Intermittent Home Health Care
What's the Difference Between Private Duty and Intermittent Care?
Home health care in the U.S. consists of two very different components. One is intermittent care. The other is private duty care.
Both of these components can include nursing, personal care and therapies such as speech/language (ST), physical (PT) or occupational therapy (OT). The primary difference is usually in the pay source. Intermittent care must be skilled care and is covered by Medicare, Medicaid and private insurance. Private duty care is usually an out-of-pocket expense.
Intermittent home care is skilled care ordered by a physician following, or in lieu of, hospitalization for an episode of illness or injury.
The initial skilled care must be provided by an RN, a PT or an ST. If the health care worker determines additional needs, additional disciplines may be requested such as OT, home health aide, a medical social worker (MSW/LCSW) and a dietitian (RD). The physician must provide orders for the additional care.
Not all pay sources will cover all of these disciplines, or they may limit the number of visits. There may be a co-pay for the patient which may influence decisions about what care is most necessary.
Home Care Visits
Intermittent home health care is provided by each discipline in what is termed a visit. The visit can be as short as thirty minutes or may last as long as two hours depending on the need. The average is about 30-45 minutes. This is not long term in home care.
Skilled Care
Intermittent home health care must provide skilled care, but the pay source expects that the patient, family or other caregiver is to be taught to provide this care if it is needed for a long term basis. The skilled discipline would then make a few supervisory visits to assess the success and discuss changes to the plan with the physician as necessary.
In other words, it is the nurse’s job to teach the patient, family or other caregiver how to do the procedures such as wound care, the insulin injections or how to change the IV cassettes in between visits. The PT, OT or ST would teach the patient and caregivers how to perform the exercises needed to regain function or improve strength or skills.
As long as a nurse or therapist is providing continued skilled care visits, the patient may be eligible for home health aide visits. Again, the HHA is expected to teach the patient or caregivers how to assist the patient with personal care such as bathing, dressing, feeding.
An MSW can make one or two visits to assist with short and long term planning for the care of the patient. The MSW can also assist with counseling issues for emotional problems and coping skills if needed.
The Goal of Home Health Care
The goal is for the patient and family or caregivers to learn and assume the care for the patient. The nurse or therapist is not there to provide the care long term. Exceptions may include patients with Foley catheters and feeding tubes which are changed periodically (i.e. once a month) by the nurse.
If patients or caregivers wish to do so, arrangements can usually be made to switch the care to a private pay system whereby the nurse or therapist does continue to provide the care and the patient or family assumes the financial responsibility for the visits.
Other Restrictions Apply
In most cases, patients must be homebound which basically means they are (temporariliy) unable to leave their home without assistance of another person.
The care must be ordered and overseen by a local physician. If Medicare is the pay source, the home health agency must be a Medicare certified agency as well.
Intermittent home health care is designed to provide a short term solution and assist patients to assume responsibility for their own care and achieve optimum outcomes for an episode of illness or injury. It is not a system to provide for custodial care. Most times patients wil be discharged from care long before their outcomes are fully realized.
