Who pays for the Aide????

[JennyHHRN]

I've been in home care for over 6 years and I swear, just when I think I have it all sorted out, I start to second guess myself. Then I ask my boss what her take on the matter is and I end up even more confused. Case in point:

Whenever we admit a patient for skilled HH services under Medicare we notify their Medicaid Waiver case manager or Care Management (other funding source for private care to the elderly in MI) to place their Aide services on hold. ONLY THE BATH SERVICES! We did this because I was told it is the patient's right to receive personal care under HH benefit.

Now if the patient has private care in place for chore services and a bath, it gets really sticky. Only the hour they would get for a bath gets placed on hold and the chore services continue on as normal. When the patient gets D/C'd from HH skilled care, then all aide services go back to being paid for by the other programs.

The curve ball came when I remembered being told as an adm nurse to assess if the patient had any paid or non-paid caregivers in the home to assist them with personal care/ADL's. If yes, a paid caregiver or family member has been willingly assisting patient for some time, then an order for a bath aide was not needed.

So we get a patient on service for foley cath mgmt. Patient has a privately paid (live-in) 24hr caregiver in the home. Do we now send in bath aides 7 days per week because the patients family wants her bathed daily?

See, I'm confused all ready just trying to pose the questions!!! Does anybody have a clear cut operating procedure at your agency?

[homehealth43130]

Home health aide services are bundled under the Medicare home health benefit. So the general rule is that if Medicare is primary and another funding source is secondary ie Medicaid Waiver, the aide services that would normally be provided under the Medicare benefit need to be provided by the Medicare agency. So we treat thoes cases the same as you have described.

If a patient is privately paying for aide services - no other public funding- then we treat it just like they were receiving services from their family. They have the right to decline aide services. We document that the aide services were offered and that the patient has declined.

Under they Medicaid waiver, they don't have the option of declining because of the public funding - Medicaid is always the payer of last resort. We notify their Waiver case manager and make the arragements through her with the Waiver agency.

Hope this helps.

[renerian, BSN, RN]

Sticky it is,

I have seen patient's want the care and agencies both provide a m-f hha and I have seen other's deny providing it, the person appealed and won so the agency get socked. It is sticky.

ren

[JennyHHRN]

Thanks to both of you.

Hey Ren, when I first read your message I thought your M-F stood for a profanity, then I realized you meant MONDAY thru FRIDAY...It was funnier the first read thru.... .

-jen

[renerian, BSN, RN]

Jen,

Wow your welcome............I went back re-read my post and yes it does sound like I am cursing out the aide LOL.

renerian:imbar