What is the Difference Between Home Health and Personal Care?

Home Health involves skilled care needed for you or your loved one. Personal Care (or Skilled Care) deals with nursing, physical therapy, occupational therapy, speech therapy, social worker services, and a certified nurse to assist with bathing. All of these are temporary with the goal of improving patient help so they can get back to doing what they love. These health services are usually covered by insurance with a doctor\’s order. 

Personal Care involved “non-skilled” care. Care that is rendered to you is not performed by a licensed clinician and they range from helping clean the house and picking up groceries to helping run errands and assisting with activities of daily living. These services are usually paid our of pocket or covered by long term care insurance.

***Advice from Charlin: If you are under the age of 45 we would highly recommend getting long term care insurance. Over the years, we have seen so many families that have not prepared for the worst and when that time comes are financially unprepared. Having a long term care insurance plan secures you for life hurdles and allows you to dip into that fund if the time comes when you need extra financial assistance.***

What is the Difference Between Home Health Care and Hospice?

The short answer is that Hospice is for patients with a terminal illness that are not expected to live more than 6 months in care, while Home Health Care can be issued for many reasons and lengths of time.

Hospice focuses primarily on the patient and the patient’s family being comfortable throughout the entire process. Unlike Hospice, Home Health Care places the most focus on helping patients regain function and general recovery.

Coverage is also different for Hospice and Home Health Care. Hospice is 100% covered by Medicare. Hospice coverage includes medications, home medical equipment, and various other costs recommended by the doctor. Coverage for Home Health Care varies based on insurance plans or the degree of care Medicare/Medicaid deems necessary.

If you have specific questions about your insurance coverage for Home Health Care, calling your provider is recommended.

What Does Homebound Mean?

Homebound is a term Medicare uses for patients who are unable to leave their homes without assistance or can’t leave the home due to external risks. Homebound status must be issued by a doctor.

A medical doctor must perform an evaluation before issuing homebound status to a patient. Homebound status can require a doctor to reevaluate the status of the patient every 60 days. Qualifying for Medicare Home Health Benefits can designate a patient as homebound, however, this still requires an initial evaluation by a medical doctor.

Is Physical Therapy Covered by Medicare?

Physical Therapy can be partially covered by Medicare Part B for medically necessary outpatient care. Please note that not all Physical Therapy programs are covered by Medicare. In order to find out more about the physical therapy you are interested in, contact the provider and ask if they accept Medicare.

Some doctors may recommend physical therapy programs that are not covered by Medicare. Be sure to ask your doctor if the program they recommend is covered. If it is not, ask if there are any alternatives that are covered by Medicare.

How Long Does Home Health Care Last?

Home Health care consists of 60-day episodes. These 60 days are able to be extended if there is still a need for home health care to be present. Per Medicare, there is no limit to the amount of 60-day episodes one may have. But ALL health qualifications from the initial evaluation must be present to continue into the next 60-day episode of care. 

The recertification period occurs within the last 5 days of the first 60 day period. The doctor who is overseeing the care during the 60 day period must agree to the extension. If all goals and coordination between the patient and the Home Health Team are met then discharge can occur at any time. The doctor must be notified about patient discharging arrangements as well.

Who Pays for Home Health Care Services?

Both Medicare and private insurance providers can pay for Home Health Care Services. Some specialized costs may be out-of-pocket depending on the scope of your coverage.

Medicare requires patients to have been evaluated by a doctor and to be under a medical plan established by that doctor to be eligible for Home Health Care benefits. The doctor must certify that you need one or more of the following to receive Medicare Home Health Care benefits:

• Intermittent skilled nursing care (other than drawing blood)

• Physical therapy

• Speech-language pathology services

• Continued occupational therapy 

• Social Worker Services 

Private insurance providers often have much different criteria for patients to be eligible for Home Health Care services and benefits. If you are looking for Home Health Care benefits from a private insurance company, please contact your provider for more information.

How Much of Home Health Services is Covered by Insurance or Medicare/Medicaid?

Medicare totally pays for Medicare-certified Home Health Services provided by an approved home health agency. Out-of-home services like visits to the hospital, doctor, or other clinics may still have out-of-pocket charges. If you are unsure if something is covered by Medicare under Home Health Benefits, ask your doctor or talk to a Medicare representative.

Private insurance plans may cover all, part, or none of Home Health Service costs based on your plan. The best way to go about receiving Home Health Service coverage from private insurance is by talking to a representative and getting everything you need prepared before receiving care and billing.

Does Medicare or Private Insurance Cover In-Home Caregivers?

Medicare will cover the costs of in-home services provided by an approved home health agency. This requires a patient to be evaluated by a doctor and to currently be under a care plan issued by a doctor. Here’s what Medicare says about payments:

Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs. Getting treatment from a home health agency that’s Medicare-certified can reduce your out-of-pocket costs. A Medicare-certified home health agency agrees to: 

• Be paid by Medicare 

• Accept only the amount Medicare approves for their services 

To find out if your private insurance covers in-home caregivers, contact a representative at your provider to ask questions. Many private insurance providers only cover in-home care partially, so make sure to find out how much of the cost will be covered.

