Recently my colleague, Alan Hille, wrote a blog post about the risks associated with owning a home healthcare agency. He outlined the unique risks associated with administering clinical care in a non-medical environment. That reminded me that there is often misunderstanding about the types of care people receive in their home. I thought we might take a step back and define these terms for clarity.
It is understandable that we might get confused when we hear businesses say that they provide home healthcare, in-home care and hospice care and think these are same businesses. In the past, the medical industry used these terms interchangeably but now they each have clearly separate definitions.
The main difference between these services is the level of care that is needed for the type of client. This also affects which services are covered by Medicare.
Home healthcare involves skilled care provided by nurses or health aides (licensed allied medical professionals who have had special training). Home healthcare nurses can administer medication. There is also specialized in-home care for patients in rehabilitation. The common theme is that this type of care is administered by professionally licensed personnel including social workers, physical therapists, registered nurses and health aides. This type of care is predominately prescribed by physician. Medicare will cover a specified amount of in-home medical care that has been prescribed by a physician.
In-home care includes non-licensed caregivers that would remind clients to take medication, but not administer. They typically help with light housework, preparing meals, companion care and incidental transportation for appointments. These are nonmedical personnel that help the client with his or her daily life activities. Because they are not medically necessary and therefore not prescribed by a physician, this type of care is not covered by Medicare but may be covered if the individual has a long-term care policy and specific conditions apply. Of course all policies will vary.
Hospice care is for patients with life-threatening illness. The services are not always provided at the patient’s home. In addition to in-home care, hospice care may be provided for clients that are in a nursing home, assisted living facility, or a hospital. Normally, hospice services are prescribed by the physician for end-of-life care. Medicare will cover physician-prescribed hospice care.
Business owners in each of these categories of care need to be educated on the specific risks they will be exposed to. They can benefit from ongoing consultation with a healthcare risk management expert for advice on how to minimize risk and avoid any potential lawsuits. It goes without saying that they should also be sure they have the right liability insurance coverage in case of an adverse event.
Brokers, did you know Ultra has an exclusive program with binding authority for outpatient medical facilities? Learn more here: Ultra Health Express
Very good article Michele.
I myself find many people do not understand there really is a difference – even some carriers need to be educated. Glad to know Ultra Risk is a company that we can go to for the right type of coverage for our clients.
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