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GUEST COLUMN: The Who, What & Where of Home Care

By Carol Keopf, R.N.

There’s no place like home, especially when it comes to creating a healing environment during an illness or after a surgery. Most people recover faster and the cost is usually much less than lengthy hospital stays.

WHAT is homecare? Homecare is defined as skilled care delivered on an intermittent basis outside a hospital setting. Examples include nursing services; home health aid assistance; and medical social services. In order to be eligible for Medicare reimbursement, homecare must be intermittent and the patient must meet all “homebound” criteria. In addition to Medicare reimbursed services, homecare companies can provide nurses or caregivers that stay from 2 to 24 hours shifts under private duty. Some agencies also provide non-skilled care or custodial care, which consists of housekeeping, shopping, etc. This type of care is not covered by Medicare.

WHERE is homecare performed? It can be most anywhere you call home—from a single family dwelling, apartment or assisted living facility to a homeless shelter as long the patient is consistently there for visits from providers.

HOW do you get homecare? It starts with a call and possibly a visit to your doctor. Let him or her know that you want homecare service. Your doctor will contact a homecare agency with orders. Keep in mind that you and your loved one have the right to choose the homecare provider. If you choose someone other than the one you were referred to, make your wishes known to your physician. The homecare provider will then visit the patient and develop a proposed care plan with input from both the patient and caregiver. The physician must be willing to oversee treatment and sign off on the plan of care, which may be renewed if certain criteria are met.

WHO pays for homecare? Homecare expenses can be paid by state and federally funded programs like Medicaid and Medicare, private insurance, HMOs and PPOs, or long-term care insurance. Some patients pay for their own care.

WHEN might homecare be helpful? Homecare may be appropriate after a hospitalization, to manage pain, to teach caregivers about disease, to address gait or balance issues, for medication management, and to manage behaviors and dementia.

Homecare agencies differ widely in their capabilities and skill. Research all your options and choose a homecare provider as carefully as you would choose a surgeon or a hospital.

Carol Keopf, R.N. is Nurse Liaison for Vanderbilt Home Care Services Inc. Contact Carol at (615) 936-0336 or at


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