Even though home health care is considered ‘a necessary benefit’ of Medicare, that doesn’t mean it’s easy for elderly and disabled individuals to get the right support through this government program. There are specific conditions that must be met in order to qualify for home care coverage through the Medicare system.
Most notably, an individual needs to be considered homebound, which means he or she is unable to get out and about on their own. They could qualify if they prove the necessity for skilled nursing services intermittently. They might also qualify if they have a specific care plan prescribed by their doctor which requires home care services. If they require any type of occupational or physical therapy, that might also permit somebody to be eligible as they could already receiving care from a ‘Medicare certified’ home health care agency.
As reported by the Miami Herald in its health blog, Finding home healthcare under Medicare plans can be difficult, written by Allison Horton in a ‘Special to the Miami Herald’:
“The goal of home healthcare is to provide treatment for an illness or injury, according to Medicare. But, it is often a high bar to clear to get approval for home healthcare, said Phil Moeller, author and writer about Medicare and Social Security for the “PBS News Hour.”
People are eligible for Medicare coverage of home healthcare under certain conditions, which include: being certified homebound, needing intermittent skilled nursing services or physical or occupational therapy, having a care plan from a doctor, and receiving care from a Medicare-certified home health agency.
“It can be hard to find a really good home health agency because agencies have a hard time finding qualified people because the positions don’t pay a lot,” Moeller said.”
While it is notable that home health care can certainly reduce hospital readmissions, improve health, and also boost quality of life, it can also save the federal government significant amounts of money by helping people avoid far more costly nursing home and other care options.
It’s not always easy to become eligible and there are other hurdles, including having difficulty finding a home health agency willing to provide these services. Some may not provide the services because of distance from their operational base while others have been accused of only choosing those elderly clients who are deemed to be “financially advantageous” to them.
This can sometimes leave people without the services they desperately need, and this latter issue is one that can sometimes be considered the most tragic, especially given the very real need many seniors have following injuries or some type of hospitalization.