Home Health Care vs. Non Medical In-Home Care

10/12/2016 05:40 pm ET Updated Oct 18, 2016
Home Health Aide
Home Health Aide

They sound similar—but they provide very different services. Here’s an overview regarding the differences between the two:

What is Home Health Care?

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF). Usually, the person providing care can only provide what’s been prescribed by a doctor.

These types of services include occupational therapy; wound care; pain management; IV therapy and injections; or mobility training for those who have had their mobility impaired.

Home health care is generally covered by Medicare. However, it won’t cover all aspects of home health care, such as medications administered in the home, or anything that falls under non-medical in-home care—sometimes there is an overlap in services.

Medicare also won’t pay for full-time care; only home health care delivered on a part-time basis qualifies for Medicare coverage. The program covers up to 35 hours per week of care.

There are other limitations to home health care coverage as well. For instance, the patient must be home bound—although they can be mobile using a wheelchair or other mobility device. Home bound essentially means they can not leave to go see a doctor or receive other necessary medical care. The home health care agency must be certified and approved by Medicare, and all services must be prescribed by a doctor under a “plan of care.”

In addition, while Medicare will cover an unlimited number of visits as infrequently as every two months, if you or your loved one needs daily care, Medicare will only cover it if there is a predictable end in sight. If the patient’s condition is chronic and long-lasting, and if care is needed on an ongoing, indefinite basis, it may not be covered.

What is Non Medical In-Home Care?

Non-medical home care (also known as Custodial care in some states) is a service that helps those in need by assisting with activities of daily living (ADLs) in order to continue living life from the comfort of his or her own home. Home care is a model that can include both professional and informal support networks such as family, neighbors, and friends. This type of care is not covered by Medicare.

Non medical in-home care usually refers to in-home assistance with ADLs—including bathing, dressing, light housekeeping, cooking meals, using the restroom, transferring; management of medication, transportation, and companionship.

Some agencies and professionals offer both types of services, and there may be some instances where a single person might provide both medical care in the home and assistance with daily activities. However, Medicare does not cover non-medical in-home care, even when it is provided by the same agency or the same individual who provides the home health care.

Most home health care agencies and providers of non-medical in-home care are referred by hospitals and doctors. However, you can hire one on your own. If you choose to do the hiring yourself, make sure to do your research and double check that the agency is Medicare-approved.

Originally written for Senior Planning by Cheryl Culbertson; published with permission. Cheryl Culbertson is the Owner/Founder of Elder Options of Texas. Elder Options of Texas is an online directory for Texas seniors, baby boomers, children with aging parents, and caregivers. Their Lifestyle Articles section focuses on important issues facing families today.

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