FAQs
Please select your question.
What is the difference between a home health aide and a personal care aide?
A personal care aide can assist a patient with household chores and personal care. A personal care aide takes a seven-day New York State Training Course. The aide learns how to work with children, the elderly, the mentally ill, the mentally retarded, and the physically disabled. Safety and accident prevention and food, nutrition, and meal preparation are also taught. Classes in personal care include bathing, hair care, skin care, nail care, assisting with dressing and assisting with ambulation.
A certified home health aide must complete the personal care aide training and then studies for an additional five days learning how to perform "health-related tasks". These are:
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Assisting with prescribed exercises Assisting with ostomy care
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Assisting with the use of oxygen, nebulizer, ace bandage
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Assisting with a dressing change Measuring vital signs (Temperature, Pulse, Respirations, Blood Pressure)
Medicare and certain other medical insurance plans require that a certified home health aide is used on their cases.
Who will pay for home care services?
What is the Medicare Home Care Benefit?
The Medicare program began in 1965. A Medicare beneficiary who meets the conditions for coverage is entitled to home health services under Part A which cover 100% reimbursement for the covered services. A previous hospital stay is not required and there is no visit limitation placed on the beneficiary as long as coverage conditions are met and the skilled care provided is reasonable and necessary.
The following criteria must be met in order for the Medicare beneficiary to qualify for home care services:
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The patient must be homebound. While an individual does not have to be bedridden to be considered "confined to the home", the condition of the individual should be such that there exists a normal inability to leave the home, that leaving the home requires a considerable and taxing effort by the individual, and that absences of the individual from home are infrequent or of relatively short duration, or are attributable to the need to receive medical treatment." (HIM11, Section 204.1)
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The patient must be under the care of a physician who is willing to sign a plan of care for home care services.
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The patient must receive care in the patient's place of residence.
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The beneficiary must be in need of skilled nursing services on an intermittent basis, physical therapy or speech therapy. These are the primary qualifying services. The patient must need and receive a primary service in order to be eligible for any secondary service. The secondary services are home health aide, occupational therapy and medical social services.
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Skilled nursing and/or home health aide services must be provided on an intermittent or part-time basis.
Medicare does not pay for the following services:
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Medications
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Comfort items
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Meals on Wheels
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Transportation services
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Private duty nursing services
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Custodial care
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Maintenance therapy
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Homemaker or chore services
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Services that are not medically reasonable or necessary
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