Are you considering having a private home health caregiver? Is this the best course of action for home health care? Can you afford to pay for this type of care? If these are some of the questions plaguing your mind, read on.
Private home health caregivers are an ideal choice, especially when you or an elderly loved one is struggling with activities of Daily living (ADLs) like bathing and dressing, after surgery, or when you have a chronic illness or a disability.
Private home health care covers a wide range of services, allowing you to have tailored treatments and personalized care that meets your unique needs.
Understanding Private Home Health Care
Obtaining the right medical care when needed will ensure proper and fast healing when you have a chronic health condition or recovering from surgery.
Understanding how private home health care works will help you determine the level of care your loved one needs.
Medical care doesn’t stop when you are discharged. When you are ready to leave the hospital or want to stay in the comfort of your home and receive skilled rehabilitative, personal, and medical care, private home health care is an option worth exploring.
Definition of Private Home Health Care
Private home health care is skilled medical care services provided by a licensed medical professional in your home. Under private home health care, a registered nurse (RN) or a qualified caregiver will visit your home to provide the necessary healthcare service.
This type of care can range from personal to intensive care, like round-the-clock dementia care.
With private home health care, you will have ongoing support, and the caregiver will ensure you can easily access all available resources.
You can access private home health care services from your home, your loved one’s residence, or a senior living home.
Benefits of Opting For Private Home Health Care For Seniors
Having a private home health caregiver means welcoming a stranger into your home, which can be frightening. However, the benefits far outweigh this fear.
When you engage the services of private home health care providers, you will have the following benefits, which will enhance your quality of life.
- Familiar Environment: With private home healthcare, your loved one can remain in the comfort of their home, surrounded by family, and receive necessary medical care simultaneously.
- Undivided Attention: You will receive undivided attention and support from your caregiver.
- Retain Independence: Your beloved senior will receive assistance when needed, ensuring they remain in control of their life.
- Reduced hospital trips: since a registered nurse or a nurse aide will be helping with monitoring your well-being, you won’t have to keep going to the hospital for wound dressings and blood pressure monitoring, among other essential services. This will help you save money and reduce exposure to risks and stress.
- You will recover faster from your illness.
- Private home healthcare allows you to remain in a safe and secure environment, which minimizes the risk of accidents and falls.
- Your family will have peace of mind knowing that a qualified and skilled caregiver is supporting you in your home.
Services Offered in Private Home Health Care
The services offered in private home health care are limitless. Depending on your unique situation, you will receive care ranging from nursing to specialized medical services like laboratory work.
During a visit to your doctor, you can develop a care plan to address your needs together.
Some of the home health care services you will receive may include the following:
1. Doctor Care
A doctor may visit your home to diagnose, treat, and periodically review your health needs.
2. Nursing Care
One of the most common types of private home health care is nursing care, and this will depend on your needs. A nurse will consult with your doctor and set up your care plan.
Some of the services you will receive from a registered nurse include and not limited to:
- Intravenous therapy
- Wound dressing
- Medication management
- Pain control
- Ostomy care
- General health support.
3. Physical, Occupational, and Speech Therapy
A physical therapist (PT) will create a care plan to help you regain and improve your muscle strength. If you have joint pain or issues with your balance, working with a physical therapist will greatly help.
An occupational therapist (OT) will help you if you have any developmental, physical, emotional and social disabilities. An OT will help you relearn how to carry out your ADLs, such as eating, dressing, and toileting.
A speech therapist (SP), on the other hand, can help you regain speech or the ability to communicate when you have a speech impairment.
4. Healthcare Social Services
A healthcare social worker will come to your home and provide counseling services. They will also help you locate available community resources essential to your recovery. Sometimes, these social workers may be your case manager, especially if you have a complex medical condition requiring coordination between several service providers.
5. Nutritional Support
A dietician can visit you at your home and provide a dietary assessment. Then, they will develop a care plan that factors your nutritional needs and supports your treatment plan.
