Qualifying for Home Health Care Services

Home heath care services can be defined as restorative services that are provided in a patient's home. After being discharged home from the hospital or from an acute rehabilitation unit, if you are considered "homebound" and require intermittent skilled therapy then you would qualify for home health services. Many people have an interest in continuing skilled therapy following their hospital discharge or rehab stay, but they are not aware of the guidelines used to grant home health care services payable by insurance companies. Also, many treatments which were once done in the hospital setting are now being done at home with the continued improvement of medical technologies, and the home health care service is usually less expensive than the inpatient alternative in the hospital. The following guidelines will give a general understanding of what criteria are necessary in order to qualify for home health:

1. The patient must be under a physician's care - A physician who follows the patient is needed to sign orders on the patient's behalf and also to certify the need for skilled services through the insurance companies. The physician, along with the skilled home health care workers, creates a plan of care to specifically outline the needs and goals for the patient.

2. The patient must be essentially "homebound" - Homebound is defined as the inability to leave the home and can apply to the elderly, infants, children, and adults alike. If there is a safety risk in leaving the home or even a fear of leaving the home, a patient can possibly be granted a homebound status. Exceptions can be made for leaving the home while still maintaining homebound status. Those include: short and infrequent trips, mainly to the doctor, attending church, going for a haircut, etc. where the patient does not drive him or herself.

3. Skilled services must be necessary following discharge to home - This includes services such as skilled nursing, physical therapy, occupational therapy, speech-language pathology, and medical social services.

It is often best to research the local home health agencies in order to learn about the types of services they provide. Not all agencies provide all the possible skilled services a patient may need. Getting a recommendation from the doctor or social worker is appropriate, but patient's have the right to choose which home health agency they wish to provide the in-home care. As an added note, those on Medicare should go to "Home Health Compare" on www.medicare.gov on the web to make sure the agency is Medicare-approved. It is important to remember that Medicare only pays for home health services that are given by a home health agency that meets Medicare's standards and is certified by Medicare.