Home Health 101

The Goal

Home health care provides skilled medical services in your home to help you recover from illness, surgery, or injury, or to manage chronic health conditions. The goal is to improve your health, increase independence, and help you stay safely at home.

Who Provides It

A team of healthcare professionals including registered nurses, physical therapists, occupational therapists, speech therapists, medical social workers, and home health aides. They work together under your doctor's orders to help you reach your health goals.

Where Care Happens

Care is provided in your home, wherever you live: house, apartment, assisted living facility, or family member's home. The key is that you're receiving care outside of a hospital or skilled nursing facility.

The Duration

Home health care is typically provided for a specific period based on your needs, usually 60-day episodes. Medicare covers care as long as you continue to need skilled services and show progress toward goals. Some people need just a few weeks; others may need several months.

Home Health vs. Home Care

Home health care is skilled medical care ordered by a doctor and often covered by Medicare. Home care (or personal care) provides non-medical assistance like housekeeping and companionship, usually paid out-of-pocket. They're different services with different purposes.

Your Right to Choose

You have the right to choose your home health agency. You can switch agencies if you're not satisfied with your care. Medicare encourages you to compare agencies using quality ratings on Medicare Care Compare.

Skilled Nursing

Registered nurses provide wound care, IV therapy, medication management, disease education, vital sign monitoring, catheter care, and coordination of your overall care plan. They're your primary point of contact with the home health team.

Physical Therapy

Physical therapists help restore mobility, strength, and balance. They work with you on walking, transferring, climbing stairs, and exercises to improve function and reduce fall risk. PT is one of the most common home health services.

Occupational Therapy

Occupational therapists help you perform daily activities like bathing, dressing, cooking, and other tasks. They may recommend adaptive equipment and teach energy conservation techniques for daily life.

Speech Therapy

Speech-language pathologists help with swallowing difficulties, communication problems, and cognitive rehabilitation after stroke or brain injury. They work on safety with eating and drinking.

Medical Social Work

Social workers help with emotional support, connect you to community resources, assist with advance care planning, and help navigate insurance and financial concerns related to your care.

Home Health Aide

Home health aides assist with personal care like bathing, grooming, and dressing under the supervision of a nurse or therapist. This service is provided only when you're also receiving skilled nursing or therapy.

Homebound Status

You must be "homebound," meaning leaving home requires considerable effort due to illness or injury. You can still leave for medical appointments, religious services, or occasional trips. Being homebound doesn't mean bedridden.

Skilled Care Need

You must need skilled nursing care, physical therapy, speech therapy, or continued occupational therapy. The services must be medically necessary and ordered by a doctor.

Doctor's Orders

Your doctor must certify that you need home health care and establish a care plan. The home health agency and your doctor work together on your treatment plan.

Medicare-Certified Agency

You must receive care from a Medicare-certified home health agency. These agencies meet federal standards for quality and safety.

Intermittent Care

Medicare covers "intermittent" skilled care, meaning you need nursing or therapy visits periodically rather than full-time care. Typically, visits are a few times per week.

OASIS Assessment

Outcome and Assessment Information Set - a standardized assessment tool used to evaluate your condition at the start of care, during care, and at discharge. OASIS data is used to develop your care plan and measure quality.

Care Plan

Your individualized plan of care that outlines your diagnoses, medications, services needed, visit frequency, goals, and expected outcomes. It's developed by the home health team and approved by your doctor.

Episode of Care

A 60-day period of home health services. If you still need care after 60 days, a new episode can begin. Medicare pays agencies a set amount per episode based on your care needs.

Star Rating

Medicare's 1-5 star quality rating for home health agencies based on patient outcomes, patient experience, and how often patients end up in the hospital. Higher stars generally indicate better quality.

Skilled Care

Medical care that requires the expertise of a licensed professional like a registered nurse, physical therapist, or speech therapist. Medicare only covers skilled care, not custodial care.

Homebound

A Medicare requirement meaning you have trouble leaving home without help due to illness or injury. You're not required to stay home completely, but leaving must be a taxing effort.

Face-to-Face Encounter

A requirement that your doctor or certain other practitioners see you in person before certifying your need for home health care. This must happen within certain timeframes.

Recertification

If you need home health care beyond the initial 60-day episode, your doctor must recertify that you continue to need and qualify for skilled services.