Home From the Hospital – What Services Are Covered


You just arrived home from the hospital and were told some services could be covered by the Medicare program at your residence.  What are they and what other services that might not be covered by Medicare could still be helpful at home?  Here is a summary.

OT, PT, and Home Health.  Occupational therapy (commonly referred to as OT) and physical therapy (PT) are two common types of at-home services under Medicare.  You may need to know the difference since Medicare is very specific about what types of services that would be covered by each.  I found this out while recovering from a shattered broken shoulder years ago.  When I was first recovering I could not participate in PT because the shoulder had not yet healed enough but I could be involved in an OT program. 

Occupational therapy is a confusing term for those not in the field.  You might suppose it means getting you back to work at an occupation outside the home.  Actually, recipients of OT may be and often are retired or homemakers or disabled and not intending to learn employment skills.  I discovered that occupational therapy has to do with being able to perform basic tasks such as dressing and showering.  It is task related.  Physical therapy, on the other hand,  has to do with regaining strength and capacity.

Occupational Therapy and Home Health.  Occupational therapy and home health aides’ services may overlap in some areas.  OT is intended to get you to do things on your own.  Home health aides help you to perform certain tasks.  For activities like showering you might have both OT and home health.    It may be helpful to say what you want to be able to do and find out who can help you with a given task.

One thing I began to realize is that sometimes an aide or therapist may be able to help you perform one task but not another that you really want to accomplish.  For example for my work I really wanted to be able to write and type for obvious reasons.  What I learned is that even though my shoulder was broken I was experiencing difficulty using my right hand.  That was a surprise.

I wanted to know how to write since the injury severely affected my right hand and fingers.   I asked specifically for this help and the occupational therapist gave me ideas using exercise and a heating pad.  If there is anything you need to be able to do you should check with the therapist and see whether it is within their guidelines.

Different types of assistance, OT, PT, nursing care or hospice could be prescribed for you on leaving the hospital.   It matters what the orders are.

Here are some things you and your family need to know if you are rehabbing at home. 

Homebound.  You might be told you need to be homebound to receive Medicare services at home.  Homebound means that due to your illness or injury, leaving home is either contraindicated or it takes a considerable and taxing effort for you to leave your home.  However, if your absences require assistive devices or special transportation and they are infrequent or of relatively short duration, such as attending church services or participating in a therapeutic or medical treatment then you might still be considered homebound.  If you can work or drive outside the home you are probably not homebound. 

What Services to Expect.  Skilled Nursing.  If your orders include home visits by neighborhood nurses, then you can expect to have your vital signs taken such as blood pressure, heart and so on.  Where appropriate, you may receive instructions on diet and medication and they may check on wound care or give injections.  They do not provide non-medical services.

I learned that home health can help with showers but not fold laundry.  OT can retrain you to do laundry while you are recovering.   Home health assists with personal care. 

Non-medical home care.  Finally, non-medical home care involves feeding, dressing, bathing, assisting with toileting, but could also mean running errands, taking you to the doctors or providing companionship.  Since it is non-medical it is not covered by Medicare but it can be an essential part of your recovery.  It does not require a prescription and you can determine when you want it and how much.

About the Author Janet Colliton

Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.

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