6. Pharmaceutical Services
Sometimes, you can deliver your medical equipment and medicine to your home. If you need them, a private home health caregiver will help train you on using the delivered equipment or medication, which might include intravenous therapy.
7. X-ray and Laboratory Services
A technician can visit your home with a portable X-ray machine and perform these services, saving you a trip to the hospital. Specific laboratory procedures, like urine and blood tests, can also be performed at home.
Importance of Tailored Care Plans in Private Home Health Care
A tailored care plan is essential in private home health care. After conducting a comprehensive assessment, a healthcare provider will tailor their services to meet your unique needs. The provider will collect data on your current medical condition and lifestyle preferences.
The information they gather during the assessment will form the basis for developing a care plan to meet your care goals. The aim of a care goal, whether short—or long-term, is to identify problems that need to be considered with your medical condition, interests, and lifestyle.
A private home health care provider will work closely with you and your family to ensure you obtain appropriate essential services.
Once your private home health care professional develops this individualized care plan, it serves as a road map that shows the best way to manage and improve your medical outcome over time. It also gives healthcare providers the direction they need to follow to provide quality services in line with their needs.
Payment Options and Coverage
You and your family can explore several payment and coverage options to cover the cost of private home healthcare.
The first thing you need to determine is the type of home healthcare you need. This will make finding the right payment option that fits your budget is easy.
For instance, if you require medically necessary private home healthcare services provided by trained healthcare professionals like therapists or registered nurses, you must dig deeper into your pockets or combine various payment options, as this is the most expensive level of home healthcare.
You can use a combination of Medicaid, Medicare, veteran benefits, long-term insurance, and private pay.
However, you need to be eligible to receive this type of insurance for care. Your doctor needs to classify you as homebound, which makes it easy to access funding from Medicare, Medicaid, and long-term care insurance coverage.
When you are deciding on an ideal payment option, remember to consider your:
- Assets
- Savings
- Insurance coverages
- Pension
These can go into covering the cost of private home health care.
Insight Into Coverage For Home Health Care Under Medicare, Medicaid, and Long-term Care Insurance
When paying for senior care, you and your family must explore ways to make long-term senior care affordable. In most cases, Medicaid and Medicare will come in handy as they can help you pay for private home health services.
However, be aware that only some qualify to receive funding from these programs. Whether Medicare or Medicaid will help fund your care depends on various factors, such as your age, the level of care you need, and income.
If you are considering ways to pay for private home healthcare services, the following questions will help guide you:
- Which long-term care services will you use with each coverage?
- Do you qualify for these programs?
- How much you will have to pay out-of-pocket for your care?
- What is the duration you can receive the specific benefits under each coverage?
- Will your estate reimburse the government in case you pass away?
It’s important to differentiate between each program, as this will help you determine which services to pay for.
Medicaid
Medicaid is a federal and State financial aid program that provides healthcare coverage to people with low incomes and assets who may have incurred huge medical bills.
Medicaid also helps vulnerable populations without health insurance. This financial aid program is the largest source of healthcare insurance funds for most Americans. Medicaid provides coverage for long-term care through community-based organizations, nursing homes, or at home.
Eligibility
Medicaid eligibility varies with each state. To be eligible for Medicaid and have it cover your long-term care, you must meet specific asset and income limits and functional requirements.
Additionally, it would help if you met specific non-financial eligibility criteria, such as being a resident of the State in which you are applying for Medicaid. You must be a United States citizen or a qualified non-citizen.
When applying for Medicaid, it’s advisable to contact the state medical assistance office for more information.
Once you are determined eligible for Medicaid in your State, your coverage becomes effective on the first day of your application month or on the day you applied.
Sometimes, if you were eligible when you applied, the benefits can be covered up to three months before your application month. However, the coverage will only stop if you meet the eligibility criteria and requirements by the end of the month.
How to Be Eligible for Medicaid through “Spenddown”
Sometimes, your income might exceed Medicaid’s threshold, and you may need assistance due to the high cost of your medications or treatments.
A Medicaid “spend-down” enables you to reduce your countable income by allowing you to subtract medical expenses. After lowering your countable income, you may become eligible to receive Medicaid assistance.
