Family Care Tenders
Certified Nursing Assistant (CNA)
Scholarship Program

CNA checking patient pulse

Medicare & ADL's

Medicare Home Health Care Eligibility

10,000 people turn 65 each day. They also become eligible for Medicare. 42% of Medicare retirees age 65 and over have limitations in activities of daily life. Because Family Care Tenders, LLC will be concentrating on family caregivers of family members currently receiving or are eligible for Medicare benefits with a smaller mix of Medicaid and private insurance, the following information is provided.

To get Medicare home health care benefits, you must meet these four conditions:

 

  • A physician must decide that medical care is needed in your home, and make a plan for your care at home; and

 

  • You must need at least one of the following:  intermittent (not full time) skilled nursing care (RN) or physical therapy or speech language pathology services or continue to need occupational therapy; and

 

  • You must be homebound.  Homebound is defined as being unable to leave your home without considerable effort.  When you leave, it must be infrequent trips for a short period of time such as to receive medical attention or attend religious services; and

 

  • The home health agency caring for you must be approved by the Medicare or Medicaid program.



If you meet all four of the conditions in the previous section for home health care, Medicare, Medicaid or private insurance will cover:

 

  • Home Health Aide (CNA) services on a part-time or intermittent basis. A home health aide does not have a nursing license. The aide provides services that support any services that the nurse provides. These services include help with personal care such a bathing, using the toilet or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.

 

  • Physical therapy, speech language pathology services and occupational therapy for as long as your doctor says you need it.




                                           Activities of Daily Living (ADL's)

 

Activities of Daily Living (ADL's) is a term used in healthcare to refer to daily self-care activities within an individual's place of residence, in outdoor environments, or both. Health professionals routinely refer to the ability or inability to perform ADLs as a measurement of the functional status of a person, particularly in regards to people with disabilities and the elderly.

Basic ADLs consist of self-care tasks, including:

 

  • Personal hygiene and grooming

  • Dressing and undressing­

  • Feeding oneself

  • Functional transfers, e.g. getting out of bed­

  • Voluntarily controlling urinary and fecal discharge

  • Elimination

  • Ambulation (walking or using a wheelchair)­