Significant confusion exists about Home Health Aide services under Medicare. While Medicare does in fact allow Home Health Aide services, the scope of the services permitted is extremely limited.
Much of the confusion centers around the terms Home Health and Home Health Aide. Home Health comes in many forms in Florida including Home Health Agencies, Nurse Registries, and Homemaker-Companion Services. Only Home Health Agencies and Nurse Registries can legally provide Home Health Aide services.
Home Health Aides can provide assistance with Activities of Daily Living (ADLs) which are also known as personal or hands-on care. ADLs are services where the Home Health Aide must actually touch the patient. Other services known as Instrumental Activities of Daily Living (IADLs) are often and erroneously referred to as home health services. Actually no special training is required for an individual to provide assistance with IADLs. IADLs include for example laundry, light housekeeping, meal preparation and like services where the Aide does not have to lay hands on the patient.
Additional confusion arises because in the long term care settings where Medicaid, the VA, and Community Programs as well as private pay settings, the Home Health Aide that provides assistance with AD Ls also performs IADLs as part of their duties.
Only Home Health Agencies that are Medicare Certified can provide Home Health Aide Services under Medicare. The Medicare guidelines state that the need for a Home Health Aide must be temporary or intermittent AND the patient must be receiving a skilled service such as Nursing or Physical Therapy. Additionally, the services must be necessary to the treatment of the patient’s illness or injury.
Medicare guidelines further restrict the services that a Home Health Aide can offer to “hands-on personal care”. Medicare defines such care as bathing, dressing, grooming, caring for hair, nail, and oral hygiene which are needed to facilitate treatment or to prevent deterioration of the patient’s health, changing the bed linens of an incontinent patient, shaving, deodorant application, skin care…foot care, and ear care.
In the Medicare environment, the Home Health Aide may only assist with ADLs where almost all non-Medicare environments permit the Home Health Aide to provide assistance with both AD Ls and IADLs. These constraints of the Medicare Home Health Aide benefit are almost universally misunderstood.