The Medicare Benefit Many Miss: Home Health

by Diane Dennis RN

50plus Magazine

Ralph recently had hip replacement surgery. His physician ordered physical therapy to support his recovery from surgery, help regain strength and increase his range of motion. The order was written by his primary care physician for outpatient therapy. This meant his wife Julia would have the responsibility of helping Ralph get into the car, driving him to the appointment, staying with him, driving him home, and safely getting him back into the house. Both are 82 years old.

Julia was worried Ralph might fall and re-injure himself. She was also concerned that if he did fall, she would not be able to lift him. Also, Julia is diabetic and must check her blood glucose levels throughout the day. This added to her worries: what if she needed to check her levels and give herself Insulin during this trip?

This couple was not aware that since Ralph is homebound and cannot drive, he qualifies for Home Health Services (HH), regardless of whether Julia can drive. HH provides in-home nursing and other skilled health services. If a doctor orders Home Health, Medicare pays. Neither Julia nor Ralph knew this, so didn’t know to ask. Their lack of knowledge created undue stress and left them vulnerable to potential risk of injury to one or both.

This is an example of Medicare services that too often go underutilized. Perhaps Julia — knowing she could drive her husband, not wanting to complain and not knowing there was help — did not express her fears. She simply didn’t know Ralph could get physical therapy at home.

As a Geriatric Case Manager, I see homebound clients asked to provide their own care. Sometimes this care is not only complicated but is identified as a skilled procedure.

More people are opting to stay home for recovery from surgeries and illnesses instead of entering a facility. Hospitals are discharging post-op patients earlier due to overcrowding during COVID outbreaks. Some of the most common scenarios that qualify for HH include wound care, diabetes management, cardiac care, and physical, occupational or IV therapy.

If you or a family member wonder whether you qualify for Home Health Services, ask your primary healthcare provider.

*Names and personal details have been changed to protect their privacy.