Can home health come every day? Understanding Coverage and Options

According to Medicare, most home health services are approved on a part-time or intermittent basis, meaning they are not typically offered daily. This critical distinction helps explain the limitations and nuances of the question, 'Can home health come every day?'

Quick Summary

The frequency of home health visits depends heavily on medical necessity, a doctor's orders, and insurance coverage, especially Medicare. While short-term, medically necessary daily visits can be approved, ongoing, 24/7 care is generally not covered, necessitating a look into alternative caregiving arrangements.

Key Points

• Home Health vs. Private Care: Home health is typically short-term and medically necessary; private duty care provides long-term, non-medical assistance.

• Medicare's 'Intermittent' Rule: Medicare generally covers home health visits for temporary, medically necessary periods, not for daily, long-term care.

• Daily Visit Exceptions: Short-term daily visits can be approved for acute needs, such as post-surgical recovery, based on a doctor's orders.

• Physician's Orders Required: A physician must certify the medical necessity of home health services and oversee the patient's care plan.

• Explore Alternatives for 24/7 Needs: For round-the-clock or daily custodial care, private pay or long-term care insurance are necessary.

• Combined Care Plan: Many families use a mix of Medicare-covered home health for medical needs and private duty care for daily assistance.

Home Health vs. Private Duty Care: What's the Difference?

Understanding the distinction between these two types of in-home care is crucial for determining how often you can receive help.

What is Home Health Care?

Home health care refers to a range of medical services provided in a patient's home for a temporary period. It is designed to help a person recover from an illness, injury, or surgery and is almost always prescribed and overseen by a physician. The goal is to get the patient back to a state of independence. Services covered under this model are typically skilled in nature and may include:

• Skilled nursing care (wound care, injections, monitoring)
• Physical, occupational, or speech therapy
• Medical social services
• Home health aide services (bathing, dressing) when combined with skilled care

What is Private Duty Care?

Private duty care is a broader, non-medical type of in-home support. It is not limited by a doctor's orders and is paid for out-of-pocket or through private insurance, not Medicare. These services can be arranged for any frequency, from a few hours a week to 24/7 coverage. Private duty caregivers assist with:

• Custodial care (bathing, toileting, dressing)
• Light housekeeping and meal preparation
• Companionship
• Transportation
• Medication reminders

Medicare Rules and the 'Daily' Question

For most people over 65, Medicare coverage dictates the frequency of home health visits. Medicare will only cover services if they are considered "medically necessary" and provided on a "part-time or intermittent" basis.

Understanding "Part-time or Intermittent"

• Intermittent care typically means services are provided less than 7 days a week, or less than 8 hours each day for a short period of up to 21 days.
• Short-term, temporary exceptions may allow for more frequent visits for a brief time if the patient's provider determines it's necessary. For instance, a patient recovering from a complex surgery might require daily wound care for a week or two.

When Daily Care is NOT Covered

Medicare explicitly does not cover ongoing, 24/7 care. If a patient's needs exceed the "part-time or intermittent" threshold, they will likely be denied coverage. This is a crucial detail that often catches families off guard, forcing them to seek other care options.

How to Determine Your Eligibility for Daily Home Health

To secure the highest possible frequency of visits, you and your family must meet specific criteria and follow a clear process.

The Steps to Getting Approved

1. Doctor's Order: A physician must assess your health and create a detailed care plan, which specifies the type and frequency of services needed. This is the foundation of your home health coverage.
2. Certification: The doctor must certify that you require intermittent skilled nursing care or therapy services and are considered "homebound" (meaning it's a major effort to leave your home).
3. Home Health Agency: The care must be provided by a Medicare-certified home health agency.
4. Recertification: If your needs continue, the doctor can recertify the plan of care after 60 days. This process can be repeated as long as the care remains medically necessary and intermittent.

When Home Health Is Not Enough: Exploring Alternatives

If your needs go beyond what home health can provide, several other options exist.

Comparison of Care Options

Care Option	Frequency	Who Pays?	Best For	Typical Services
Home Health Care	Intermittent (e.g., weekly or a few times per week)	Medicare, Medicaid, Private Insurance	Post-hospital recovery, short-term skilled needs	Skilled nursing, therapy, home health aides
Private Duty Care	As often as needed, including 24/7	Out-of-pocket, long-term care insurance	Long-term needs, assistance with daily living	Custodial care, companionship, meal prep
Assisted Living	24/7 on-site staff	Out-of-pocket, long-term care insurance	Social engagement, supervision, help with daily living	Meals, medication management, activities
Skilled Nursing Facility	24/7 skilled nursing care	Medicare (short-term), Medicaid, Private Insurance	Complex medical needs, rehab, long-term skilled care	Continuous skilled nursing, therapy

Practical Steps for Caregivers and Families

Navigating the healthcare system can be overwhelming. Here's how to ensure your loved one receives the appropriate level of care.

1. Start with the Physician: Always begin by discussing your loved one's needs with their doctor. They will determine medical necessity and initiate the process for home health care.
2. Contact a Reputable Home Health Agency: A certified agency can help you understand the specific services and frequency available under your insurance plan.
3. Explore Alternative Funding: For daily, non-medical care, look into long-term care insurance, veterans benefits, or private-pay options. A financial planner specializing in senior care can be a valuable resource.
4. Create a Blended Care Plan: In many cases, families use a combination of home health for skilled needs and private duty care for daily assistance with activities of living. This ensures all needs are met comprehensively.

For more information on Medicare's specific coverage rules, it is helpful to consult the official source at the government's website: Medicare.gov.

Conclusion

While it's possible for home health to come daily for short, medically necessary periods, it is not a long-term solution for 24/7 care needs. The frequency is strictly tied to a physician's orders and insurance criteria, particularly Medicare's "intermittent" rule. For sustained, daily support, families must look beyond traditional home health and consider private duty care, assisted living, or other alternatives. By understanding these options and working closely with healthcare professionals, you can create a comprehensive care plan that meets your loved one's specific needs.

Frequently Asked Questions

Does Medicare pay for home health to come every day?

No, Medicare typically does not pay for home health services to come every day on a long-term basis. It covers care that is "part-time or intermittent," meaning less than 7 days a week, and only for a specific period of medical necessity.

What if I need care every day after surgery?

For short-term, acute needs like post-surgery recovery, a physician can order daily home health visits. This is typically temporary and medically justified, and the frequency will decrease as your condition improves.

What does 'homebound' mean for home health eligibility?

To be considered homebound, it must be a major effort for you to leave your home, and you can only leave for short, infrequent periods for non-medical reasons or for medical appointments.

Can a home health aide come every day?

A home health aide's services are typically covered by Medicare only when they are combined with skilled care (like nursing or physical therapy). For daily, long-term assistance, you would need to hire a private duty caregiver out-of-pocket.

What is the maximum number of home health hours Medicare will cover?

In most cases, Medicare covers up to 8 hours a day for skilled nursing and home health aide services combined, with a maximum of 28 hours per week. Temporary exceptions for up to 35 hours per week may be approved by a doctor.

How do I get daily non-medical care at home?

To get daily non-medical care, such as help with bathing or dressing, you will need to arrange for private duty care. This can be paid for out-of-pocket, through long-term care insurance, or potentially through some state-specific Medicaid programs.

What is the difference between home health and private duty care frequency?

Home health is typically intermittent and scheduled based on medical need, while private duty care can be arranged for a consistent daily or 24/7 schedule, as it is not limited by insurance guidelines.