The Difference between Home Care and Home Health Care:

Will Medicare Pay For Home Health Care in Palm Beach County?

Home health care in Palm Beach County isn’t simple. Let’s define some terms first: there’s a difference between Home Care ( in-house care), and Home Health Care. Home Health Care, as provided by Medicare, will send a professional to check on your loved one. Home Care, or in-house care, will keep a professional with your loved one at all times. The medicare option would make sure medicines were changed. The Home Care provider would make sure they were taken by the individual needing assistance. One option is more comprehensive, the other more perfunctory. As it turns out, options like Medical Supplemental Insurance will cover the deductible and the co-payments, but different areas of coverage will not be added. The result of the situation is that no real value is added on the home-care side of things. This option isn’t going to cover the needs of patients with Cognitive Impairment or Dementia.

Home Health Care Palm Beach County

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What Medicare Does:

There is some hope, however. The cost of keeping an individual healthy in the home is a medical necessity. Thankfully, Medicare has recognized this; so they will recoup some of the expense. There are certainly a number of other insurance institutions which will likewise cover necessary costs. But Medicare is a government institution, so it is full of hidden caveats.

For example: say your great aunt is in her late seventies and has developed Cognitive Impairment. Well, she can move about the house fine. She was a gymnast in the fifties, after all! However: she can’t remember what time of the day, month, or year it is; and she keeps calling you Walt because of your spectacles. Your name is Steven, but you love her anyway. The thing is, Great Aunt Sally really likes to walk every morning, and walking is good for her. Regular exercise is usually recommended throughout an individual’s life, provided they’re healthy enough for it. Since Great Aunt Sally can leave the house, Medicare will not cover the in-house medical necessities she desperately needs. She doesn’t fit into the bureaucratic rubric of the government provision, so she is excluded from their aide. Unfortunately, that is how these things work. Furthermore, personal care isn’t covered in the visits; adding to bureaucratic redundancy. Visits from professionals in this area are short and impersonal. Basically, somebody’s stopping by to make a mark on a checklist and move on. There’s also been a 3.5% decline in reimbursements on the yearly until 2017, according to the Centers for Medicare and Medicaid Services. This is another notch against seniors who desperately need that support, and one reason some don’t support the government institution. While professing to aide, through bureaucracy, those who need help often don’t get it. And while there are Medicare “PACE” Programs, their availability is strictly limited to specific places. It’s not available to most people.

You see why it’s so important to distinguish between “Home Health Care” and “Home Care”. While you may come across the terminology in the government paperwork, what that terminology implies and what it is aren’t the same.
How does Medicaid Fit Into the Picture?

Also, Medicare and Medicaid aren’t the same. Designed to help seniors remain actively living in their own homes, Medicaid is an insurance service that does cover some expenses. Health, in-home supports, non-medical home care–some of these things are definitely covered by Medicaid. The catch is that rules of Medicaid are often specific to a given state, and governed by the auspices of HCBS. HCBS stands for “Home and Community Based Services”. A given HCBS form will authorize different rights and provisions per state, and furthermore they’re no kind of guarantee. There are lists that can be quite long that a senior citizen may have to wait on, because HCBS provisions are often coupled with a cap.

According to payingforinsurancecare.com, Florida no longer uses HCBS waivers but now provides Managed Long Term Care, or MLTC. Under the Statewide Medicaid Managed Care Long-Term Care Program of Florida, (SMMC LTC), Home Care is a covered benefit in Palm Beach County. Palm Beach County is part of Florida, and these provisions are for the entire state. However, there are a number of waivers which no longer are active in the state of Florida, such as Nursing Home Diversion, Aged and Disabled, Consumer Directed Care Plus Waiver, and Cognitive Impairment. All this information is current as of 2015.

The Veteran Component:

There are a number of options for Veterans. The Department of Veterans Affairs (DVA) offers three different kinds of benefits in the realm of Home Care. Furthermore, those select individuals that need more attention are usually able to get higher amounts. Aid and Attendance, Improved Pension and Homebound are the three different benefits offered by the DVA. To see if your loved one qualifies, you can check Paying for Senior Care (http://www.payingforseniorcare.com/longtermcare/resources/veterans_pension.html). There is also an option called Veterans-Directed HCBS, and this is still available in Florida. Keep in mind, no crossover is allowed between Veteran programs and conventional Medicaid programs.

No Medicaid, No VA Benefits:

If you have a loved one who needs home health care in Palm Beach County, but they’re not eligible for either Medicaid or VA benefits, there are options. Usually these options come under the unofficially named “Nursing Home Diversion” heading, and can include cash assistance, care services, respite, transportation–even meals. While these may not be the best option, they are an option.