Home Care, Home Infusion, and Durable Medical Equipment
What is home health care?
Home health care refers to services that are provided in the home to assist a person with a medical condition. These services can be "skilled" (provided by a nurse, or physical/occupational/speech therapist) or "unskilled" (provided by a home health aide, social worker or volunteer).
Homecare is for people who are homebound. If you are able to get out of the house for needed medical care, your insurance company may not cover home care services. Homebound is defined as:
- Due to illness or injury, the patient requires the aid of supportive devices such as crutches, canes, wheelchairs, or walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence.
- Leaving the patient’s home is medically contraindicated.
- The individual should be unable to leave home or leaving home must require a considerable and taxing effort.
However, there are some exceptions. You may still be considered homebound if you only leave home temporarily for medical care, such as attending a senior day program, going to dialysis, or receiving chemotherapy/radiation. Also, occasional absences from the home such as a trip to the hairdresser, a walk around the block, attendance at a wedding, funeral, or other infrequent or unique events are permitted while receiving homecare under homebound status.
Skilled services are typically covered by insurance. Non-skilled services are only covered if and when you have a skilled need for which you are receiving care.
Skilled needs include
- Medication monitoring/teaching by a nurse.
- Checking vital signs.
- Patient/family education, and teaching.
- Wound care.
- Physical/occupational/speech therapy.
Non-skilled needs include assistance with activities of daily living (ADL’s) like bathing, dressing, and eating. This may also be called custodial care.
Skilled home care is usually provided on a short term, transitional basis. Many individuals are referred to home care after a hospitalization or a new medical diagnosis to aid in the transition between hospital and home and to provide a vital link between the home and the medical team providing care for the patient. Homecare providers are the eyes and ears of the medical team in the field. They report findings, signs, symptoms, and concerns to the medical team and can help identify issues that may impact a patient’s well-being between office visits.
What is home infusion?
Home infusion is a type of home health care that involves giving IV (intravenous) therapy. This could be IV antibiotics, chemotherapy, pain management, fluids, or nutrition services. Home infusion providers manage central lines (e.g. PICC lines, Hickman catheters) and provide supplies and teaching for the management of these catheters in the outpatient setting.
Insurance companies vary greatly on their coverage of home infusion services. It is important to communicate clearly with the infusion provider about your infusion coverage as well as any out of pocket expenses associated with your infusion care BEFORE you start treatment. For example, Medicare does not cover home IV antibiotics or central line care. Some insurance companies will not provide home services if the same service could be provided in an outpatient or doctor’s office setting.
Another important thing to know about infusion care is that a nurse will not be coming out to administer every dose of treatment. It is expected that the patient or caregiver will learn how to manage the home IV needs independently. Also, the same "homebound" rules for home care do not always apply to home infusion cases. You won’t necessarily be hooked up to a huge IV pole to wheel around your house. Many home infusion pumps now fit in a backpack or hip pack and allow you to continue to live an independent life outside of the hospital or infusion center, regardless of the need for IV therapy.
What is durable medical equipment (DME)?
Durable medical equipment is any type of device that aids the patient in the home that improves quality of life. Examples of DME include walkers, wheelchairs, commodes, shower chairs, power scooters, oxygen, and hospital beds.
As with infusion and home care services, payment for medical equipment by insurance companies varies greatly. Any request for equipment submitted to the insurance company for payment must be medically necessary. Your healthcare team should order the equipment and is responsible for providing the equipment company with any necessary documentation to facilitate payment. You may be responsible for a monthly rental fee for some types of equipment. Most insurances will not cover two types of assistive devices; i.e. you can’t get a walker and a wheelchair covered by the insurance company at the same time.
You can privately purchase some DME, like canes, shower chairs, adult diapers, and commodes at local drug stores or online. This can also be cost-effective as you may actually pay less to buy the equipment rather than paying monthly rental fees.
How do I access these services?
Home health, infusion, and DME needs are coordinated by your healthcare team. If you feel you or your family member could benefit from home care services, be sure to ask a team member to help facilitate the referral. Ask friends, family, and neighbors for names of agencies they may have used for home services in the past; you can request a specific provider of service (as long as the provider is in-network with your insurance). Finally, it is a good idea to check your insurance coverage for home care, infusion, and DME before you receive services so you will know what to expect regarding out of pocket costs.