What Is Home care?
Home care is a simple phrase that encompasses a wide range of health and social services. These services are delivered at home to recovering, or chronically ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Why Home Health Care?
Steadily escalating health care costs have made it necessary for the health care industry to look for alternatives to long and costly hospital stays. It has been shown that through a combination of modern high-technology home medical equipment and strong in-home nursing and supportive services, home care is a viable and far more cost-effective alternative. As a result, home care has increasingly become the preferred service.
Many patients find that they are happier and more comfortable in their own homes than they could be in a hospital or nursing home. Home care also facilitates the patient’s recovery through the use of a familiar and relaxed environment in which the patient’s family and friends can contribute more readily to his or her personal sense of well-being. South Jersey Healthcare HomeCare
South Jersey Healthcare HomeCare program provides a full range of comprehensive health care and supportive services in the home.
Our services enable patients who are ill or incapacitated to receive high-quality professional health care in their own homes. Home health care is convenient, comfortable and cost-effective, and it allows the person served to maintain dignity and independence.
All services are provided by our qualified staff who are thoroughly trained, licensed and bonded for the protection of our clients. A Board of Trustees composed of volunteers from Salem and Cumberland counties oversees the activities of the organization.
South Jersey Healthcare HomeCare is certified to receive reimbursement under the Medicare and Medicaid programs and is licensed by the New Jersey Department of Health. The program is accredited by the Joint Commission on Accreditation of Healthcare Organizations
For more information, or to make a referral, please call (856) 878-6000.
What Types of Services does HomeCare Offer?
Skilled Nursing
Health care services, case management, medication supervision, wound care, injections, cardiac care, catheter care, IV care, cast care, pre-natal care, and post-partum maternity care, terminally-ill patient care, post operative care, and patient/family education.
Home Care Aide
Patient personal care, meal preparation and feeding and other procedures specified in a written plan of care by and R.N. case manager.
Occupational Therapy
Occupation Therapists help individuals who have physical, developmental, social, or emotional problems that prevent them from performing the general activities of daily living (ADLs). Occupational Therapists instruct patients on using specialized rehabilitation techniques and equipment to improve their function in tasks such as eating, bathing, dressing, and basic household routines
Physical Therapy
Physical Therapists work to restore the mobility and strength of patients who are limited or disabled by physical injuries through the use of exercise, massage, and other methods. Physical Therapists often alleviate pain and restore injured muscles with specialized equipment. They also teach patients and caregivers special techniques for walking and transfer.
Speech Therapy
Retraining and rehabilitation in essential language and communication skills, and swallowing function, lost from illness or disability.
Nutritional Counseling
Assessment of dietary needs relative to the patient’s care plan, guidance with menu planning, and meal preparation.
Social Worker
Emotional and social counseling with patient and family, long term planning assistance, bereavement counseling, caregiver’s support group offered to families caring for a home-bound loved one.
Respite Care
Services designed to provide periodic relief for full-time caregivers.
Volunteer Friendly Visitors
Volunteer friendly visitors are volunteers from the community who care about people and are sensitive to the needs of the homebound. These men and women bring another dimension to the lives of the homebound elderly through their home visits.
Who Pays for Home Care Services?
In many cases the costs of home care are covered by Medicare, Medicaid, and most private insurance plans. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Those not covered may pay privately. However, no one is ever turned away from SHJ HomeCare Services of South Jersey because of an inability to pay. Home Health Care Under Medicare
Who is Eligible for Home Health Care?
All Medicare beneficiaries can get home health care benefits, if they meet certain conditions. The following information describes home health care benefits covered by the Original Medicare Plan.
How Can I Get Care at Home?
To get Medicare home health care you must meet these four conditions:
- Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
- You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services or continue to need occupational therapy;
- You must be homebound. This means that you are normally unable to leave home. Being homebound means that leaving home is a major effort. When you leave home, it must be infrequent, for a short time, or to get medical care, or to attend religious services; and
- The home health agency caring for you must be approved by the Medicare program.
Medicare and Home Health Care Services Covered:
The Original Medicare Plan covers these home health care services:
Medicare Services Covered
-
Part-Time or Intermittent Skilled Nursing Care .
-
Part-Time or Intermittent Home Health Aide Services .
-
Physical and Occupational Therapy .
-
Speech Language Pathology Services .
-
Medical Social Services .
-
Medical Supplies (not drugs or biologicals) .
-
Durable Medical Equipment .*
*The Original Medicare Plan usually pays 80% of the approved amount for certain pieces of medical equipment. You may have to pay 20% of the approved amount for durable medical equipment. Ask your supplier “Do you accept assignment?”
Assignment could save you money. For more information, call 1-800-MEDICARE (1-800-633-4227) and ask for a free copy of “Does your doctor or supplier accept assignment?”