For instance, if your monthly income is $1,500, and you live in a state that only covers individuals making less than $1,215. If your State allows for a Medicaid “spenddown,” you can qualify for Medicaid by spending $285 on medical expenses monthly. This cost can cover your doctor copays, prescription drugs, or long-term senior care costs.
You will also need to find out your State’s spend-down period. This spend-down period varies from one to six months in different States. Once you spend down to your State’s Medicaid income limit, you become eligible if you meet all other requirements for the period you need Medicaid assistance.
If you are considering a Medicaid spend down, you must track all your medical expenses and keep all the relevant documents.
Medicaid Long-term Coverage
Regarding long-term care coverage, Medicaid is the largest health insurance public payer. It covers:
- Emerging and ongoing medical care
- Nutrition and dietary counseling
- Medical equipment and supplies
- Doctor visits
- Home health aide to help with personal care
- Long-term senior care services provided at nursing homes
- Transportation assistance
- Basic home modifications,
- Health social worker services,
- Long-term care is provided at a senior’s home. (Personal and nursing care),
- Community-based care services (laundry, case management, and personal care).
- Skilled nursing care
- Rehabilitative services, especially after an injury or illness
- Long-term healthcare-related services resulting from physical or mental conditions.
You may be eligible to receive long-term care depending on the level of personal care you require. You may need assistance that indicates you need to be in a nursing home or have private home health care at your place.
Eligibility requirements differ in each State, and you should visit your State’s medical assistance office for more information.
Medicaid Waivers
Medicaid waivers enable different states to offer extra services beyond basic Medicaid coverage. These waivers, commonly called home and community-based services (HCBS), ensure that even though you might need care services in an institutional setting, you can still access these services in the comfort of your home.
Medicare
Medicare is a federal government program that provides health insurance to all Americans aged 65 or older. It also covers younger persons with specific disabilities and health conditions, such as permanent renal failure or Lou Gehrig’s disease.
Sometimes, Medicare requires you to share in the cost of some services resulting in more healthcare options at a lower price. However, this arrangement can create some complexities while seeking Medicare funding.
Four types of Medicare programs can help you with healthcare funding. These are:
Medicare Part A
- Skilled nursing care
- Hospice
- Home-based medical costs
- Hospitalization
Please note that Medicare Part A does not cover assisted living, long-term care, or custodial care.
If you receive Social Security benefits, this plan will automatically cover you. If you do not receive Social Security benefits, you can enroll here and start enjoying the coverage.
Medicare Part B
This type of Medicare covers for
- Preventive services
- Outpatient care
- Ambulance cost
- Mental healthcare services
- Some medical equipment
Medicare Part C
This type of cover is also known as the Medicare Advantage plan, and it covers the following:
- Medical costs
- Hospital costs
Once you are eligible for Medicare Part A&B, you are also eligible for Part C. You can purchase this coverage from private agents or insurers instead of Medicare.
When purchasing this coverage, ensure it covers Medicare Part A and B’s services. This coverage has the advantage of covering extra services like vision, hearing care, and dental.
Medicare Part D
This type of insurance covers prescription drugs. As a Medicare Part A or B enrollee, you can enroll for this coverage to receive supplemental or subsidies on your prescription medication cost.
The original Medicare (Parts A and B) usually doesn’t cover prescription drugs.
Medicare Eligibility
To be eligible for Medicare, you need to:
- Be 65 or older
- Have permanent kidney failure or amyotrophic lateral sclerosis (ALS)
- Have a disability that the Social Security Administration determines
- You meet Social Security or Railroad Retirement Board (RRB) benefits
- If your spouse ( whether living or deceased) meets the eligibility requirements for Social Security benefits or RRB.
- If you have a deceased child who, before death, was fully insured
- If you or your spouse were government employees and have paid Medicare takes for the required period
You can enroll for Medicare during its annual enrollment period or make changes to your Medicare to cover the benefits you wish for.
