Welcome Wisdom

Care Management Optimizes Home Health

by Felicia Juntunen, CMC, ECM Director of Care Management

Elder Care Management care managers regularly provide advocacy for clients in medical settings, everywhere from the physician’s office, to hospital, to home. Care managers assist with facilitating medical orders to help ensure clients receive the prescribed care and treatment. Home health is one of those benefits that a care manager frequently engages on a client’s behalf. Home health features nursing and therapy services provided where the patient lives. Services are temporary and geared toward helping patients regain lost function after an event that has caused some level of disability. Home health may include nursing care, physical therapy, speech therapy, and occupational therapy – all with a restorative focus.

Because home health providers work with patients in their home setting, it is an especially critical service for home-bound individuals or those recovering from health events that caused serious limitations in their ability to seek follow-up treatment in a clinical setting. Meeting the patient in their home helps the home health team gain an increased understanding of the patient’s strengths and any barriers that may impact their progress and recovery. Home health providers may contribute to a patient’s longevity at home by suggesting safety modifications and facilitating orders for durable medical equipment like grab bars, a raised toilet seat, or a shower bench.

To receive home health services, the recipient must be under the care of a doctor who orders the services and is responsible for regularly reviewing the plan of care created to meet the patient’s needs. The patient’s condition must be expected to improve with the care provided and within a reasonable period. The home health agency is responsible for developing a treatment plan and providing skilled therapists to provide any therapy. Home health services are covered under Medicare Part A and Part B and the home health agency must be Medicare certified. It’s important to know that Medicare does not pay for 24-hour home care, homemaker services like shopping or cleaning, or for care focused on activities of daily living like bathing and dressing.

Care managers can help optimize the home health experience for both the patient and the home health provider. Because care managers often oversee the scheduling and coordination of medical care for their clients, a care manager can facilitate the introduction of home health services and assist with scheduling future appointments. A care manager can provide helpful background information about the client to guide the home health team in their approach to best support the client. For example, a care manager will have accurate information about a client’s baseline functioning prior to whatever event has caused their need for home health. This information will assist the home health team in developing a realistic therapeutic plan. A care manager can also communicate with any client caregivers and pass along critical information to the home health therapists. Another important role a care manager can play is to update the client’s family or other responsible parties about their progress. Finally, if necessary, a care manager can provide advocacy for the client if services need to be extended, appealing to the home health agency and physician to continue the services.