Home Health Care: What You Need to Know

Home health care allows people to receive certain healthcare and support services in their own homes instead of going to a nursing home, rehabilitation facility, or other healthcare setting.

Home health services may be helpful for people recovering from an illness, surgery, hospitalization, or injury, as well as those managing certain chronic health conditions.

Depending on your needs and eligibility, home health care may include:

• Skilled nursing care
• Physical, occupational, or speech therapy
• Wound care
• IV therapy
• Medication management
• Certain personal care services
• Care coordination

Services vary by agency and by the patient’s medical needs.

How Do I Get Home Health Care?

Home health care is generally provided when there is a medical need and the patient meets the requirements of their insurance or healthcare program.

For Medicare-covered home health services, specific eligibility requirements must be met, including a healthcare provider determining that skilled services are medically necessary.

Conditions or situations that may lead to a home health referral include:

• Heart disease
• Cancer
• Parkinson’s disease
• Recovery after surgery or orthopedic replacement
• Lung disease
• Recovery after hospitalization
• Wound care
• IV therapy
• Certain injuries or illnesses

If you think you or a loved one may benefit from home health care, talk with your primary care provider or treating healthcare professional. They can determine whether a home health referral is appropriate.

How Long Does It Take to Start Home Health Care?

Once a referral is made, the home health agency generally reviews the referral and determines whether it can provide the services you need.

Timing can vary depending on your medical needs, insurance requirements, agency availability, and whether additional information or documentation is needed.

If you are leaving a hospital or rehabilitation facility, ask before discharge when home health services will begin and who will contact you.

How Do I Pay for Home Health Care?

Coverage depends on your insurance, medical needs, and eligibility.

Medicare, Medicaid, and private insurance may cover certain home health services when their requirements are met. Coverage is not automatic, and some services may not be covered.

Before services begin, ask:

• Does my insurance cover these services?
• What services are covered?
• Will I have out-of-pocket costs?
• How many visits are covered?
• Do I need a referral or prior authorization?

If a service isn’t covered, you may need to pay out of pocket or explore other community resources.

What Should I Expect When Home Health Comes to My Home?

What happens during a home health visit depends on the type of care you receive.

If a Nurse Visits

A home health nurse may:

• Check your vital signs
• Assess your health and recovery
• Review medications
• Provide ordered treatments
• Perform wound care when needed
• Monitor for changes in your condition
• Answer questions about your care
• Communicate important changes to your healthcare provider

If You Receive Therapy

Physical, occupational, or speech therapists focus on your individual needs.

Therapy may help with:

• Strength and mobility
• Walking and balance
• Daily activities
• Communication
• Swallowing
• Home safety
• Recovery after illness, injury, or surgery

Who Coordinates My Home Health Care?

Your home health team may include nurses, therapists, aides, social workers, and other professionals.

A case manager or care manager may coordinate your services. Depending on the agency and your needs, this person may be a nurse, therapist, or another qualified member of your care team.

This person can be an important point of contact and help communicate information among members of your healthcare team.

Is Home Health Care the Same as Hospice?

No. Home health care and hospice are different services.

Home health care generally focuses on helping a person recover, manage a health condition, or remain safely at home while receiving medically necessary care.

Hospice focuses on comfort and quality of life for people who are nearing the end of life and meet hospice eligibility requirements.

Both services have specific eligibility and coverage requirements.

How Long Can I Receive Home Health Care?

There isn’t one set amount of time that applies to everyone.

The length of home health care depends on your medical needs, treatment goals, progress, care plan, and insurance coverage.

For Medicare-covered home health services, you must continue to meet eligibility and coverage requirements.

Sometimes services end because you have reached your goals or “plateaued,” meaning additional skilled services are not expected to provide further improvement.

Being discharged from home health does not necessarily mean you feel completely recovered or no longer need assistance.

What If I Still Need Help After Home Health Ends?

If you still need assistance after home health services end, talk with your healthcare provider about what options may be available.

You can also contact your local health department or community organizations to learn about programs that may provide assistance with transportation, meals, personal care, medical equipment, or other needs.

Ask your healthcare team:

“What happens now that home health is ending, and what resources are available to help me remain safely at home?”

You Don’t Have to Navigate Home Health Care Alone

Home health care can be an important resource for people recovering from illness or managing health conditions at home. But referrals, insurance, medications, multiple providers, and changing care needs can make the process difficult to navigate.

Our Father Patient Advocacy LLC provides personalized nurse patient advocacy to help individuals and families understand their healthcare, organize their care, communicate with their healthcare team, and remain involved in important healthcare decisions.

You remain in control of your healthcare. Our role is to help you understand the process, ask the right questions, and make sure your voice is heard.

This article is for general educational purposes and is not a substitute for medical, legal, or insurance advice. Home health eligibility, services, and coverage vary based on individual circumstances, medical needs, and insurance requirements.

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