Rehabbing at Home Under Medicare


If you just finished your long awaited surgery and decide to go home but need additional help, Medicare may have help for you. Even if you are not on Medicare your private health insurance might also have provisions for at-home assistance. Here are some descriptions of the types of help available and what they can or will not offer.

First know the types of assistance available and whether they apply to you.

The terms in the field are OT (Occupational Therapy), PT (Physical Therapy), and Home Health Care (Skilled Nursing). There is also Non-Medical Home Care which is another category entirely and is not covered by Medicare but, even so, this type of assistance may be very helpful both while you are recovering and beyond.

Medicare can be very specific about what it covers. You might want to check what your orders are before leaving the hospital.

Occupational therapy is a confusing term. The name implies it is intended to provide recovery so you can return to work. That is not necessarily the case. In fact, recipients of OT may be and often are retired or homemakers or disabled and not intending to relearn employment skills. Occupational therapy has to do with being able to perform basic tasks such as dressing and showering. It is task related. If you are working with an occupational therapist you might try to do things in a different way that would otherwise be uncomfortable without assistance. Physical therapy, on the other hand, concerns regaining strength and capacity. You could be lifting weights or stretching.

Some services can overlap. For instance here are examples from occupational therapy and home health. While 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 might be helpful to say what you want to be able to do and find out who can help you with a given task. Think about what is it you would like to do but are unable to perform because of your temporary disability and then discuss this with your occupational therapist.

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.

Visits by Nurses. 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. Your nurse might check on wound care or give injections. Nurses who visit the home do not provide non-medical services.

Non-medical home care. Non-medical home care is for the longer term and is not covered by Medicare. It 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 and you pay privately 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.

What you are looking for, really, is a plan of care to get you back to where you were or nearly so. The various professionals involved can assist you to achieve that goal. When discussing Medicare, the time is limited. Medicare rehab at home, like rehab in a nursing facility or step down unit, does not exceed 100 days and usually is much less but, in the right case can send you on the road to recovery.

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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