Generally, in home care (Personal and Companion Care) is not covered
by Medicare however there are some very specific criteria which, if met, will allow a portion of the costs to be covered.
Specifically, in order
for someone to be eligible for Medicare coverage the following conditions must exist:
- There must be a considerable and taxing effort to leave home;
- There must be a skilled need (nursing or therapy);
- There must be a change of status such as a hospital stay, medication change, or new diagnosis;
- The patient must be under the care of a physician;
- There must be a Plan of Care; and
must be intermittent.
As an example of the type of situation
that could be covered assume someone has just returned home from a hospital stay for a broken hip and now needs physical therapy.
That physical therapy is a skilled need and would likely be covered. As a result of that "skilled" need other
services may also be covered such as bathing. Bathing help by itself would not be covered but when it can be combined
with a skilled need coverage is possible. This can significantly lower the overall cost of care.
Generally, Medicare agencies will not charge for an assessment to see if any of their services could
be covered. To explore possibilities further you can go to Caretenders web page, a Boston area certified agency at http://www.almostfamily.com/CareTenders/ or call their Newton office at 617-332-5015 and ask for Karen Moorman.