Can a person get home health aids paid for by Medicare?

Your response to me:
"My mom did have very limited visiting nurse and PT visits after hospitalization"

And this was not paid for by Medicare? If the hospital Doctor recommended in home care, it should have been mostly paid by Medicare. As I explained in an earlier post. Medicare only pays 80% of what they consider reasonable. The 20% not paid is paid by Moms supplemental or her. A Medicare statement will show you this. Then you receive a statement from the supplemental showing what they paid. If there are any deductables that have not been met, then there will be a balance due.

I think it would be helpful for you to set up an appointment to talk to a SW at your county Office of Aging. You tell her what Moms needs are and she can tell u what resources are available to Mom. If you have any problems understanding how Moms health insurance works, they can explain. Medicare pays what Medicare pays but supplementals are different. Maybe Mom needs a supplemental that best fits her needs.

Medicare Advantages are becoming a big thing. They are now PPOs which mean if you stay in network, more of the bill gets paid then if you go out of network. But with Traditional Medicare and MA, you must use Medicare doctors. If the doctor you chose is not a Medicare doctor, than you pay out of pocket. And again, a MA may fit Moms needs better.

The only way that Medicare will pay for homecare is if it is doctor-ordered. More often than not, the doctor's office has to submit the order to Medicare a few times.

I'll tell you straight, right now because I have a homecare business.
Medicare will not pay for eldersitting services and companionship hours.

They will give a few hours a week for homemaker/companion to help with things like cleaning, shopping, or appointments but those hours are very limited.

If your mother is on Medicaid, she can qualify for coverage if she's moved into a managed care facility.
In some states Medicaid will cover 24 hour homecare. Not others though.

This subject has many details. From reading posts on the forum it does seem that home health/hospice services may have a regional or “what the market will bear” aspect as to what they offer.

Home Health services and hospice services are both covered by ORIGINAL Medicare but they aren’t both available at the same time. In fact the company I use has both a Home Health Division and a Hospice Division. I first used the Home Health for many years and then when my LO was eligible for hospice switched to the hospice division.

These two groups basically provide the same services but are compensated differently by Medicare.

Of course Hospice also provides needed supplies and equipment. Neither provide “hours” of custodial care.
Think about how much time a doctor spends with a patient on a maintenance type visit. 15 min maybe.
The HH nurse takes vitals, weighs the patient on a routine basis, discusses health issues. They ask the questions the nurse asks when you go to the doctor and advise if a dr visit is needed.
The aide is usually available for a few times a week to give baths and a little personal care. The aides we had would change the bed linens, put on a load of laundry, occasionally heat a bowl of soup, things that didn’t take but a few minutes. That in addition to the baths, shampoo, etc.

Community MediCAID, on the other hand, will provide more services for those who qualify financially and medically. I’m not familiar with how that interacts with hospice. I don’t know if community medicaid services continue after a person goes on hospice? Posters will say their parent has X number of hours per week through Medicaid but I don’t remember anyone posting about having both. Seems that they would.

Of course, LTC is provided by Medicaid in Skilled Nursing Facilities which provides 24/7 care AND in that case, you have 24/7 care and can be on hospice both.

Ideally that means the patient has the regular SNF care as well as the hospice nurse coming in once a week or anytime needed and in my aunts case a daily visit from the aide.

If you have an ADVANTAGE Medicare plan, you would need to call the number on your moms insurance card to find out what services are offered AND under what circumstances you would actually qualify. There are over 4,000 advantage plans in the country, supposedly about 40 to choose from in each persons area. So a hard and fast rule isn’t available that I am aware of. Remember these are private companies. They are licensed and paid by the gov but they aren’t a gov company.

That also may be why you never received home health after hospitalizations. It’s a benefit of Original Medicare. Again if you have an Advantage plan you will need to call them.

Intermittent nursing means the patient needs less than 24/7 skilled nursing services. If they needed 24/7 skilled nursing they would need a hospital. This refers to Part B of original Medicare and is for homebound patients which basically means the patient has difficulty leaving home. You don’t have to be bed bound to receive home health, my mom was never bed bound and she had it for years. Recertification is necessary on a regular basis which is done by an RN. If you check how much time a nurse spends with a patient in hospital or SNF, not that much. Certainly not hours.

Same with PT/OT. If you need it, it is available. But recertification is required after the initial visits to keep it going. My mom had OT for several years as did aunt.

It’s also a caveat worth noting. Medicare may state that certain services are provided but the HH agencies and Hospice Groups, being private, have autonomy.

"We never got a single visit paid for even after a hospitalization"

I don't understand this. The only way Medicare does not pay is if the doctor does not except Medicare. Medicare pays what they consider reasonable. So if the doctor is a Medicare doctor he bills lets say $100 for the visit. Medicare says $80 of what they feel is reasonable and the doctor has to except it. Medicare than pays 80% of what they consider reasonable, $64. The balance of the $16 is paid by the supplemental insurance. If the doctor does not except Medicare, the supplemental will not pay either. You must ask when setting up an appt if Medicare and the supplement are excepted by the provider.

