Sometimes proper recovery begins from the inside, and this happens when the body feels secure and safe in the comforts of a more familiar setting. The monotonous routine and bleak ambiance of a hospital can adversely affect a patient’s mental health and willpower.
Home health care services provided by licensed skilled nurses can serve as an excellent alternative to spending a cold, non-stimulating day and even months at a hospital or medical facility.
These services allow the patient to experience quality medical assistance by well-trained certified nurses while enjoying the liberty of being in the comforts of their own home. This means that the patients can enjoy the warm embrace of their beds and blankets and live around the people they love and trust while still getting skillfully treated for their sickness or injury.
When one has decided to take their treatment outside the boundaries of a hospital, they usually have two main options. They could either go for a skilled nursing facility or bring skilled nursing into their homes for home health care.
Let’s discuss what it means to receive skilled nursing care at home and Medicare’s role!
What is Skilled Nursing and Home Health?
Skilled nursing by definition means that a patient’s care and treatment can only be taken care of by a licensed nurse. To attain this license in California, nurses need to meet requirements and complete specific academic programs to qualify as skilled nurses.
As mentioned earlier, skilled nursing is usually available at either a skilled nursing facility or at someone’s private residence (home health care).
A skilled nursing facility is a registered rehabilitation and medical treatment center for patients who wish to continue their treatment outside the hospital. They are designed to treat a patient who does not need to stay at a hospital but cannot recover at home by themselves.
These medical facilities and centers offer qualified treatment and services from licensed nurses, psychotherapists, physiotherapists, and speech therapists. They provide transitional care to help a patient eventually recover and return home. You can receive ongoing 24/7 treatment with less intensive physical, speech, and occupational therapy. These facilities are usually not divided into departments like in a hospital. Instead, they have a warmer, less stern, and more interactive environment.
Skilled nursing facilities are different from nursing homes. Nursing homes have patients who need a higher level of assistance and non-medical care to carry out their everyday tasks. They are usually dominated by elderly people who need help with all their tasks and typically plan to stay longer.
In comparison, skilled nursing facilities usually have people of all age groups recovering to eventually head home. Besides this, nursing homes do not always have a doctor available.
Home Health services or home health care are a wide range of medical services and treatments provided to patients at their homes. Home Health treatment usually proves to be less costly and just as effective as the one provided at a hospital or a skilled nursing facility.
Patients receiving home health care can get the same hospital-like treatments such as injections or intravenous drips, being monitored on machines, getting their wounds and injuries treated, etc.
Many non-medical services, such as getting assistance with dressing, walking, eating, bathing, etc., also come under home health services. These services do not require a licensed nurse. They can be provided by any person certified in offering assistance in the relevant areas.
How Does Skilled Nursing Care Help in Home Health?
Integrating skilled nursing into home health care means bringing highly qualified nursing services into the patient’s personal residence. The patient can receive injections and medication, get monitored and have their bandages changed, or receive other hospital-like treatments while staying at their home.
Research shows that when skilled nursing can be made available at home, it benefits the patient numerous ways. For instance, while hospitals may offer cure and relief, they also come with a monotonous environment, impersonal conversations, and mind-numbing machine beeping sounds.
Homes offer security and familiarity but cannot aid a person’s recovery and wellness on their own. Skilled nursing into home healthcare can serve as a viable solution here.
Some of the well-researched and proven benefits of skilled nursing care when provided at home include:
- Recovering around the uninterrupted support and love of the family. Familial companionship boosts the patient’s willpower and prevents emotional distress from loneliness and lack of meaningful conversations.
- Recovering with homely independence, freedom, and comfort. Incorporating skilled nursing into home health allows the patient to feel heard, seen, and free. This also dramatically impacts the patient’s mental well-being and can aid in their recovery.
- Having a well-trained and up-to-date medical staff, just like a patient would essentially need at a hospital. Skilled nurses must undergo proper training and academic programs to attain a license that periodically requires upgrading and renewal. This means that these experienced nurses are up-to-date with new research and evolving medical treatments and help patients make a faster recovery.
- Having a full-time committed team. Busy family members may find it challenging to provide constant care. In this case, skilled nurses can fill the gap and indeed be there for the patient at all times. This is particularly important for handling medical emergencies.
- Receiving assistance with the correct diet and nutrition as per the patient’s needs.
- Receiving assistance with managing the time, amount, and dosage of medication.
- Developing a more personal relationship between the healthcare giver and the receiver. Research shows that patients benefit greatly from personalized relationships between them and their caregivers. Having skilled nurses around the patient at home means that the two have greater chances of forming a more personalized relationship. This helps them better understand one another and makes the process of treatment and recovery more positive and bearable.
