If your loved one is in need of either temporary or permanent 24 hour in home care, you may have come to the realization that you cannot handle this yourself. If the elder patient needs intermittent skilled nursing care, then you definitely need help from a professional care provider. Which brings us to the question, Does Medicare cover 24 hour in home care? In brief, the answer is 'no'. But what exactly does Medicare cover? What are your 24 hour in home care options outside of Medicare? We hope to shed some light on these important questions in this blog post.
Created by the Medicare Rights Center, the website Medicare Interactive (www.medicareinteractive.org) is designed to answer questions about Medicare benefits, rights, and options. The website succinctly identifies home health care items NOT covered by Medicare:
- 24-hour a day care at home
- Prescription drugs (must be enrolled in Medicare Part D)
- Meals delivered to your home
- Homemaker or custodial care services (i.e., cooking, shopping, laundry)
So…what are your options for 24 hour in-home care in Austin, TX?
While Medicare is a U.S. Federal program to help defray health care costs for the elderly, its coverage in most cases only provides for minimal care needs. Many families have additional long-term health care insurance or prefer to pay out of pocket for the best 24 hour in home care. Such expanded services may include:
- Skilled nursing care services, as inspected and regulated by the Texas Department of Aging and Disability Services
- Personal care such as bathing, dressing, grooming, performing hygiene tasks, incontinent care or dental care
- Family respite and/or vacation care
- At-home recovery care from day surgery or hospital-admission surgery
- Medication management
- Meal preparation and assistance with eating
- Transfers in and out of bed, wheelchair or motor vehicles
- Light housekeeping and laundry
- Transportation to physician appointments, dentists, shopping or errands
What in-home care does Medicare cover?
Medicare can help pay for in home care (except 24 hour in home care) if each of the following is true:
- The patient is considered homebound - Needs another person or special equipment to leave home, or a doctor believes leaving home may be harmful
- The patient needs skilled care - Includes intermittent skilled care, but does not include occupational therapy unless other requirements are met
- The patient's doctor signs a home health certification stating that the patient qualifies for Medicare home care because he or she is homebound and needs intermittent skilled care. The certification from the doctor must meet specific requirements that can be found here.
- The patient receives care from a Medicare-certified home health agency (HHA).
Even when the above four requirements are met, Medicare coverage may be limited. For example, Medicare covers skilled nursing services and home health services up to seven days a week for no more than 8 hours per day and 28 hours per week. A doctor must renew the orders at least every 60 days. It is therefore important to confirm coverage prior to committing to any caregiver services or schedules. More information about what is and isn't covered can be found here.
Hill Country Care Providers offers 24 hour in home care for our Austin, TX clients, meaning that Medicare does not cover these stellar care options. In fact, we are an entirely private pay home health agency. We are focused on providing premier in-home care, not simply on providing the minimal care covered by Medicare. Our clients either have additional long-term health care insurance or prefer to pay out of pocket for the best care available.