What Do I Do if a Family Member Keeps Falling Out of Bed at Night?

Falling out of bed can be dangerous for older people or those with special needs and scary for their families. Thankfully there are many options to prevent falling out of bed from happening in the first place.

There are thousands of Home Medical Equipment (HME) options for bed safety. Things like safety rails, grab bars, and motorized lifts are available at most HME retailers without a prescription. Remember to contact Medicare or your private insurance provider before buying a specific piece of HME to ensure you will get reimbursed.

If regular HME options won’t work for your situation you may qualify for Home Health Care services. In order to do this you need to speak with your doctor to set up an evaluation followed by a care plan that must be followed.

***Charlin Advice: In our experience over the years we have seen several families also utilize personal care services during night shifts. Families will hire a personal care companion to be at the bedside throughout the night to make sure that their loved one is safe. Hiring a personal care companion can also help prevent family-caregiver burnout.***

How Do I Get Home Health Services?

The first thing you should do is call your primary care physician (PCP) or medical doctor (MD) and let them know you are considering home health services. Your MD will write an order and fax it over to the home health provider of your choice. 

You as the patient have the right to interview any Home Health Providers and choose the best fit for your needs. If you are not happy with a recommended care provider, please note that you have the right to transfer at any time. 

It is important to make sure that your preferred Home Health Provider educates you on what to expect during your care. Once you have picked your Home Health Provider, they will evaluate and assess you based on the orders of the MD. If you are having trouble finding a home health provider, use Google or Medicare.gov to find the right Home Health Provider for your needs! 

Some key things to know are that you must have a visit with your MD either 90 days prior to the start of home health or 30 days after. The reason for this is to make sure that the MD evaluates you in-person in order to coordinate efficiently with the Home Health Provider.

Who Decides if a Family Member or I Go on Hospice?

You do. The decision to go on Hospice Care is made together with you, your physician, and your loved ones. Once Hospice Care is started, you are able to make the decision to stop services if you choose to pursue alternative treatment.

Which Services Does Hospice Cover?

The main services covered by Medicare Hospice Benefits may include:

• Medical Doctor & Nurse fees

• In-home health care workers

• Social work costs

• Medication costs

• Home Medical Equipment costs

• Home Medical Supply costs

• In-home physical & occupational therapy

• Dietary & Nutrition counseling

• Short ‘respite’ hospital costs (which allow loved ones a short care break, if needed)

• Certain emotional & spiritual counseling (check if your desired service is covered)

Keep in mind that the hospice services covered by Medicaid differ from patient to patient. If you are unsure if a specific cost is covered, be sure to talk to your Medicare representative for more information.

How Much Do I Have to Pay Out of Pocket for Hospice?

Approved Hospice services & programs are paid for 100% by Medicare, Medicaid, and many private insurance providers. Be sure to ask about any costs you think may not be covered by Medicare, Medicaid, or private insurance. You don’t want to authorize a service or purchase an expensive piece of in-home equipment that will not be covered by insurance.

Where can Hospice Care be Provided?

Hospice care primarily takes place in the patient’s home. Hospices services provided by Medicare, Medicaid, and some private insurance providers will specify where the patient will need to be in order to receive Hospice Care.

Hospice services and programs are sometimes authorized to take place through programs in hospitals, extended care facilities, nursing homes, assisted living centers, or other health care locations.

How Do You Qualify for Hospice Care?

Individuals may qualify for Hospice Care when the following criteria are met:

• A medically documented decline in overall health

• A life-limiting condition present with short life expectancy if left to run its normal course

• Evaluation by a hospice nurse

• Physician medical consent

How Often Do Patients Receive Hospice Care?

A Hospice Interdisciplinary Team is available 24 hours/day, 7 days/week. The frequency of visits and level of care is dependent upon patient and family needs. Hospice care is based on a hospice care plan determined by the patient, family, doctor, and hospice team.

When Does Hospice Care End?

Hospice care can end at any time if the patient chooses. At the time of death, most hospice services end and any rented medical equipment or caregiver property will be picked up.

There are also times when a hospice patient improves or recovers and “graduates” from hospice care. If this occurs, the patient is discharged from hospice.

At Charlin, Hospice Care will continue to provide support to the patient’s family for a period of one year after their loved one dies. Talk to us today if you have specific questions about Hospice Care Services that occur after the death of a loved one.

Charlin Health Services Questions

Here are a few answers to the most common questions we get from patients and families.

What Areas Does Charlin Health Services Cover?

Charlin Hospice serves the counties of Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise.

How Do I Contact Charlin Health Services for an Evaluation?

Please contact our offices at:

Charlin Home Health

• Phone: (972) 423-4170

• Email: info@charlinhealthservices.com

• Fax: (972) 578-7803

• EFax: (972) 920-3222

Charlin Hospice

• Phone: (972) 423-4170

• Email: info@charlinhealthservices.com

• Fax: (469) 368-0999

• EFax: (972) 920-3771

You can also contact us by clicking here for our contact page. We’re here to help if you have any questions about Home Health Care, Hospice Care, or other medical issues.