- It is a far more cost-effective treatment. A study showed that the cost of receiving skilled health care at home is nearly 40% less than receiving the same care at a medical facility. Moreover, the National Association of Home Care research in the US showed that the average cost of treatment at a medical center or skilled nursing facility is almost four times the average cost associated with having experienced nurses provide therapy at home.
- It is covered by Medicare if a specific set of criteria and conditions are met.
What Qualifies as a Skilled Nursing Need?
When a patient’s medical condition is such that assistance can only be provided by a professionally certified health practitioner, then they must opt for skilled nursing.
Besides this, to qualify for skilled nursing, the patient must need services that can only be legally provided by an experienced, certified, licensed nurse. Here are some examples of such services to give you a better idea of whether you or a loved one needs skilled nursing:
- The injection of intramuscular or intravenous (IV) medication that needs to be injected or administered after every 8 hours or more.
- Intravenous (TPN)
- Treatment of a wound that requires multiple dressing changes within a day.
- Deep tracheal suctioning.
- Care for insertion and removal of urinary catheters.
As a result of their treatment, a patient is to remain bedridden for several weeks (1-8 weeks) and qualifies for a skilled nursing need.
Besides this, a patient is eligible for receiving skilled nursing when the services they require are to be provided at an intensity or frequency that cannot be provided by simple visits made by a caregiver. Instead, they need full-time attention from skilled nurses.
Moreover, suppose a patient is at risk of experiencing mental or physical illness episodes. This risk can be prevented by having a skilled nurse around. In that case, they can qualify and are encouraged to seek help from a qualified nurse at home.
Finally, if a patient’s condition is considered medically unstable, that condition requires frequent and timely managerial decisions to be made. They qualify for skilled nursing care.
Does Medicare Pay for Skilled Nursing Care at Home?
Medicare does cover the cost of skilled nursing at home if a patient can adequately qualify for such a need and manages to meet some set conditions.
Once a patient is qualified for receiving Medicare, they can apply for it either online or through the help of their doctor/physician.
Medicare covers home health nursing services if:
- The skilled nursing care is intermittent or part-time. This means the service is required for less than 7 days per week, or less than 8 hours per day, for 21 days or less. After a detailed review, particular circumstances might allow some exceptions to be made.
- The services include physical, speech, or occupational therapy.
- The service includes injectable osteoporosis drugs (for women).
- A doctor can certify that a patient is to remain homebound.
Medicare does not cover:
- 24/7 skilled nursing care needed at home
- A patient’s special meals delivered at home
- If the only essential services are personal nursing care services such as dressing, bathing, or toilet use.
In California, Medi-Cal covers home health care and services as part of its Medicaid Plan under certain conditions. The medical services that can qualify as necessary and pertinent and require skilled nurses at home and the medical equipment that comes with it are all covered by Medi-Cal.
What Happens When You Run Out of Medicare Days?
Suppose a person’s need for skilled nursing at home exceeds 7 days per week, for less than 8 hours per day for 21 days. In that case, they are no longer eligible to receive Medicare’s home health benefit.
If one needs additional Medicare home health benefits, Medicare offers 35 hours per week home health benefits. However, it will carefully review a patient’s case before approving such a request.
A patient can continue to receive Medicare home health benefits as long as the patient rightfully qualifies for them. For this, the patient needs to recertify their care plan provided by the doctor every 60 days. The doctor is allowed to make reasonable changes in the hours and procedure of the service after reviewing that the service needed is still necessary.
It is highly advantageous to bring the expertise and other benefits of skilled nursing into a recovering patient’s home, where they feel most liberated and safe. It ensures that the recovery process does not cause any further harm to a patient’s mental and emotional stability.
This means that when a person’s whole body and mind should solely be focused on getting better, loneliness and distress do not hinder the recovery process.
They can also better understand the procedures and trust the caregivers, thanks to a more personalized relationship that can develop between them.
The patient can also benefit from advanced medical treatments and equipment that can only be provided by a licensed health practitioner while being tucked in a familiar and warm bed.
The fact that these services are also covered by Medicare can prove to be a source of relief, as well. The patient’s family can support and continue treatment and recovery without getting troubled by massive financial burdens.
To sum it up, integrating skilled nurses into home healthcare has proven to maintain the patient’s quality of life and give it a chance at improving. Suppose you want to avail the various benefits associated with skilled nursing as a part of home health services. In that case, the AtHome Health Care Team is here to help. Get in touch with us today to learn more.