modern medical interventions are helping people live longer with multiple chronic conditions; access to care remains challenging for those most frail elderly patients. Increased home care services can help fill that need. A randomized clinical trial by Naylor et al showed that hospital readmission rates and length of hospital stays were significantly reduced in the elderly group receiving a detailed discharge plan and home-care protocol for those at greatest risk of complications.(2) The intervention group had a more extensive follow-up with advanced care nurses and a more individualized plan based on healthcare needs. The control group received a routine discharge protocol and referral to home care as needed. At 24 weeks post-discharge the intervention group had 6.2% vs 14.5% in multiple readmissions and had a an average hospital stay of 1.53 days vs 4.09 days. During that same time frame the intervention group had $0.6 million in Medicare reimbursements vs $1.2 million in the control group. This study demonstrates that by having good follow-up care for seriously ill elderly patients post-discharge we can reduce the number of ER visits.
- List the 5 requirements to determine eligibility for Home Care Services under Medicare.
- List home care professional services, available disciplines, diagnostic services, therapeutic services, and supportive services, that are available to geriatric patients who are living in the community.
- Describe steps to arrange home care services from the emergency department
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Murtaugh C, Peng T, Totten A, Costello B, Moore S, Aykan H. (2009). “Complexity in Geriatric Home Healthcare “. Journal of Healthcare Quality, 31(2): 34-43.
- Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. (1999). “Comprehensive discharge planning and home follow-up of hospitalized elders.” JAMA, 281(7): 613-620.
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Kathryn Denson MD, Colleen Crowe MD, Bambi Wessel, Yana Thaker, Gabriel Manzi MD, Judi Rehm, Fast Fact #25: Home Care Services & the Geriatric Patient, March, 2013.
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