FREQUENTLY ASKED QUESTIONS
Do you have minimum number of hours?
Do you provide transportation?
Do you offer on-call service so we can reach someone after hours?
Which services are covered by Medicare, Medicaid, Long Term Insurance and if I pay privately?
We are often asked if we have a minimum number of hours per day or week. The basic answer is NO. We do not have a minimum but we would like to share with you the challenges that can arise when either little hours are requested and/or stable frequency is not set. Even though our home health aides are our direct employees, most of them complete employment applications at multiple agencies and can take on assignments from any agency as they please. This is true for our agency as well as others. Naturally, being paid hourly, home health aides look for work with a good amount of hours (at least 3-4 hours per day) and if they accept cases with less hours, they are likely to quit on the case if another one with more hours is offered to them elsewhere. As the result, the Patient may experience high turnover rate of new aides, which is something most Patients are looking to avoid. Even though we have many Patients receiving as little as 1-2 hours per day and we will do our best to accommodate every situation, it is important to understand challenges that can arise and reasons behind them.
Most of our caregivers are licensed drivers and own a vehicle. They can drive our Patients in their own car or use Patient’s car. If you choose to use our caregiver’s car, we only ask that you reimburse them directly for gas expense. Keep in mind, we do not provide “medical transportation”, which requires a special vehicle and a separate professional license. Also, in most cases, we will not allow our caregiver to be a passenger, if Patient chooses to drive. For live-in cases, Patients who allow our caregivers to drive their car are advised to contact their auto insurance company to add additional driver to their policy.
Yes. After our regular office hours (M-F, 9am-5pm), our answering system allows callers to be connected to a representative 24 hours per day, 7 days per week. Keep in mind that in the even of real emergency, you must call 911 since we do not operate as an emergency service and valuable time may be lost calling us first.
The complete answer to this question would require many pages but we will try to simplify it in order to underline the key differences.
ORIGINAL Medicare Facts (also known as TRADITIONAL Medicare):
- Fully covers skilled care such as intermittent nursing visits, which often include wound care, blood pressure monitoring, medication management and teaching, medication administration and teaching, psychiatric care and a wide range of other skilled nursing procedures.
- Fully covers Physical Therapy, Occupational Therapy and Speech Therapy.
- Fully covers visits by Clinical Social Worker.
- May cover non-skilled care (assistance of an aide) but only while receiving skilled care and when such care is necessary and no caregiver is available to provide it. This level of care is strictly limited to the most essential ADLs (Activities of Daily Living), which include bathing, dressing, assistance with toileting, transfers and some personal care items. A typical visit of this nature lasts about 1 hour and therefore, Medicare should not be considered as a long-term care solution.
- All services must be ordered and approved by a physician. Typically, your primary care doctor, specialist or hospitalist can write a prescription for skilled care and you get to decide which agency to use (Patient Choice).
For more information, visit http://www.medicare.gov/Pubs/pdf/10969.pdf
ORIGINAL Medicaid Facts:
- Offers non-skilled care (assistance of an aide), which is limited to certain tasks such as bathing, dressing, feeding, assistance with transfers, using the bathroom among few other tasks. It does not however cover transportation, shopping, cleaning, laundry, cooking, etc., which may be covered by other programs. A typical visit of this nature should last about 1 hour and in some cases, more than one visit per day will be allowed. Currently, FL Medicaid allows up to 3 visits per day, when necessary criteria is met. This may change...
- For those who do not have Medicare, may cover nursing services.
- For children up to the age of 20, may cover therapy services.
- All services must be ordered and approved by a physician. Typically, your primary care doctor, specialist or hospitalist can write a prescription for Medicaid approved services and you get to decide which agency to use (Patient Choice). Ordering physician must recertify need for continued care every 60 days.
For more information, visit:
http://www.fdhc.state.fl.us/Medicaid/pdffiles/2012-2013_Summary_of_Services_Final_121031.pdf (Home Health Services - Page 61).
Long-Term Care Insurance – often referred to as (LTC):
- Long-Term Care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.
- Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living (ADLs) such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.
- When home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed. It will pay for a visiting or live-in caregiver, companion, housekeeper and sometimes a therapist or private duty nurse up to seven days a week, 24 hours a day (up to the policy benefit maximum).
- You can request a caregiver prior to obtaining an authorization from your LTC insurance and once authorized, they will pay from the date care started. However, care does need to be authorized by your long-term care insurance and we help you with submitting documentation to obtain authorization. When care is requested prior to being authorized, a deposit is often collected and used to pay salaries of our caregivers until care is authorized and paid for by your LTC insurance.
- Authorizations are typically granted when a person is expected to require care for at least 90 days and be unable to perform 2 or more activities of daily living (eating, dressing, bathing, transferring, toilet-ing, continence). In some cases, a doctor may need to certify medical necessity, which may include the need of assistance due to a severe cognitive impairment.
- There is often a daily dollar amount limit and there are some policies that pay less than 100% of amount billed. It’s important to know this in advance. (If needed, Patients can purchase additional hours at our discounted rate).
- There may be an “elimination period” (initial number of days that patient must pay out of pocket, before policy will start paying).
- Policies usually end when either the total dollar amount is utilized (usually few hundred thousand), or policy term comes to an end, whichever comes first.
- Care Coordinator from your LTC (usually a nurse) will make routine follow up calls and/or visits to your home in order to re-authorize and if necessary modify continuation of care (increase or decrease number of hours authorized).
When Patients choose to pay privately for services we provide, all limitations as set by various insurance companies or federal/state programs are eliminated. Therefore, Patients can freely decide which service they need and how often. Whether it’s skilled care, or non-skilled assistance of a caregiver. Pricing will depend of the type and amount of services utilized. Please call us so we can customize a plan that works for you. For a list of services provided by us, please click services.