At WV Caring, we know that living with an advanced illness can be overwhelming. We understand this challenging time you are experiencing, and our team wants you to know that you are not alone. We’re often asked which kind of care does my loved one need: home health or hospice?
We like to describe and identify services as the right care at the right time. While the goals for both kinds of services are different, the overall goal is to provide the best care for the patient. Both services are explained along with the differences.
Home Health Services
Home health care focuses on healing patients who are recovering from an acute stay in the hospital, injury, or who are living with a chronic illness through therapeutic treatment and rehabilitation. Home health helps patients who require intermittent skilled nursing care, physical therapy, speech-language pathology or continued occupational services to help them recover and get back to their optimal health in the convenience of their home.
According to the official U.S. Government site for Medicare, Medicare.gov, the Home Health Benefit is outlined. Medicare will pay for reasonable home health visits if all the following requirements are met:
- The patient needs skilled care.
- The patient is homebound.
- Care is authorized by a physician.
- The home health agency is Medicare-certified.
Who’s eligible?
All people with Part A and/or Part B who meet these conditions are covered:
- You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
- You must be homebound, and a doctor must certify that you’re homebound. You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
How often is it covered?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services like these:
- Part-time or intermittent skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide services (personal hands-on care)
According to a Community Health Accreditation Partner organization, there are additional services that can be provided in the home but are not included in the Medicare home health benefit. Medicare covers home health if the patient’s condition qualifies:
- Visiting Nurse. Only if the patient is homebound and has a teachable caregiver at home.
- Visiting Nurse Assistant. Covered if the patient qualifies.
- Psychological Services. Covered if the patient qualifies.
- Home Medical Equipment. Covered 80 percent under Medicare Part B if the patient qualifies.
- 24/7 After Hours of Support and Visits. After-hours availability varies significantly between agencies. Emergencies are often handled by the hospital ER.
- Continuous Care. Only available where the need is finite and predictable.
- Medical and Disposable Supplies. Some supplies covered; The patient must qualify.
- Dietician Services. The patient must qualify.
- Physical, Speech and Occupational Therapy. Covered with restrictions on occupational therapy.
- Oxygen. Covered under Medicare Part B; copay and deductibles apply; The patient must qualify.
- Physician services. Physician 80 percent of approved charges covered under Part B.
With Home health Medicare doesn’t pay for:
- 24-hour-a day care at home
- Meals delivered to your home
- Homemaker services
- Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
These services are not provided compared to hospice care services:
- Spiritual Care
- Volunteers
- Medications Related to Hospice Diagnosis
- Respite Care
- Inpatient Care
- Services Provided in a Skilled Nursing Facility
- Bereavement Services
Home health services cannot be given to patients in a long-term care facility. The length of service offered is determined by the amount, frequency and time of the services needed for the patient’s condition to be improved through therapy.
HOSPICE CARE
Hospice care improves the quality of life for those who are facing a terminal illness. According to the Hospice Foundation of America, Inc., hospice offers practical support for the caregiver(s) during the terminal illness and grief support after death. Hospice is Medicare’s first-proven, effective coordinated care model.
At WV Caring, we provide holistic care in a patient’s home to help families better manage medical, emotional, and spiritual needs. We have helped thousands of patients and families transition through limiting illnesses since 1983.
Our team offers customized, well-coordinated and comprehensive care covered by Medicare, Medicaid, and private insurance. And, WV Caring provides care for those who have an inability to pay for care.
Medicare benefits coverage for hospice care includes:
- Visiting Nurses:To provide hands-on care for the patient
- Physicians: Attending and Hospice Medical Director
- Clinical Nursing Assistant, CNA, for personal care needs
- Social worker: For emotional and psychological support
- Chaplain: For spiritual care
- Bereavement Services: Before and up to 12 months after a patient’s death
- Volunteers: To provide companionship, run errands, light housekeeping
- Medical and Disposable Supplies
- Medications related to Hospice Diagnosis
- Home Medical Equipment: Covered 100 percent; no copay or deductible
- Oxygen: Covered 100 percent; no copay or deductibles
- 24/7 After Hours Support and Visits
- Inpatient Care: Covered for acute symptom management
- Respite Care: For caregiver distress
- Dietician Services: Covered based on the patient’s needs.
- Physical, Speech, and Occupational Therapy: Covered based on the patient’s needs.
- Services provided in a Skilled Nursing Facility: Available if the resident is not accessing their skilled nursing home Part A Benefit.
All of these are covered in the Medicare Part A Benefit, with no out-of-pocket expenses for the patient. It is more cost-effective for terminally ill patients and their loved ones than home health.
Most patients receive hospice services from a Medicare-certified hospice organization, which provides each patient with an interdisciplinary team who comes to the patient’s home, whether it’s assisted living communities or nursing homes. A physician determines that the patient has a terminal illness with a life expectancy of six months or less or the normal source of the disease. Patients can stay in a federally funded hospice program for more than six months, but only if they’re re-certified as still likely to die within six months.
WV CARING | HOSPICE AND HOME HEALTH SERVICES IN WEST VIRGINIA
At WV Caring, our goal is for patients and family members to spend valuable time together for as long as possible. Hospice care is best utilized when we can establish a plan of care early in the last stage of life.
We offer a program of coordinated care for people with a severe illness, and a team approach of care that involves the patient, their doctor, hospice nurse, home health aide, social worker, chaplain, and volunteers. Our services are available on-call 24 hours a day, 7 days a week.
WV Caring offers you compassionate, patient-focused care. We come to you, wherever you call home and help coordinate customized care for your benefit while assisting you to access other resources in the community, as needed.
If your loved one needs hospice or home service care, call us at 1-866-656-9790.