Medicare is primarily a heath provider. Only pays for Rehab, which is limited. In home care if doctor deems it necessary after a hospital visit or feels physical therapy is needed. They pay for Hospice care. They do not pay for the round the clock aides.

The problem may be, does Mom have straight Medicare with a supplement or a Medicare Advantage? Medicare Advantages are suppose to honor Medicare A&B. Which would cover "in home" if Mom had been hospitalized. In home is recommended mainly to get people back on their feet after days in a hospital. Its basically PT and OT. An aide comes a couple of X a week to bathe the client. Its not a longtime thing. This is not something that a doctor would order for a bedridden person. Your friends client, it may have been agreed that the client would do well having "in home" PT to help with walking or balance. An aide would come with that but again, it is not permanent. Only so many days will be covered.

I have no idea how Medicare"intermittent" care works. There was a member that said she used it for her Mom and Aunt. I feel though that the word "intermittent" means just that, care is not constant.

Office of Aging, with the aide shortage they also may not be able to guarantee constant care. I know with my County, they only have so many aides to go around. Getting an aide also goes by income.

The only thing I can see you being able to do is get Mom on Medicaid for "in home". I don't think they will cover 24/7 care though. They may pay family, they may require u go thru an agency.

For 24/7 care you may need to place Mom and have Medicaid paying their share. Moms SS and pension will pay her share.

It will really be hard to find free 24/7 care.

Is your mother on hospice? That’s another thing to think about. They will provide some support and they have volunteers that help as well.

Call Council on Aging and schedule a consultation with them. They will answer your questions and give recommendations for your specific needs.

Best wishes to you and your mother.

Thank you everyone for your input. Since mom is on hospice she does get a CNA twice a week for bathing (in addition to nurse and social worker visits). But either the paid caregiver or a family member has to be there, they don't provide any of the required 24 hour care.

Interestingly the volunteer can be alone with her, but she only comes for an hour a week.

I learned that my friend, who is a HHA, brought her patient to the same PCP my mother had and he prescribed in home care. I was puzzled and then I found out this lady is on Medicaid. I think what was said below is correct, they're considered home aids, not medical personnel, so most insurances, including Medicare, do not cover them.

Your parent must need Intermittent Health Services--nursing services-- in order to qualify.

I would call either your local Area Agency on Aging or VNS to go over if mom qualifies.

If she is "chronic and stable" she won't. It's not for custodial care, housekeeping services or help with ADLs. It's only for health related issues.



https://www.medicare.gov/coverage/home-health-services

Have you ever spoken with Council on Aging in your area? They do assessments on individuals and can guide you on how to proceed.

Council on Aging will provide a limited number of hours of help. They usually work in four hour shifts. They will bathe and prepare meals for your mom, tidy up in her room, change bedsheets, etc. There is usually a waiting list so check into it as soon as you can.

Your situation is different from what my mother’s situation was.

My mother’s doctor ordered home health for her to receive help for her mobility issues due to her Parkinson’s disease.

A physical and occupational therapist worked with my mother on balancing skills and improving her strength. Home health also sent an aide to help with bathing.

Medicare did pay for it. Mom also had Humana Gold Plus.

Medicare will NOT pay for custodial care, which is what in home aids are, they are not home health aids, as in medical personnel. It is health insurance.

If you can not pay for aids to help then you would apply for medicaid.

If you want in home doctors visits or therapies you will need to run down how that is provided in your area.

I think with Medicare (as opposed to Medicaid) this depends upon what the MD has ordered for patient needs. It would not be just home health aid getting paid by Medicare unless a hospice situation. And that's only a few baths a week, in all truth, though you DO get contact with a social worker to guide you for other things, and access to equipment including beds. The care would be by need as prescribed by MD. And it may also be somewhat dependent on your Advantage program if there is one.

I would discuss with Medicare itself online or check your Medicare 2024 booklook, which should just have arrived in mail for all Seniors in the country. Access Medicare online, and you can also call them. I would also discuss with medical care providers, primarily the MD.

Medicare doesn't ordinarily pay for home health aids to keep people in homecare. That usually is private pay. Even in Hospice, if 24 hour care is required that is paid for by the patient.
I hope that when you research you will come to AC to help others answer this question; Your hard work can benefit others. And I hope some here have attempted to get paid for home assistance and can give you info. But I suspect you will be left checking on a lot of this yourself.

You might consider paying for the services of an independent board certified patient advocate. Check for them at www.NPAF.org.
You can search the Medicare site for a "Medicare Consultant" by typing that into their search engine.
You can also try reaching out to an aging life professional at www.aginglife.org.

Sometimes you just need expert guidance and have to pay a bit to get it. I sure do wish you the best of luck. Go to the top bar on this AC site and access "topics" looking up topic for aid alphabetically.

Good luck!