As Medicare reimbursements have fallen, it appears many North Texas doctors have chosen to say goodbye to or opt out of treating patients under Medicare. Opting out means that doctors aren’t subject to Medicare’s rules, which limits what they can charge. Currently, the top 10 Texas cities for opt-outs include Houston, Dallas, Plano, Fort Worth, Arlington, and Frisco. Read this D-Magazine article to discover more.
Our society is aging. Every day, 10,000 Americans turn 65 and become eligible for Social Security. With each passing day, the demand for quality, in home care increases significantly. Ideally, we rely upon family and friends to provide help when needed. For many families, however, this might not be an option. Distance, job demands, or life circumstances may prevent us from providing the needed care.
The Dallas/ Fort Worth area has several hundred agencies providing a wide range of home care services. Navigating the maze of “home care” can be a real challenge, even to health care professionals! There are so many questions: What is Medicare Home Health Care and how does one qualify? What is private duty, companion care? How are they different and, most importantly, who pays the bill?
Medicare Home Care
Medicare Home Health care is usually given in the home under the doctor’s orders. It is paid for by Medicare. The goal of home health care is to treat an illness or injury. In addition, Medicare Home Health strives to help an individual to get better, regain independence, and become as self-sufficient as possible.
Medicare Home Health care services include skilled nursing, physical therapy, occupational therapy, and speech therapy. This care involves intermittent visits in the home, once or twice per week, depending on the physician’s order.
To qualify for Medicare or to have insurance cover Home Health Care, the following four (4) requirements must be met:
- Care must be ordered and overseen by a physician
- Patient must be seen by the physician prior to home care visits
- Patient must be “homebound” with potential for rehabilitation
- Care needed is skilled rather than custodial
Although Acappella in Home Care does not provide Medicare services, we can direct you to the right agencies with the skilled services your loved one needs.
Private Duty is a broad term that encompasses all kinds of in home care. It includes companion care, live-in care, custodial care, and nursing care. Private duty is paid for by long term care insurance or by the patient or his/her family. It can be short term, such as after a hospital stay, or long term, such as assisting a client with dementia who can no longer live alone. Most people prefer to age in place, at home, in familiar surroundings. Private duty services range from companionship care to highly skilled nursing care, during periods that range from a short visit to 24 hours a day. Private Duty caregivers can help with light home management, errands, meal preparation, housekeeping, or transportation to the grocery store, pharmacy, or doctor’s office. Skilled private duty nurses offer care to those who require medically intensive care for long term chronic conditions, or skilled nursing care following a hospital stay. Skilled nurses also provide comfort and care to patients at the end of life.
Private Duty Home Care
- RN Care such as IV administration, tube feeding, ostomy care, wound care, and trach care
- RN Medication Management
- RN One-on-One care around the clock
- RN/LVN Post Op Care (at the hospital bedside or at discharge)
- Grooming and dressing
- Oral care
- Medication reminders
- Meal preparation
- Light housekeeping
Finally, do your homework! Ask these questions to any potential Home Health Agency:
- Are they members of the Better Business Bureau?
- Are their employees W2?
- Are they insured and bonded?
- Are they licensed?
- Can you see a copy of their last survey?
- Can they give you references?
- Do they do supervisory visits?
- How is their staff trained?
- Does the agency have a full time Registered Nurse on staff?
- How do they handle calls after hours?