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Texas Home care provides services to persons of all ages and
includes preventive, acute, sub-acute, rehabilitative, and long-term care.
Services range from simple assistance in activities of daily living to high-tech
IV therapy. Respite care is short-term temporary relief for caregivers and is
available under the most appropriate category of care to meet the needs of the
client and caregivers.
In Texas there are three major categories of home care
provided through licensed Home and Community Support Services Agencies: Home
Health,
Hospice
and Personal
Assistance Services
Home
Health
Licensed & Certified Home
Health
Must provide
skilled nursing services and at least one of the following other therapeutic
services: physical, speech, or occupational therapy, medical social services, or
home health aide services in a place of residence to be used as a patient’s
home. Services are provided in
accordance with Medicare Certification standards and may be provided to Medicare
and Medicaid recipients.
Licensed Home Health
Must
provide one or more services required by an individual in a residence or
independent living environment such as: nursing, physical, occupational, speech,
or respiratory therapy; medical social service; intravenous therapy; dialysis;
service provided by unlicensed personnel under the delegation of a licensed
health professional; the furnishing of medical equipment and supplies (excluding
drugs and medicines); or nutritional counseling. Skilled nursing must be provided in
accordance with a physician’s plan of care.
Personal care services do not require physician orders. However, the services must be supervised by a
registered nurse. Services may be
provided to private pay clients and certain private insurance beneficiaries or
government aid recipients. However,
Medicare and Medicaid will not reimburse for home health services provided in
this category.
Hospice
Hospice provides a coordinated program of palliative
care to terminally ill patients, and supportive services to patients, their
families and significant others, in both home and facility settings, through a
physician-directed plan of care. Specialized services include medical, nursing,
home health aide, social services, spiritual care, bereavement services,
volunteer services, and other appropriate counseling services. The hospice
philosophy of care provides support for persons in the last phases of incurable
illness so that they may live as fully and comfortably as possible. Hospice care
seeks to enable patients to lead an alert, pain-free life and to manage symptoms
so that their last days may be spent at home or in a home-like setting.
Personal Assistance Services
Provides routine, ongoing care or services required
by an individual in a residence or independent living environment that enable
the individual to engage in the activities of daily living or to perform the
physical functions required for independent living, including respite services.
Personal care (feeding, transferring, toileting, ambulation and exercise,
bathing, dressing, grooming, routine care of hair and skin, meal preparation,
and assistance with medications normally self-administered) may be provided by
unlicensed personnel without nursing supervision. Other services such as
intermittent catheterizations, gastrostomy tube feedings, and administration of
medications may be performed by unlicensed personnel under RN delegation and
supervision.
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Who
Pays For Home Care? |
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Medicare Pays If...
Medicare Part A (Hospital
Insurance) will pay for home health care visits if:
- Services are ordered by a
physician.
- The patient is homebound
because of illness or injury.
- The patient needs part time or
intermittent nursing care, physical therapy, or speech language pathology
(qualifying services). Medical social services, occupational therapy and home
health aide (i.e. personal care) services are covered only if the patient is
receiving one of the qualifying services.
- Routine medical supplies needed
by the home health nurse are also covered under the Medicare Home Health
benefit. Services that are not covered include full-time nursing care, drugs and
IVs (with some exceptions), homemaker/ housekeeping help, and routine/ custodial
care.
Medicare
Part A will pay for hospice care if the patient:
- Is certified to be terminally
ill with a prognosis of six months or less.
- Understands that hospice care
is palliative care which provides comfort, not curative treatments.
- Elects the Medicare Hospice
Benefit, which waives coverage of other Medicare services for only the terminal
diagnosis. Other services provided in relation to conditions other than the
terminal diagnosis are covered under the regular Medicare
benefit.
Medicare
Part B (Medical Insurance) covers home visits by your physician and management
of the plan of care by your physician with a 20% copayment.
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Long-Term Care Pays If...
The Texas Department of Human
Services provides long-term skilled home health and personal care services to
those meeting financial, medical, and functional criteria through a variety of
programs. These programs include Primary Home Care, Family Care, Community Based
Alternatives waiver, In-Home and Family Support Services, Client-Managed
Attendant Services, and Community Living Assistance and Support Services.
Area
Agencies on Aging (AAAs) provide homemaker
/ house keeping and personal assistance
services through Texas Department on Aging funds. Contact your local TDHS office
or AAA (listed in the Blue Pages) for additional information regarding these
programs and services.
Private
Insurance Pays If....
Employer or
union-offered group medical coverage and individual health insurance policies
may cover basic home health services. Each health plan should be reviewed for
specific coverage information. Long Term Care insurance policies may pay for
certain services based upon medical and/or functional
limitations.
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