Frequently Asked Questions About Home Health Agencies

Home health agencies provide skilled nursing and rehabilitation help for people who are home bound on a short-term basis. If you have limited mobility due to a temporary injury or illness and need in-home medical help, you could get it through a home health agency. Here are answers to a few questions many people have about them:

Are home health agency services covered by insurance?

They can be. It depends on your policy-every policy is different. You can also get coverage for services through Medicare, Medicaid, or Veteran’s Administration insurance, although you’ll have to meet certain requirements to qualify.

For Medicare, you can get 100% of the costs covered if your doctor deems skilled rehabilitation or nursing services necessary for the short term.

Can I get other services provided?

If you need in-home nursing or rehabilitative care, you may also need help with activities of daily living such as bathing, dressing, and light housekeeping; these services may also be provided through the agency.

Some offer long-term nursing and other services on a more permanent basis, although these services may not be covered by Medicare or most health insurance policies.

Where can I find home health agencies?

Usually, you would get a referral to a local home health care agency from your hospital or doctor. You can also check online. If you’re looking for yourself, be sure that the agency is certified by the Department of Health or the appropriate agency or organization in your state. Your Department of Health may provide a list of certified agencies in your state.

How are agencies regulated?

In most states, home health agencies are regulated at the state level, and the laws governing what they can and can’t do are different in each state. Some states do not regulate home health agencies directly; in Texas, oversight is provided by the Texas Department of Aging and Disability Services http://www.dads.state.tx.us/providers/HCSSA/howto.html.

Most of the time, whether a home health agency is regulated by the state or by a separate agency, they are required to follow licensing rules for all staff-so someone without the proper medical training and certification could work as a companion, for example, but not administer medication or give injections.

How do I know if I need home health?

Usually, your doctor will refer you to one if you need one-and you can’t get Medicare coverage for these services without a doctor’s referral. In general, however, services may be needed if you or a loved one prefers to stay home-or has been discharged from the hospital-but still needs more care than the family is capable of providing.

Not all agencies are the same, and depending on your state, conditions may vary in terms of the types of services the agency can provide and what is covered by insurance. However, if you start with a doctor or hospital referral, you are likely to be able to find an agency that can provide you with the services you need.

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