Industry jargon can be confusing for outsiders, whether the focus is technology, finance, or construction. And when it comes to healthcare, some medical professionals accidentally gloss over important topics that are complicated for many patients and their loved ones. One of the most common misunderstandings during the hospital discharge process is the topic of “home health.”
“Home health” refers to skilled nursing care that is provided intermittently in the home and is covered by Medicare or insurance, whereas “home care” describes long-term caregiver services that are usually an out-of-pocket expense. This guide will empower families by outlining the roles of each service for patients post hospital discharge and may also help healthcare professionals appreciate the value of private-duty home care in Torrance and the South Bay.
“Home Health” is not “Home Care”
Home Health IS:
- Nurse visits to the home for medical needs, such as wound care and catheter care
- Physical therapy, occupational therapy, and speech therapy visits
- Typically covered by Medicare or insurance
Home Health is NOT:
- “Personal care” or help with “activities of daily living,” such as general supervision, dressing, bathing, toileting, and meal preparation
- A substitute for family caregivers or professional caregivers
In short, families should think of “home health” as medical care and “home care” as assistance with the activities of daily living in terms of grooming, dressing, bathing, and going about one’s day. There are occasional exceptions to these general rules. For example, “home health” may provide intermittent bath visits for a short period of time. But generally speaking, these definitions reflect the different services.
*Please note, a handful of “home care” agencies, such as BrightStar Care of Torrance, also provide private-duty/concierge (out-of-pocket) nursing services.
Families May Need to Supplement Nurse/Therapy Visits
Many families will find home health services are best complimented with private-duty home care for the afore-mentioned needs (help with activities of daily living, such as bathing and dressing). Home care services do not replace Medicare or insurance-covered home health nurse/therapy visits but instead work in tandem to facilitate improved patient outcomes and better quality of life.
“Family caregivers” may also assist recently discharged loved ones with supervision and activities of daily living. But many are too busy to do so given work and other obligations. So, not all families are fortunate enough to provide the care themselves. Also, some people find value in enlisting the help of professional caregivers. Patients often respond better to “professionals” than to fellow loved ones, especially when it comes to adult children caring for aging parents.
Hospitals are Focused on “Population Health Management”
When it comes to patient care, families need to remember their loved ones are viewed both as individuals and as members of larger groups. In fact, one of the hottest buzz terms in healthcare these days is “population health management.” While the strategy makes sense for hospital leaders working to manage the health of thousands of patients, its implementation sometimes affects patients in different ways.
Population health management is a guiding force behind care coordination efforts. Patients with similar demographics and diagnoses generally follow similar paths through the hospital system and then in the home environment post discharge. For example, someone might receive a set numbers of nurse and therapy visits based on his or her diagnosis and other criteria. But what if a loved one needs additional help that isn’t “approved” by hospital or Medicare guidelines?
Home care services can help address the specific needs of individuals beyond the scope of Medicare and insurance perimeters. The extra services will likely be “out of pocket,” but there’s peace of mind knowing they are available. Plus, most home care agencies offer flexible schedules to accommodate a variety of budgets.
Many Patients Will Fall Into a “Gap” Between Home Health & Home Care
In addition to providing supplemental caregivers, a specialized home care agency, such as BrightStar Care of Torrance, can also provide concierge nursing and therapy visits. As with professional caregiver services, concierge nursing is typically an out-of-pocket expense and not covered by Medicare or insurance. However, it helps fill a gap that’s all too common for millions of Americans.
A typical scenario in which a family might enlist the help of concierge nursing is when a loved one uses a G-tube post hospital discharge. He or she will likely have Medicare home health visits a couple times per week, but those may not be sufficient to address the daily needs. In such cases, nurses, and hospital staff train family members to carry out nursing duties in between visits. But many people aren’t comfortable being so hands-on with their loved one’s care. And “non-medical” caregivers from most home care agencies aren’t legally allowed to perform nursing duties on behalf of clients, nor are they proficient to do so.
Currently, few home care agencies employ licensed nurses to complement their non-medical caregiver staff. But BrightStar Care of Torrance is an exception and offers a variety of concierge healthcare professionals, from aides who provide basic help with activities of daily living to registered nurses who manage PICC lines, G-tubes, and catheters. So, families with loved ones who fall into a “gap” between home health nurse visits and non-medical home care can still get the extra nursing help they need through a concierge service.
“Home Health” is Transitional and Temporary
Medicare home health services are designed to “transition” patients safely from the hospital back home. Therefore, they are not intended to be a permanent solution for patients with ongoing nursing needs. In fact, hospitals are specifically seeking to reduce hospital readmissions within a 30-day period post discharge. So, patients with continuing nursing needs often cannot rely on Medicare home health to care for them long term.
Examples of patients who may need nurse visits beyond the scope of post-discharge home health include those with Parkinson’s disease, people with paralysis, and anyone who lacks mobility. Their nursing needs might last for years or decades, and only a home care agency with licensed nurses, such as BrightStar Care of Torrance, is equipped to deliver ongoing services without limitations.
Putting it All Together
Ultimately, hospital case managers, social workers, discharge planners, and doctors all want the best for their patients. But they are also bound by the limitations of Medicare and insurance guidelines, which means continuing “home health” (nurse/therapy) visits are limited. And while the system generally functions well for the majority of patients, some will require additional help through private-duty “home care.”
Those who do enlist the help of a Torrance or South Bay home care agency will find they have many options. However, the vast majority will be limited in scope and can only provide “non-medical” caregiver services to aid with activities of daily living. But a handful of companies, such as BrightStar Care of Torrance, can also accommodate home-based medical needs with licensed nurses, including RNs, LVNs, and physical therapists. So, families do have options to address their individual circumstances.
If you’re seeking additional home care support for a loved one or patient in Torrance or the South Bay, be sure to contact BrightStar Care today for a free assessment from our Director of Nursing (Registered Nurse)!