Personal Provider Services: Routine, ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes health related services performed under circumstances that are defined as not constituting the practice of professional nursing by the Board of Nurse Examiners through a Memorandum of Understanding with the Department in accordance with Health and Safety Code §142.016 and health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or physician.
Who Uses Home Care? Persons discharged from the hospital who are not fully recovered. Persons with chronic conditions such as diabetes, kidney disease, or stroke that requires frequent monitoring and can no longer meet their needs alone. Persons with a terminal disease, such as cancer or AIDS, who need personal care, pain management, and emotional support. Persons with limited mobility who need assistance with activities of daily living. Families who need respite from caregiving and emotional support in dealing with a loved one who needs special care. A child with special life-sustaining equipment who can thrive at home and school with nursing support.
Why Use Home Care? Allows for early discharge from hospitals and prevents or postpones institutionalization Is the extension of the physician at home, providing confidence and peace of mind Is personalized one-to-one, tailored to the needs of each individual allows maximum freedom for the client Is cost effective when compared to hospital or nursing home care Supplements (does not supplant) the family's resources and efforts in caring for loved ones at home, keeping families together Allows persons to remain in their own homes, proud and independent.
MEDICARE PAYS IF....
Medicare Part A (Hospital Insurance) will pay for home health care visits if: ~ Services are ordered by a physician. ~ The patient is homebound because of illness or injury. ~ The patient needs part time or intermittent nursing care or physical, speech, or occupational therapy. Medical social services and home health aide (i.e. personal care) services are covered only if the patient is receiving nursing care or physical, speech, or occupational therapy. ~ Routine medical supplies needed by the home health nurse are also covered under the Medicare Home Health benefit. Services that are not covered include full-time nursing care, drugs and IV's (with some exceptions), homemaker/housekeeping help, and routine/custodial care.
Medicaid Home Health Public Assistance recipients (AFCD, SSI) that are covered by Medicaid can receive home health benefits as an alternative to more costly hospital or nursing home care, and is limited to skilled nursing, physical therapy, and home health aide services.
Long Term Care Pays If.... The Texas Department of Human Services provides long-term skilled home health and personal care services to those meeting financial, medical, and functional criteria through a variety of programs. These programs include Primary Home Care, Family Care, Community Based Alternatives waiver, In-Home and Family Support Services, Client-Managed Attendant Services, and Community Living Assistance and Support Services. Area Agencies on Aging (AAAs) provide homemaker/housekeeping and personal assistance services through Texas Department on Aging funds. Contact your local TDHS office or AAA (listed in the Blue Pages) for additional information regarding these programs and services.
Choosing A Home Care Provider: Finding the best home care provider for your needs requires a little research, but it is time well spent. Quality of care and competency of personnel will be overriding factors. You have the right to choose any home care provider who is qualified to provide the services you need, although that choice may be restricted somewhat if you are enrolled in a managed care plan (such as a Medicare HMO). Here are some questions to consider when deciding which home care provider is best for you.
1. How long has the provider been serving the community and what services does the provider offer? 2. Does your physician know the reputation of the provider? 3. Is the provider certified by Medicare? Only Medicare-certified agencies can provide services covered by Medicare. 4. Is the provider licensed? In Texas a home care agency must be licensed by the Texas Department of Health as a Home & Community Support Services Agency. What other credentials does the provider maintain? 5. Does the provider have written statements describing its services, eligibility requirements, fees, patient rights, confidentiality, complaint procedures, hours of service, and emergency arrangement? 6. How does the provider select its employees? Does the provider ensure that its workers are functioning under written personnel policies, clinical protocols, and malpractice insurance? What back-up systems are in place to ensure continuity of care? 7. Will the agency continue to provide services if Medicare or other sources of reimbursement are exhausted.
New Creations Heatlh Care, Inc. 1816A West Avenue San Antonio, Texas 78201
