Eligibility

can be difficult to determine.

THE BEST WAY TO KNOW if you or your loved one is eligible for home health services is to call us. The government website has every detail listed and you may want to peruse that as well. Talking with you directly gives us a chance to hear your circumstances and provide you with best options.

Until we hear from you, below is information you might find helpful.

Under Medicare requirements the following criteria must be met:

A normal inability exists to leave home and, consequently, leaving home would require a considerable and taxing effort.
If the patient leaves home, the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment.
The patient has a condition due to an illness or injury that restricts ability to leave their place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person or if leaving home is medically contraindicated.

The above are Medicare rules, as stated by the Federal government.

Essentially, the patent has to be "homebound" but we realize that word sometimes means different things to different people. The patient can still socialize (and we highly recommend that!) but there are rules regarding how the patient gets to the social event! If the patient has private insurance other than Medicare, those rules don’t necessarily apply.

If you are covered by Medicare Part A

To receive home health aide services with 100% coverage, the patient must be homebound, have orders from a physician, and need treatment requiring a skill such as nursing or specialized therapies.

If you are covered by Medicare Part B

Medicare will pay 80% with a 20% co-pay and an order from the physician, a need for a specialized therapy (physical, occupational, speech), and the ability to have therapies performed in the home. Note that under this plan, nursing or home health aide is not covered.

Private Duty

Services include personal care such as bathing and meal preparation, sitters, or light housekeeping. Patients cover the costs of nursing, physical, speech, and occupational therapies.

Navigating the nuances of coverage and care can be complicated at a time when you are feeling anxious and concerned. Please call us. We do our best to make the information straightforward and applicable to the patient and family. We will be happy to talk with you about eligibility and many other important issues surrounding good care. We look forward to hearing from you. •

Grayson Home Health