Many people confuse the benefits available from Medicare with non-medical home care. In Colorado there are two classes of home care.
Class A, is considered Skilled and also referred to as Home Health or Home Care, it includes Nursing Services, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Services and a Certified Nursing Assistant.
Class B, is considered non-medical Home Care and supports and compliments the Skilled Services of a Class A Agency, with additional hours to help seniors with Activities of Daily Living. These services are not covered under Medicare and therefore are private pay or may be covered under Long Term Care Insurance Policies.
Class A, Skilled Services; is designed to assist seniors with home care who are home bound, have been given a doctors script and will show improvement with skilled services. A senior must be over 65 years old to qualify for Medicare. Events that may trigger Skilled Home Health include; a fall that results in a broken hip or injured back, a serious UTI, Pneumonia, complications from one or more chronic diseases (COPD, Chronic Heart Failure, Diabetes, Cancer, stroke), issues related to ALS, Dementia or Parkinson's; anything that creates a hospital admittance that lasts for 3 or more days.
Once the 3 day rule is met, patients have several options. 1. Go to a Skilled Nursing Facility: Medicare and/or Medicare supplements will cover anywhere from 12 -20 days. Some have a co-pay, others will cover the Skilled Nursing Facility stay up to a certain time period (Basic Medicare covers 20 days in a Skilled Nursing Facility fully, and then from 21-100 days there is a co-pay of 144.50/day). After leaving the Skilled Nursing Facility you are generally given a script and/or recommended to a Skilled Home Health Agency to provide ongoing care in the home. This last as long as you show improvement or up to the 60 day episode; the average number of visits is 16.
Another option you have after leaving the hospital is to go directly home with the Services of a Skilled Home Health Agency.
Whether you decide to go to the Skilled Nursing Facility or go directly home, most people find that the 2-4 hours/week that Medicare covers free of charge, is not enough care for a senior to fully recover. This is where non-medical home care, Class B comes in. Skilled Home Health for the most part does not help with Activities of Daily Living. To avoid a return to the hospital and stop the cycle, consider adding non-medical home care to your health care plan.