What is Medicare Home Health?
To qualify for Medicare home health, you must:
- Enroll in Medicare.
- Have services certified by a physician.
- Be 'homebound' -- so sick you cannot leave your home.
- Require highly skilled nursing or therapy services.
- Require only intermittent services (for 24/7 care, you'd be sent to an institutional facility).
- Upon admission, have the home health agency complete a 15-page form detailing everything from your life expectancy/prognosis to whether you are continent to how well you can express your needs.
- Receive care only over a 60-day period (after that, a physician would be needed to recertify need).
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Medicare home health encompasses a wide range of health and social services, including skilled nursing care, physical therapy, speech therapy, occupational therapy, medical social services and home health aide services that are related to the skilled services needed. Servic es are provided as part of a 60-day episode of care.
To qualify for home health services, an individual must be Medicare-eligible -- that is, elderly or disabled, and require skilled nursing services of some type of therapy (physical, occupational, or speech-language).
Home health services must be ordered by a physician who establishes a plan of care, detailing specific services at specific frequencies, that must be closely followed and documented by the home health agency. The beneficiary's physician must attest that the patient is "homebound" -- that is, the patient must be confined to the home by illness or disability, and unable to leave without assistance or going through "considerable and taxing" effort. The patient must need skilled therapy services on a part-time basis and the needs must be intermittent, not continuous, to qualify for Medicare coverage.
Notably, some have argued that the various stages of requirements placed on Medicare home health services are too restrictive, keeping this cost effective care from many who could benefit and ultimately costing the Medicare program more for other forms of care. In a June 12, 2006 letter providing input from state governors during federal efforts to reform Medicaid and other programs, the National Governors Association discussed barriers spilling over into Medicaid due to Medicare long-term care policy, and called for an expansion of home health care.
Who are the Beneficiaries of Home Health?
Compared with the overall Medicare population, Medicare home health beneficiaries are:
- Older;
- More predominantly female;
- More likely to be widowed;
- Poorer;
- Less educated;
- Less healthy;
- Have more chronic health conditions;
- Less able to perform activities of daily living; and
- More likely to be cognitively impaired
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In 2007, 3.1 million senior and disabled Americans received Medicare home health services. A July 2009 study by Avalere Health LLC, a Washington, DC-based health care strategy and public policy organization, prepared for the Alliance for Home Health Quality and Innovation, analyzed data from the Medicare Current Beneficiary Survey (MCBS) and the Medicare Standard Analytical Files. It reported the following:
- Beneficiaries using home health are older than the general Medicare population. Over half of home health users are 75 or older, as compared to the general Medicare population, most being are 74 or younger.
- Home health users are predominately female. About 64 percent of home health users are women, as compared to the overall Medicare population, of which roughly 56 percent are women.
- Home health users are more frequently widowed than the overall Medicare population. Almost half (45.2 percent) of home health users are widowed, as compared with 29.5 percent of the overall Medicare population. Nearly 63 percent of home health users are either widowed, divorced or separated, or never married.
- Home health beneficiaries have lower annual incomes thatn the general Medicare population. Nearly three-quarters of Medicare beneficiaries using home health services have incomes less than $25,000, compared to about 58 percent of the overall Medicare population.
- Medicare home health patients are less likely to have finished high school or attended college, compared to more than one-third of the overall Medicare population that achieved some college education.
*Article "All About Medicare Home Health II", from Caring October 2009 issue, page 25.
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