What Doesn’t the Original Medicare Plan Cover?
Medicare does not pay for the following:
-
24-hour per day care at home.
-
Prescription drugs.
-
Meals delivered to your home.
-
Homemaker services like shopping, cleaning, and laundry.
-
Personal care given by home health aides like bathing, using the toilet, or help in getting dressed when this is the only care you need.
What is a Plan of Care?
A plan of care describes what kind of services and care you must get for your health problem. Your doctor will work with a home health care nurse to decide:
-
What kind of services you need,
-
What type of health care professional should give these services, and
-
How often you will need the services.
Your plan may also include things like the kind of home medical equipment you need, what kind of special foods you need, and what your doctor expects from your treatment. Your doctor and home health agency staff review your plan of care as often as necessary, but at least once every 60 days. If your health problems change, your plan of care will be reviewed and may change. Home health agency staff must tell your doctor right away if your health changes. You will continue to get home health care as long as you are eligible and your doctor says you need it.
Medicare and Home Health Care
Only your doctor can change your plan of care. Your home health agency cannot change your plan of care without getting your doctor's approval. You must be told of any changes in your plan of care. If you have a question about your care, you should call your doctor. If your agency changes your plan of care without your doctor’s approval, you have the right to appeal. Your appeal rights are on the back of the Explanation of Medicare Benefits or Medicare Summary Notice that is mailed to you from the company that handles bills for Medicare. The notice will also tell you why Medicare didn’t pay your bill and how you can appeal.
How Long Can I Get Home Health Services?
Medicare pays for your home health services for as long as you are eligible and your doctor says you need these services. However, the skilled nursing care and home health aide services are paid for only on a part-time or “intermittent” basis. This means there are limits on the number of hours per day and days per week that you can get skilled nursing or home health aide services. To decide whether or not you are eligible for home health care, Medicare defines “intermittent” as:
Intermittent means you need home health care for a fairly short period of time.
Hour and day limits can be increased in special cases the number of hours per when the need for more care is limited and can be week you receive care. planned ahead. Once you are getting home health care, Medicare uses the following definition of part-time or intermittent to make decisions about your coverage:
-
Skilled nursing care that is needed or given on fewer than seven days each week or less than eight hours each day over a period of 21 days (or less).
-
Skilled nursing or home health aide services combined to total less than 8 hours per day and 28 or fewer hours each week.
What Does Medicare Pay For and What Can I Be Billed For?
Medicare pays the full approved cost of all covered home health visits. The home health agency sends bills to Medicare. Before your care begins, the home health agency must tell you how much of your bill Medicare will pay. The agency must also tell you if any items or services they give you are not covered by Medicare, and how much you will have to pay for them. This must be explained both by talking with you and in writing. You may be charged for:
-
Medical services and supplies that Medicare does not pay for, such as prescription drugs.
-
20 percent coinsurance for Medicare covered medical equipment such as wheelchairs, walkers, and oxygen equipment. If the home health agency doesn’t supply medical equipment directly, they will arrange for a home equipment supplier to get you the items you need.
How Does Medicare Pay for my Home Health Care?
Medicare pays your home health agency a set amount of money for each 60 days that you need care. (This 60 day period is called an “episode of care.”) The
payment is based on what kind of health care an average person in your situation would need. Medicare has paid hospitals in this way for many years.
What Do I Do if Medicare Stops Paying for my Home Health Care?
Home health agencies must give you a notice that explains why and when they think Medicare will stop paying for your home health care. If you get this notice and your doctor believes you still need home health care and that Medicare should keep paying, you can ask Medicare for an official decision.
Medicare and Home Health Care
It is important to remember that Medicare only pays for home health services that are given by a home health agency that meets Medicare’s quality standards and is approved by Medicare. Medicare regularly inspects home health agencies to make sure that these standards are met. Your home health agency must provide you with all the home care you need, both staff and medical supplies. The agency may do this through their own staff, through an arrangement with another agency, or they may hire someone else to meet your needs. This includes nurses, therapists, home health aides, and medical social service counselors. When you start getting home care, Medicare approved home health agencies will ask you a set of questions about your health to help them give you proper care. The home health agency is required to keep this information confidential. You may ask to see this information. The home health agency will explain these questions to you, and give you written information about them. Most home health agencies accept all Medicare patients. An agency is not required to accept you as a patient if they feel they cannot meet your medical needs. An agency cannot refuse to take you as a patient because of your condition, unless the agency also refuses to take other people with the same condition.
Home Health Care Under Medicaid:
How Can Medicaid Help People with Low Incomes?
Medicaid is a joint Federal and State program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets. Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare. Medicaid has programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who are entitled to Medicare and have a low income. For more information about what Medicaid covers for home health care in your state, call your State medical assistance office. If you need the telephone number for your State, call 1-800-MEDICARE (1-800-633-4227 TTY/TDD: 1-877-486-2048 for the hearing and speech impaired).
