Topic: Help in the Home Defined

HomeCare – This is for people who need assistance in their home for Activities of Daily Living (ADL’s). This includes such things as bathing, dressing, and other activities that are necessary on a daily basis. It can also include shopping, housekeeping and cooking. This is considered custodial care and is often provided by families.

In the US this is NOT covered by Medicare as it is considered non-skilled. Again in the US Medicaid MAY cover this based on income eligibility guidelines which vary from state to state. Most insurance will NOT cover this either unless you have purchased a long-term care insurance policy. In the US VA (Veterans’ Administration) will often cover this especially if there is a service connected injury or disability. An important resource for this is your local Area Agency on Aging or if Native American your Title IV agency. This is a self-referral process for getting case management assistance with long-term needs and can include Meals on Wheels, chore services and respite services.

Home Health – This is intermittent skilled care in the home. Requirements for this include the need to be homebound, meaning difficulty and taxing effort to leave the home. The patient cannot be driving for the most part and can only leave the home on a limited basis with assistance. It includes such things as wound care (such as pressure ulcer or surgical incisions), IV management at home, teaching for such things as medication management and disease process teaching along with symptom control such as pain or constipation. This can include nursing, physical therapy, occupational therapy and speech therapy. Most home health agencies also provide a social worker to assist with any problems that arise and a bath aide/home health aide that could come in two-three times a week to assist with bathing. Many people who have had surgery or have been hospitalized for any length of time should ask for a referral if eligible. Anyone who has had multiple ER visits or hospitalizations should request a referral to try to limit hospitalizations.

In the US Medicare pays for this at 100% with no co-pays or deductibles. Medicare HMO’s and Medicare Advantage plans often will pay for this at 100% although some may have a small co-pay. In the US Medicaid pay for this in a limited capacity. Most private insurance will pay for this although there are usually limits to how long (ie 130 visits a year) or have a co-pay such as 10% until out-of-pocket is met.

Hospice/Palliative care – This is a program that is designed for people who are at the end of life for a variety of reasons. Cancer is just one of those diseases. It also can include heart disease, lung disease or neurological disease such as MS or Parkinson’s. The requirements for most hospice states that you must have six months or less to live in the “normal” course of the disease. But this does mean you can live longer than 6 months as disease is not predictable and no one has an expiration date. Hospice provides for quality of life rather than quantity of life. Home Hospice is designed to provide assistance so that a loved one may die at home surrounded by loved ones rather than in some sort of facility. Home hospice provides skilled nursing to assist with symptom management along with any other nursing care needed. Therapies (Physical, occupation and speech) can be provided to assist with any comfort needs. Social worker provided to assist with any needs that can arise such as need for long-term assistance or caregivers. Chaplain for any spiritual needs. Bath aide to assist with bathing needs to relieve caregiver of this. Also most hospices provide some sort of complimentary therapy such as massage, aroma therapy, music therapy or Reiki just to name a few. Also provided with some hospices would be an inpatient hospital admit for symptom management such as pain out of control. They also can provide several days of respite care inpatient to relieve caregiver. In-patient hospice home are provided in some areas, mostly larger metropolitan areas. In-patient hospice does vary from state to state but always provides inpatient care for end-of-life for families who are not able to care for their loved one.

In the US anyone who is covered by Medicare is eligible for this regardless if you have a Medicare HMO or Advantage plan. If you elect hospice then your Medicare kicks in and pays rather than your plan. This is paid for at 100% along with things such as medical equipment, medications related to the diagnosis and all skilled care. In the US Medicaid pays for this with no issues. In the US most private insurance will pay for this depending on the plan but there may be limitations such as number of days or actual benefits provided so you would need to call to find out the coverage.


Any advice given is based on my experiences and should not be substituted for any medical recommendations. Please speak with your provider before making any changes.