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How to Get Approved for a Home Health Aide

Seniors who live independently sometimes need assistance with their activities of daily living. This could be the result of a health issue, injury, or surgery, and the help is only needed temporarily. For other seniors, the needs may be more ongoing due to limited mobility or chronic illness.

Unfortunately, many seniors are concerned that if they express their need for assistance, they will be pressured to move into a nursing home. Thankfully, that is not normally the case at all. In fact, seniors are encouraged to continue living independently - whether in a senior living community or in their own homes - for as long as possible. A home health care aide, home care assistant, or companion caregiver offers the help needed to remain independent.

Home Health Services Coverage Through Medicare

Under Medicare Part A and Medicare Part B, there is some coverage available for eligible home health care needs. These needs are almost always temporary or intermittent and must be certified as a need by your medical provider. One requirement of home health care coverage through Medicare is that you must be homebound in order to receive these services. If you are able to go out to get these services at a provider's office, then you would not be eligible for home care.

The care provider is required to tell you upfront what Medicare will pay towards your care and what your financial responsibility will be. Always make sure to have that conversation to prevent any surprise expenses. Medicare home health care coverage includes:

  • Temporary or intermittent skilled nursing care or a home health care aide
  • Physical, occupational, or speech-language pathology therapies
  • Medical social services
  • Approved medical equipment and supplies

If you are planning for surgery, or managing a chronic illness, speak to your doctor about whether or not you are eligible for approved home health care services.

State-based Coverage for Home Care Assistance

Depending on your income and needs, your state may have a program through Medicaid to provide caregivers in your home. This care would not fall under the heading of medical or health care. Instead, the coverage is for a home care aide, home care assistant, or companion caregiver who helps you through your activities of daily living.

Often, a home care aide offers exactly the right kind of assistance for an independent senior's daily needs. Home care assistants do not provide any medical care, but they are trained to help elderly individuals, particularly those with disabilities or limited mobility, with their day to day needs. Some of these needs include:

  • General companionship
  • Moving around the home, getting up from bed, standing
  • Getting dressed, bathing, toileting, grooming
  • Light housekeeping, food preparation, and running errands
  • Setting medication reminders and managing calendars

To learn more about eligibility for state-based home care coverage, speak with your primary care doctor. If you are already in contact with a social worker, they may provide resources to get started as well.

Private Insurance and Private Pay Home Health Services

If you are not eligible for home care services under Medicare or your state's Medicaid coverage, you can still obtain them through private means. Review your health insurance policy carefully to find out if there are any provisions for home care services. If you have a long-term care coverage plan, it may be covered under that.

Without insurance, you and your family may need to pay for home health care services, or a home care assistant, out of pocket. Hiring a caregiver may seem expensive at first, but it's important to compare all of the options to find out what is actually most affordable.

If one of your family members would need to reduce their work hours to provide care, or if you would need to move into an assisted living community to get the help you need, the cost of a caregiver might be far less in comparison. Home care agencies work on very flexible schedules, so most families can determine a time period where it's most important to have a paid caregiver in the home and budget for that. For instance, you may just need help in the mornings for a few hours, but once you are up and ready for the day, you can manage on your own until a family member arrives after work.

A home care assistant, or home health aide could make a huge difference in promoting your long-term independence. This type of service allows you to manage your daily activities safely, stay on track with nutrition and medications, and thrive on your own with just the right amount of support. The important thing is to start the conversation with your doctor or your close family rather than avoiding asking for help out of fear that it will cost you your independence. The earlier you get in-home help, the better you can maintain your overall health.