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What’s the difference between home care and private care?

Intermittent home care typically involves health-related services that are delivered to you in your home and are ordered by your physician to help your recovery.

What does Medicare require to cover home care services?

  • Patient resides at home or an assisted living facility—not a nursing home.
  • Patient is homebound.
  • Patient is in need of a qualifying service—skilled nursing, physical therapy, speech therapy.
  • Home care must be medically reasonable or necessary.
  • Home care services must be ordered and monitored by a physician.

How does Medicare define a homebound patient?

In order for a patient to be eligible to receive covered home health services the law requires that a physician certify that the patient is “homebound” (confined to his/her home). The patient does not have to be bedridden to be considered confined to the home. 

However, the condition of the patient should be such that leaving home would require a considerable and taxing effort. Absences from the home are infrequent or for periods of relatively short duration, or are necessary to receive health care treatment.

How long must the patient be homebound to qualify for Medicare covered services?

Homebound status may be temporary and short-term — for as little as two weeks.

What are examples of a homebound patient?

  • Patient has unsteady gait / falls frequently / poor balance.
  • Patient needs assistance to transfer and/or ambulate safely.
  • Patient has shortness of breath at rest or with ambulation less than 100 feet.
  • Patient is unable to leave home without assistance due to cognitive issues. 
  • Leaving home is medically contraindicated:
    • Recent surgery
    • Wound infection risk
    • Decreased immune system
    • Bed bound
    • Chair bound

What does Medicare not pay for?

Medicare does not pay for:

  • 24-hour a day care at home
  • Meals delivered to a patient’s home
  • Homemaker services
  • Personal care