If you apply for Social Security disability or retirement benefits before clicking 65, you may automatically get enrolled in original Medicare. However, if you wait till 65 or older to enroll, you must sign up for Medicare coverage.
If you choose a Medicare Advantage plan, you must choose your plan, fill in the paperwork, and pay the required monthly premiums. Before filling out your Medicare paperwork, check the Social Security websites for more information.
Paying for home health care with Medicare
Once you meet Medicare’s eligibility requirements and conditions, Medicare can typically cover 100% of your medical supplies and skilled care services.
Medicare will cover the cost of your home health care once you meet the following conditions:
- Your doctor regularly reviews your care plan
- You choose a Medicare-certified home health agency
- You are homebound, according to your doctor
Veterans Benefits
You can pay for home health care services with veterans benefits if you are an eligible veteran.
The Department of Veterans Affairs (VA) runs programs that can help pay for home health care. The veterans benefits will help cover the following:
- Skilled nursing care
- Physical, speech, and occupational therapy
- Patient Education
- Home safety evaluations
- Social worker services
Choosing the Right Private Home Health Care Provider
Choosing the right private home health care provider requires careful consideration. You should look for one that meets most of your needs.
Factors to consider when selecting a private home health care agency
When choosing the right private home health care provider, focus on the following:
- Services Offered
When looking into a private home health care agency, you must choose one that offers the needed services.
Most private home health care agencies provide different services ranging from personal to skilled nursing care.
- Accreditation of the Agency
One way to know whether an agency will offer excellent care is if it is accredited and licensed by the health departments and licensing boards.
- Care Customization and The Quality of Care Offered
Consider an agency that offers certain care management practices, like its caregiver-to-client ratio. Please find out how the agency monitors, handles emergencies and supervises its caregivers. Check how the agency customizes clients’ care plans to meet each need.
- Caregiver Qualifications
If an agency hires qualified caregivers, you can be assured that the home health caregiver coming to your home will provide you with excellent care services.
It’s crucial to know that if you need skilled nursing care from an agency, the caregiver they will send you is qualified. The caregiver’s personality and skill set will match your needs.
An agency should ensure its caregivers are skilled, well-trained, empathetic, and certified before sending them to clients’ homes.
- The Agency’s Communication Channels
Before hiring a home health care agency, please find out how they communicate with their caregivers. Which communication channels do they utilize? If you have an issue, how will you go about it? Is there a channel you can use in case of an emergency?
Does the agency have a clear communication path between you, your caregiver, and your family? Are there regular updates on your loved one’s progress?
Once you meet an agency that helps answer these questions, you are a step closer to finding the right home healthcare agency.
- Payment Options
Ensure that you check the available payment options and the cost of care before engaging the services of a private home health care provider. Check if the agency expects you to be paying on an hourly, daily, or weekly basis.
Do they have hidden charges? How transparent are their billing and policies?
- Seek for Referrals from Family and Friends
When choosing the best one, you should seek the opinion of family and friends. Find out from them about their experience with private home health care providers. How was their experience? Would they recommend it?
Importance of Researching and Comparing Home Care Options
The following are some reasons and importance of researching and comparing home health care options.
- You will be financially prepared.
- You will find out if a specific home health care agency offers the services you are seeking.
- You will be mentally and emotionally ready for the change
- You can set clear lifestyle goals that align with your medical condition.
Conclusion
Understanding private pay home health care can be an overwhelming task. However, it can be beneficial. This type of senior care allows you or your elderly loved one to age gracefully in the comfort of your home, surrounded by family, and in a familiar environment.
With a private home health caregiver, you will benefit from personal care services to skilled care, tailored to your needs which will help you lead a better quality of life.
The benefits of having a home health caregiver extend beyond the support they provide. Your family will have peace of mind knowing you are at home and have a professional looking after you.
If you want to explore private-pay home health care and need help figuring out where to start, contact us today. We understand your desire to receive home health care at your house and remain in control of your life. Our caregivers have the necessary skills to help you or your loved one enjoy your golden years despite your health condition.
