The premises of care and rehabilitation are the main goals of both a rehabilitation unit and a skilled nursing facility. The differences between the two options are slight.In a rehabilitation unit,nurses, physical therapists, occupational therapists, doctors, and social workers collaborate to provide a full range of care with the ultimate goal being a return to the level of health and strength present before the patients setback.In a skilled nursing facility, physical/occupational therapists attempt to help the resident regain certain specific abilities.Social workers help with personal issues such as finances, correspondence, and transitions back to the home environment. Both resources are available to seniors who have suffered a recent set-back and need assistance to regain their strength and mobility.
Medicare reimburses an elderly person for nursing home stays for skilled nursing care and rehabilitation purposes after the elderly person has been in the hospital for three or more days (technically three midnight stays).Medicare pays 100 percent of the costs for the first twenty days of stay.From day 21 through day 100, a co-payment for each day is required.Medicare does not pay any portion of the costs after the 100th day.Medicare will discontinue reimbursement/payment if the nursing home staff decides that the patient has reached full recovery potential at any time during the first 100 days
Medical Home Health Care
Medicare covers home health care if you meet these four conditions:
Your doctor must decide that you need medical care in your home (note this is medical care not longterm care)
You must need at least one of the following: skilled nursing care, or physical therapy or speech services or need occupational therapy
You must be homebound, or normally unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons
The home health agency caring for you must be a medicare provider
Skilled nursing care Skilled nursing care includes services that can only be performed safely and correctly by a licensed nurse
Home health aide services on a part-time or short term. These services include personal care such as bathing, using the toilet, or dressing. Medicare will not cover a home health aid unless you need skilled care
Physical therapy, speech and occupational therapy
Medical social services to help you This might include counseling or help in finding resources in your community
Certain medical supplies
Medical equipment when ordered and meets criteria for coverage; Medicare usually pays 80 percent of the approved amount for certain pieces of medical equipment, such as a wheelchair or walker.
It is important not to Confuse medical Home Care with Long Term Care
Now that we have discussed what Medicare will cover at home lets break it down it to simpler terms. By that I mean most people don't understand when they receive Home Health why it ends and they still feel like they have a medical need for it. Lets use several examples of home health care needs and reasons why they stop.
A 85 year old woman who has some confusion and lives alone has been discharged form the hospital after a fall at home that resulted in a hip fracture. She spent a short time in skilled nursing and went home. The doctor ordered home health care with a home health aide , registered nurse and physical therapist. The lady worked with the therapist and receive care until she was at a stand still she had progressed as far as she could. The therapist had her walking with a walker but she still needed help with taking a bath and remembering to take her medications and remembering to eat. Home Care informs her that services will stop. She no longer has a medical need. she still needs help, but it has become a custodial needs.
