Home health care is designed to keep patients in their homes and communities for as long as possible. Living alone and taking care of our own needs becomes more difficult as we age. However, this doesn’t necessarily mean that you are ready for assisted living or a nursing home. Home health care is a middle ground that allows you to get the specialized care you need while staying in your own home.

Many people have no idea how to go about qualifying for these services though. Often, the elderly and people with disabilities will try to hide how difficult it is for them to accomplish daily tasks instead of reaching out for help. Fear of being forced to move into an assisted living facility holds them back. However, not everyone needs full-time care. Lots of people can remain independent with the right support network, which can often include home health care.

What is Home Health Care

A Home Visit of a Doctor to Check the Home Health Care

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Home health care has goals, and often they include helping patients remain in their homes rather than allowing circumstances to force them into a nursing home before they are ready. Admittedly, there may come a point when a live-in facility with 24-hour care is necessary. There is a gray area where round-the-clock skilled care is too much, but people still need help to hold on to their independence. This is where home health care comes in.

In-home health care services are not one-size-fits-all. Like any other treatment plan, your services will focus on your individual needs. Maybe you need a home health aide to come in the morning to help you shower, dress and get something to eat. Perhaps you need skilled nursing care to administer medications and monitor an illness. There are even physical therapists, speech therapists, and occupational therapists who work in their patients’ homes. The ability to get these services at home is a game changer.

Patients can receive home health care on a short-term basis, such as after a surgery or injury. Other times, patients need longterm in-home assistance. The services you can now get at home are every bit as effective as the care patients receive in a skilled nursing facility or hospital. This not only allows the patient to hang on to their freedom and autonomy but it also allows the people who love them to rest easy knowing they are receiving state of the art care.

How to Afford Home Health Care

An Aged Couple Checking the Affordability of Home Health Care

Image: Public Domain US, Rhoda Baer, via Wikimedia Commons.

Figuring out how to pay for in-home care is one of the most significant hurdles you will face on this journey. Planning ahead is great in theory, but life doesn’t always work like that. Thankfully, there are quite a few options available to help you pay for the care you need. Although the specific services they offer vary, both Medicare and Medicaid provide funding for in-home care. For veterans, the VA helps fund home care. Most states have assistance programs in addition to Medicaid.

Some private insurance companies also cover home health care. However, not all of them do and just what they cover can have vast differences from plan to plan. There are also individual insurance plans that specifically cover just long-term care. Paying for services out of your pocket is another option, but not surprisingly, few people can afford it long-term. For those who do self-pay, there are tax credits available. In addition to these options, reverse mortgages, special home care loans, accelerated death benefits, and death benefits loans can all help cover the expenses of home health care.

Qualifying for Home Health Care

A Nurse Taking Care of a Old Lady for Home Health Care

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To receive in-home care, you must qualify for these services. Exactly what qualifications you need to meet varies. If you are going to pay for home health care out of pocket and are planning to hire a private worker rather than going through an agency, you won’t have to worry about meeting any qualifications.

However, if you need your insurance to cover the costs and plan to use a home care agency, you will have to jump through a few hoops. First, you will have to meet the qualifications of your doctor. Next, you will have to meet the requirements as set forth by your insurance company. Finally, some agencies that provide in-home care workers also have specifications that you must meet to qualify for their services.


Doctor and Home Health Care Patients

Image: Public Domain 1.0, agilemktg1, via Flickr

Qualifying for in-home care begins with talking to your doctor. Your physician is the one who will decide whether or not you need home health care. They will then write you a prescription or referral for the specific services your situation requires. Your doctor’s orders will also designate how often you should receive these services. In some cases, home health care is set up when a patient is being released from a hospital or another type of in-patient medical facility, such as a rehab center.

In general, doctors refer a patient for home health care either when they need short-term skilled nursing care, such as administering IV medication, or when they are unable to complete their Activities of Daily Living (ADLs) on their own. These ADLs include:

  • Eating
  • Bathing
  • Dressing
  • Toileting (getting on and off the toilet, performing personal hygiene functions)
  • Transferring (getting in and out of bed or a chair)
  • Continence (controlling bladder and bowels)

If you have difficulty with any of your ADLs, you should discuss the issue with your doctor. Although you might feel embarrassment or fear about this topic, in-home care is an option that will allow you to keep your independence. Your doctor wants to help you, so make sure you are as open and honest as possible about your situation.


A Nurse and a Home Health Care Patient

Image: Public Domain 1.0, agilemktg1, via Flickr

When people ask how to qualify for home health care, what most people want to know is how to get their insurance company to pay for it. There is no easy answer to this question because each insurance company has their own set of qualifications, as do Medicare and Medicaid. For example, Medicare requires patients to be “homebound,” or completely unable to leave their homes on their own. What’s even more confusing is that Medicaid’s qualifications vary by state.

If you have private insurance, begin by contacting the company and asking for a written copy of their requirements. Most will want you to need more services than just those provided by a home health aide, such as physical therapy or skilled nursing care. If you have Medicaid, your first step will most likely be to apply for what is called a “waiver.” Medicaid waivers pay for a wide range of services, including not only home health care but also things like vehicle modifications that are rarely covered by other entities.

Home health care agency

Although this is less of a concern than insurance requirements, agencies that provide in-home health care workers may also have their own set of qualifications. Usually, this means that you will have to shop around for another agency that meets your needs. But it is something you will want to consider.

Starting the Process

nurse hugging older woman in wheelchair

Image: Public Domain 1.0, agilemktg1, via Flickr

The process of qualifying for home health care can be a long one, so try to start the process sooner rather than later. Talk to your doctor honestly about what things you need help with. Be upfront when you meet with people who will evaluate you for home health care. Whether you are talking to your doctor, a representative from your insurance company, or an affiliate of an in-home care agency, don’t downplay your situation.

Simply put, some days are better than others. We all have good days and bad days, especially if we are battling a chronic illness or getting on in years. When they ask you questions about your daily life, don’t answer those questions based on your best days. The tendency to do this is all too common and can hurt you in the long run. Don’t exaggerate your troubles, but don’t brush them off either. Just tell them what you really face every day.

Sometimes, it is evident that you need help, such as when you have had surgery and require physical therapy to recover your function. Other times, such as when you are facing incontinence, it isn’t so obvious to others (even your doctor). Yes, it is embarrassing to talk about. But regardless, you need to let your doctor know so that you can get the right services. In fact, some of these more embarrassing issues can be exactly what qualifies you for home health care in the first place.

Featured image: CC by 1.0, by agilemktg1, via Flickr

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