Home health care may be a great option if you have limited mobility due to an injury, surgery or chronic condition. If you meet the eligibility criteria, you can benefit from receiving expert medical care from the comfort of your own home.
Read on to learn about home health eligibility requirements and when you might need medical services at home.
Understanding Home Health Eligibility Requirements
Your home health care eligibility is initially determined by your doctor, depending on your circumstances and medical needs. Other factors that may determine who qualifies for home health care services include:
- Being considered homebound with mobility issues that make it difficult to travel to appointments
- In need of intermittent skilled nursing care from health care professionals
- Not having reliable transportation if you cannot drive yourself to appointments
If you’re eligible for physician-ordered home health care services, we will assist you with coordinating your care and answering any questions you may have.
Conditions That May Qualify for Home Health Care
Certain conditions may qualify for home health care. These conditions include:
- Chronic illness: Patients with conditions like diabetes, heart disease and COPD
- Cognitive impairments: Individuals with dementia or Alzheimer’s who need regular monitoring
- Disabilities: Anyone who has trouble seeing, hearing or moving
- Injury or mobility issues: People who need physical therapy after a fall, stroke or injury
- Older adults: Seniors who may need assistance with activities of daily living and support
- Post-surgical recovery: Patients who need monitoring, wound care, or medication management after surgery
- Terminal illness: Hospice or palliative care needs
If one of these conditions applies to you, contact your doctor for home health care support. Learn more about our services at AdventHealthHomeCare.com.
Medicare and Insurance Requirements
Those who meet certain eligibility requirements for home health care through Medicare include:
- Being under a doctor or other health care provider's care where home health care services are part of their plan of care
- Having certification from a doctor that you meet homebound status, meaning you’re unable to leave your own home without help
- Receiving care from a Medicare-certified home health agency
- Your doctor states that you need one or more of the following:
- Home health aide services
- Occupational therapy
- Physical therapy
- Skilled nursing care
- Speech-language pathology
According to Medicare, “homebound” is defined as needing assistance to leave your own home, such as a medical device like a wheelchair, walker, cane or special transportation. Additionally, your doctor may recommend you stay home due to your medical conditions.
While many health insurance plans cover home care services, specifics can vary, and it’s important to review your policy on insurance coverage for home health benefits. You may also call your insurance carrier or a Medicaid representative for more information on eligibility requirements.
How to Qualify for Home Health Care
Next steps to qualify for home health care include:
- Talking to you or your loved one’s doctor about their current medical needs and how home health care services might help
- Getting an evaluation from your health care provider to see if you qualify through Medicare Part A or Part B, Medicaid or private insurance
- Requesting a doctor’s order for home health care
- Contacting AdventHealth Home Health to start your services, which may include skilled nursing care, medical social services and home health aide assistance
Throughout the qualifying process, it’s crucial to maintain communication between the patient, doctor and home health care provider to meet all medical needs.
Examples of When You Might Qualify for Home Health Care Services
If you need more information on who qualifies for home health care services, here are some scenarios to help clarify:
- Cynthia recently received a diagnosis of COPD: After qualifying through Medicare, Cynthia is getting assistance from a home health aide who monitors her health, helps with medication management and aids with meal preparation and hygiene tasks.
- Judy was recently in the hospital for a hip replacement: Due to her limited mobility at home, Judy’s AdventHealth doctor recommended skilled nursing services, physical therapy and home health aide services to help her with daily personal tasks as she recuperates.
- Roger was recently diagnosed with Alzheimer’s disease: Through his physician’s intervention, Roger qualified for home health care services, including speech therapy to help with cognition and communication. Roger was also connected with a medical social worker for support and advocacy for him and his family members.
Understanding Who Qualifies for Home Health Care Services
We know that determining who qualifies for home health care services can be daunting, but we’re here to answer your questions. Continuing care at home following an injury, surgery or a chronic condition can lower your risk of readmission and allow you to stay in the comfort of your own home while getting the whole-person health care you deserve.
Your doctor and health care team will work together to ensure you’re getting the best medical treatment no matter where you are. Learn more at AdventHealthHomeCare.com.