Medicare Managed Care Plans
Medicare managed care plans are health care choices in some areas of the country. In most plans, you can only go to doctors, specialists, or hospitals on the plan’s list. Medicare managed care plans must cover all Medicare Part A and Part B health care, including home health care.
If you belong to a Medicare managed care plan, you can only choose a home health agency that works with the managed care plan. Call your managed care plan if you have questions about the plan’s home health care rules, coverage, appeal rights, and your costs. If you get services from a doctor or a home health care agency that doesn’t work with the managed care plan, neither the plan nor Medicare will pay the bill. If you are not sure if you are in a Medicare managed care plan, you can call your local Social Security Administration (SSA) office, or call SSA at 1-800-772-1213. If you would like more information about Medicare managed care plans, call 1-800-MEDICARE (1-800-633-4227).
Social Services Block Grant Programs
Each year states receive federal social services block grants for state-identified service needs. The government allocates these funds on the basis of the state's population and within a federal limit. Portions of the funding often are directed into programs providing HCA and homemaker or chore worker services. Individuals should contact their state health departments and local offices on aging for additional information.
Community Organizations
Some community organizations, along with state and local governments, provide funds for home health and supportive care. Depending on an individual's eligibility and financial circumstances, these organizations may pay for all or a portion of the needed services. Hospital discharge planners, social workers, local offices on aging, and the United Way are excellent sources for information about community resources.
Private Third-Party Payors:
Commercial Health Insurance Companies
Commercial health insurance policies typically cover some home care services for acute needs, but benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for skilled professional home care services with a cost-sharing provision. Such policies occasionally cover personal care services. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost-sharing varies with individual policies, but often is not required.
Individuals sometimes find it necessary to purchase Medigap insurance or long-term care insurance policies, for additional home care coverage.
Medigap
Medicap insurance is designed to bridge some of the gaps in Medicare coverage. Some Medigap policies offer at-home recovery benefits, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder's physician must order this personal care in conjunction with the skilled services. Home care coverage in Medigap policies is not designed to cover extended long-term care. This type of coverage is most helpful to individuals recovering from acute illness, injuries, or surgery.
Long-term care insurance
Long-term care insurance primarily was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. However, as the public need and preference for home care has grown, private long-term care insurance policies have expanded their coverage of personal care, companionship, and other in-home services. Considerable care should be taken in selecting a long-term care insurance policy, as home care benefits vary greatly among plans. Consumers should be aware of limitations on coverage, such as prior hospitalization requirements, and pre-existing condition exclusions. Some policies may only pay for services that are already covered by Medicare.
Workers' Compensation
Any individual requiring medically necessary home care services as a result of injury on the job is eligible to receive coverage through workers' compensation.
How to Obtain South Jersey Healthcare HomeCare Services:
If someone in your family or anyone you know needs home health care services, call (856) 878-6000 ext. 6045 and speak with our Intake Department.
If the person referred is presently hospitalized, our staff will arrange with the hospital social worker, discharge planner and the doctor for proper home care.
After these contacts, the SJH HomeCare Team will design and implement an individualized health care program, which is developed in consultation with the patient, the family, and the patient’s physician.
What are My Rights as a Patient?
Home care patients have a right to be notified in writing of their rights and obligations before treatment is begun. The patient’s family or guardian may exercise the patient’s rights when the patient has been judged incompetent. Home care providers have an obligation to protect and promote the rights of their patients.
Personal Rights and Freedoms
You have the right:
-
To be treated with dignity, courtesy, consideration and respect for your person and property.
-
To auditory and visual privacy in all your care, treatment, communications and daily activities.
-
To be free from restraints, unless prescribed by your physician for a limited period of time to protect you or others from injury.
-
To be free from mental and physical abuse, and from exploitation.
-
To expect treatment and service without discrimination based on race, age, religion, national origin, sex, sexual preference, handicap, diagnosis, ability to pay, or source of payment.
-
To exercise all your constitutional, civil, and legal rights, including religious liberties, the right to independent personal decisions, and the right to give advance instruction for your health care in the event you later become unable to make decisions for yourself.
-
To withhold resuscitative services and/or withdraw life-sustaining care or services.
-
To expect assessment, treatment and information regarding the management of your pain/discomfort at a level acceptable to you.
General Information
You have the right to be informed in writing:
-
of the services available from the agency;
-
of the names and professional status of personnel providing and/or responsible for your care;
-
of the agency’s daytime and emergency telephone numbers.
You have the right:
To be fully informed, before care begins, of the agency’s ownership and control, as well as the relationships that may bring financial benefit to the agency if you are referred to other South Jersey Healthcare Adult Day Programs