What is home health care?

What home health looks like day to day

After a hospital stay for a fall, your loved one might get a nurse twice a week to check vital signs and teach the family about new medicines, a physical therapist three times a week to work on walking, and a home health aide for a few short visits to help with bathing.

When goals are met, services end.

Who qualifies under Medicare

According to Medicare.gov, your loved one must:

• Need part-time or intermittent skilled nursing or therapy.
• Be homebound: leaving home takes considerable effort or help. Attending adult day care does not disqualify them.
• Be seen in person by a doctor or other provider who orders the care, delivered by a Medicare-certified agency.

Medicare pays nothing out of pocket for covered home health services; equipment carries 20% coinsurance after the Part B deductible. It does not cover 24-hour care, meal delivery, homemaker services, or personal care when that is the only care needed.

What Medicare home health care covers

When your loved one qualifies, Medicare.gov lists these covered services:

• Part-time or intermittent skilled nursing, such as wound care, injections, IV or nutrition therapy, and monitoring an unstable condition
• Physical, occupational and speech-language therapy
• Medical social services
• Part-time home health aide care, but only alongside skilled nursing or therapy
• Medical supplies and durable medical equipment

Medicare also notes that people who need more than part-time or intermittent skilled care do not qualify for the home health benefit.

Why families with dementia run into gaps

Dementia mostly creates a need for supervision, routine and help with everyday tasks, which is exactly what Medicare home health excludes. Home health typically appears after an acute event (a fall, surgery, hospitalization) and then ends. In Florida, home health aides may give hands-on personal care, unlike companions, under s. 400.462. Our companions do not provide hands-on personal care, skilled nursing or therapy; when personal care is needed, families add a licensed home health agency or aide, and our companion can work alongside them.

Making it work at home

1. Ask the hospital discharge planner or doctor whether your loved one qualifies before leaving the hospital.
2. Be home for the first visits and tell the nurse about the dementia diagnosis and behaviors.
3. Ask the therapist to teach family members the exercises and safe transfer techniques.
4. Plan for the hours between visits and after services end.

When to call the doctor

Call if your loved one becomes suddenly confused (possible delirium), falls, stops eating or drinking, or the home health nurse raises concerns. Ask the doctor to order home health when there is a new skilled need.

Home health vs. companion care

Home health is medical, short-term and doctor-ordered. Companion care is non-medical, ongoing and scheduled by the family. Many families use both: the nurse manages the medical side while a dementia companion fills the rest of the week. See the full comparison, our after-discharge guide, and what Medicare covers.

A sample week using both kinds of help

The companion follows the therapist’s plan and does not provide therapy or nursing.

Questions to ask a home health agency

• Is the agency Medicare-certified?
• Have your nurses and aides worked with people with dementia?
• How often will each discipline visit, and for how long?
• Who do we call after hours?
• What is the plan when Medicare services end?

Florida law defines a home health agency simply as one that provides home health services, so ask specific questions rather than relying on the label.

Related terms

• Companion care
• Hospice
• Palliative care
• Activities of daily living
• Delirium
• Respite care