Appendix C:

Long-Term Care Services Home Health Care

Available Topics:

What Is Home Health Care?

Who Provides Home Care Services?

How Are Home Health Services Paid For?

Who Should I Contact for Additional Information?

What Is Home Health Care?

Home health care consists of a variety of preventive, acute, subacute, rehabilitative and long-term care services delivered intermittently in the home. Services range from assistance with activities of daily living to high-tech medical treatments. Services are prescribed by a physician and delivered by or under the direction of a health care professional in accordance with a plan of care authorized by a physician. Often home health services relate to a person's acute medical needs and are not provided over an extended period of time. Services may include various levels of nursing care and other professional health services such as occupational therapy, physical therapy, speech/language therapy, respiratory therapy and medical social work.

Services are designed to assist a person in completing medical treatment regimens, complying with self-administered medication instructions, and participating in other therapeutic activities which aid the person in maintaining health. Services may include help with medications, injections, catheters, and/or rehabilitative therapy for persons who have suffered strokes, fractures, or are recovering from surgery. Medical equipment and supplies that are related to the specific medical interventions provided may be included as part of the service.

In addition to providing care for specific treatments and interventions, skilled health care professionals may provide periodic assessments and monitor a person's health status and well-being, so that treatments can be altered to best meet the individual's needs.

Example: Anna is 78 years old, lives alone in her apartment, and is able to cook and perform personal care. Her daughter visits once a week to help with housekeeping and grocery shopping. Anna has high blood pressure and diabetes, for which she takes several medications. A home health nurse visits once a week to do a physical assessment, monitor Anna's glucose levels, and to provide nutritional counseling.

Who Provides Home Care Services?

Home health services are provided by health care professionals such as nurses (registered or licensed vocational), trained home health aides under the supervision of a registered nurse, occupational therapists, physical therapists, medical social workers and respiratory therapists. Services are provided through home health agencies that are licensed by the Texas Department of Health as Home and Community Support Services Agencies. Agencies may be "certified" (meet Medicare standards and must be utilized for this payor source) or "licensed" (meet state standards of care and may be utilized by other payor sources).

How Are Home Health Services Paid For?

Medicare Part A (Hospital Insurance) will pay for home health care visits if services are ordered by a physician, the person is homebound because of illness or injury, and the person needs part-time or intermittent nursing care or physical, speech, or occupational therapy. Routine medical supplies needed by the patient are also covered under the Medicare home health benefit. Services that are not covered include full-time nursing care, drugs and IVs (with some exceptions), homemaker/housekeeping help, and routine/custodial care.

Medicare Part B (Medical Insurance) covers home health visits and management of the plan of care by a physician with a 20 percent co-payment.

Medicaid covers home health visits as an alternative to more costly hospital or nursing home care, and is limited to skilled nursing, physical therapy, and home health aide services. To be eligible for Medicaid home health benefits a person must be considered "homebound." If a person is able to leave their home at will, the person is usually not considered homebound. Services must be prescribed by a physician and delivered in accordance with a physician's plan of care. Some medical supplies and equipment may be covered under the Medicaid home health benefit.

The Texas Department of Human Services provides long-term skilled home health services through a variety of programs to persons who meet financial, medical, and functional criteria.

Private insurance policies may cover basic home health services. Each health plan should be reviewed for specific coverage information.

Who to Contact for Additional Information

Texas Department of Human Services

P.O. Box 149030

Austin, Texas 78714-9030

(800) 252-9240 (to find out your local contact agency)

Texas Department on Aging

1949 IH-35 South

Austin, Texas 78741

(800) 252-9240 (will automatically connect to the Area Agency on Aging nearest you).

Texas Association for Home Care, Inc.

3737 Executive Center, Suite #151

Austin, Texas

(800) 880-8893

Medicare Automated Information Service

(800) 638-6833

Tips:

1. Home health care may allow for early discharge from the hospital and prevent or postpone institutionalization. Although long-term care involves much more than just medically-related care, appropriate home health services may be all it takes to allow a person to remain in their home.
2. Home health care can supplement the family's resources and efforts in caring for loved ones at home and can be an important factor in keeping families together.
3. Home health care not only provides needed services but can reduce the isolation for many elderly people living alone in their own homes.
4. Home modifications and adaptive aides increase independence and can reduce the need for and/or enhance some home health services.
5. Personal emergency response systems consist of a small device worn around the neck or on the wrist and allow the wearer to signal for help by pressing a button. They transmit a signal to an emergency monitoring center where staff attempt to determine the nature of the emergency and respond accordingly. These devices can increase a person's independence, security, and peace of mind.
6. In determining which home care provider is best for you, consider how long the provider has been serving the community and what services the provider offers. Ask your physician if she/he knows the reputation of the provider. Friends and family members who have used home health care are also good sources of information.
7. If Medicare or Medicaid will be covering the home health services, make sure the provider is a "licensed and certified" provider.
8. Ask the provider for any written statements that describe its services, fees, patient rights, confidentiality, complaint procedures, hours of service, and emergency arrangements.
9. Ask the provider how they select their employees. Do they perform background checks on their employees?
10. If you have a problem or complaint about a provider, you may contact the Texas Department of Health - Health Facility Licensure Home Health Hotline at 1-800-228-1570.

References:

The Equitable Foundation and Children of Aging Parents. 1995. Aging Parents and Common Sense: A Practical Guide for You and Your Parents. New York, NY. December.

Health Care Financing Administration. April 1996. Medicare Handbook. Washington, D.C. (Pamphlet).

National Association for Home Care. http://www.nahc.org

Texas Department of Health, Texas Medicaid Provider Procedures Manual, 1997.

Texas Health and Human Services Commission, Health and Human Services in Texas: A Reference Guide, May, 1993.

Texas Health and Human Services Commission, State Medicaid Office, Texas Medicaid in Perspective, Austin, Texas. May, 1994.

Texas Association for Home Care. http://www.tahc.org