Q. My husband and I are exploring care options as we plan for our future. We’re approaching our 70s and are having difficulty wrapping our minds around the terminology. We prefer to remain home and are willing to hire help should we need it. A good friend of ours recently had his knee replaced. After surgery, he received care in his home. A nurse looked after him, a caregiver helped give him a shower, and he had therapists work with him in his own living room. We were surprised to learn that this was all covered by Medicare. Yet, as my husband reviewed our Medicare benefits, it seems like Medicare will not cover home care should we need help as we age. Can you please explain this?
A. Thank you for bringing up a topic that confuses many older adults and their families. From what you’ve shared, it sounds like your friend received home health services after his knee replacement. What you and your husband are exploring is referred to as home care or in-home care. The two terms are often used interchangeably when they are not the same entity.
Home health provides professional medical care for older adults who require it. To receive home health, an older adult must have a skilled nursing care need or must be eligible to receive therapy services. Examples include wound care, injections, tube feedings, monitoring serious illnesses, or receiving physical or occupational therapy after a hospitalization or after receiving care at a short-term rehabilitation facility. Skilled nurses, certified nursing assistants, and/or skilled therapists come to the home to provide specific skilled services. They do not assist with personal care beyond teaching patients how to use adaptive equipment, nor do they provide companionship.
Home care provides non-medical care for older adults who need some assistance with personal care. The goal of home care is to help older adults stay safe and independent in the comfort of their own homes. With home care, a professional caregiver comes to the home to assist with basic care tasks, such as grooming, bathing, dressing, meal preparation, light housekeeping, and laundry. Home care caregivers can escort their clients to appointments, help them with errands, or take them out for a special treat. In addition to assisting with personal care, home care provides companionship. During their visit, home care caregivers provide their clients with meaningful engagement.
The client pays for home care. It does not require a hospital stay or referral from a physician. Most medical insurance plans do not cover home care. However, some long-term care insurance policies offer some coverage. Home care continues until the client chooses to end the partnership. As care needs change over time, clients can choose to receive more help and support from their professional caregivers.
It sounds like you and your husband would like to explore home care options to help you achieve your goal of aging-in-place. I would suggest you schedule appointments with a few reputable home care companies to get more acquainted with them. When you and your husband feel that you need more help at home, you’ll already be one step ahead.
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