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FAQ

Make an informed decision that suits your situation best.

If you are unfamiliar with home care or hospice services, you probably have a lot of questions.

We can serve you best if you give us a call. We will walk with you through your specific situation, consider all of your options and help you make an informed decision that suits your situation best.

Please call (414) 365-8300 to speak with one of our experts about your home care or hospice needs.


Frequently Asked Questions


Home Care

  1. How do I know if I qualify for Home Care?
  2. Can my Medicare pay for my home care.  How does that work?
  3. What does Medicare cover?
  4. What does Medicare require in order to pay for home care?
  5. I have a supplemental Medicare insurance, Part B. Will that cover more home care?
  6. I have my Medicare coverage through an insurance company.  Do I have the same home care coverage as traditional Medicare?
  7. I have a working spouse and my insurance is from an employer and Medicare.  What do I qualify for?
  8. I have insurance through an employer.  What is my typical coverage?
  9. I have a long term care policy and Medicare, what amount of service can I receive?
  10. What does care in the home cost?
  11. Is Hospice care a solution for Alzheimer’s patients?
  12. How can you tell what type of care your loved one will receive before they sign up?
  13. Will I be able to reach the caregivers frequently?
  14. My parents need care, I cannot do it all anymore, they do not want outside help.  What do I do?

Hospice

  1. What is Hospice?
  2. When does someone start Hospice Care?
  3. Where is Hospice Provided?
  4. Will Hospice provide 24-hour care?
  5. How long does Hospice Care last?
  6. What if I am in hospice care and need help in the middle of the night, weekend, or holiday?
  7. Can my doctor be involved with my hospice care? Will I continue to have office visits?
  8. What is my doctor's role during hospice?
  9. Can I go to the hospital or the emergency room during hospice?
  10. How is Hospice paid for?
  11. Do I have to be coming from a hospital to qualify for hospice care?
  12. Do you have to be a code status of "Do Not Resuscitate," DNR, to be in hospice?

Answers

Home Care

 

 

How do I know if I qualify for Home Care?

Technically anyone can have home care.  Much of the care provided in the home is paid for by the patient; therefore, no qualifying is necessary.  Qualification only comes into play when the patient wants to use insurance towards Home Care.

 

 

Can my Medicare pay for my home care.  How does that work?

Good News! Medicare is the largest payer of home care in the United States, so you can certainly use it to pay for your home care.  In order to make this happen, you must qualify under Medicare’s “Conditions of Participation.”

 

Basically, Medicare determines what qualifies as “care in the home” within the Conditions of Participation. Agencies certified by Medicare, nationwide, must all follow these established Conditions of Participation in order to receive payment.

 

For more information about how you qualify under Medicare, read "Quick Reference Information: Home Health Services" from the DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services.

 

 

What does Medicare cover?

Medicare covers services such as nursing, physical therapy, and speech; if one of the first three is covered Medicare will also pay for occupational therapy, aide, and social work services if needed.

 

 

What does Medicare require in order to pay for home care?

  • The patient must be home-bound.  That means a generally inability to get out without he the assistance of another person and with difficultly.  You can still see their physician.
  • The need for some type of skill.  By skill Medicare means a licensed nurse, physical or speech therapist.  Without the need for a skilled service Medicare pays for no care in the home.
  • The need for care is intermittent.  In other words, Medicare does not pay for round- the-clock care.
  • The need is for care.  Supervision, housekeeping, shopping,  and activities to manage a household are not considered health care by the Medicare program and not covered.

* Click Here for more info on Home Care *

 

 

I have a supplemental Medicare insurance, Part B.  Will that cover more home care?

Unfortunately, it will not.  Medicare Part A pays for 100% of home care services at this time.  Part B is a supplemental insurance used to pick up co-pays, and it does not cover any additional services beyond what was previously stated.

 

 

I have my Medicare coverage through an insurance company. Do I have the same home care coverage as traditional Medicare?

Usually, yes. What differs in most cases is that the insurance company is managing your utilization and requiring frequent prior authorizations for home care. When you have Medicare through an insurance company it is important to read the materials they provide you for explanation

 

 

I have a working spouse and my insurance is from an employer and Medicare. What do I qualify for?

In this case, your spouse’s insurance is primary and applies first.

 

 

I have insurance through an employer.  What is my typical coverage?

Most employer insurances differ on their home care coverage.  A deductible co-pays and annual visit limits are common.   Additionally, many require prior authorization.  In the case of commercial insurance we verify coverage for you.  Your policy will also explain what your coverage is.

 

 

I have a long term care policy and Medicare, what amount of service can I receive?

Individuals with long term care insurance have coverage for care beyond the Medicare benefit.  Most long term care policies will pay a certain amount per day for care in the home in addition to what Medicare covers.  The long-term care policy will cover large blocks of time in the home to prepare meals, do laundry, run errands, plus the personal care and supervision that many individuals require.   In cases like this our agency will bill Medicare for what Medicare will cover and the long term care policy for the remainder.

Long term care policies frequently have a varying number of days that you must wait to qualify based on the policy you purchased.  Most also have daily or annual limits.  Long-term care policies usually require that you need assistance with one or more activities of daily living (ADLs), such as walking, eating, bathing or toileting.   Our verification staff can explore your policy limits with you.

 

 

What does care in the home cost?

Nursing and therapy visits usually cost between 0-200 per visit.  These types of visits are almost always paid for by insurance.  The type of care that individuals usually pay for out-of-pocket is aide or homemaker type care.  This form of home care usually ranges from -30 per hour depending on the type of care desired and the provider.

 

 

Is Hospice care a solution for Alzheimer’s patients?

Hospice care is appropriate for anyone nearing the end-of-life.  While a person with Alzheimer’s disease may not be completely aware of their surroundings or oriented to person and place, the family members are.  Hospice care is for the patient and the family.  Helping the family members is a large part of the hospice role in providing care.

 

 

How can you tell what type of care your loved one will receive before they sign up?

In the process of discussing care with a nurse in our Intake Department, we will begin the discussion with you about what care is desired.  Each patient is unique and so are their needs.  The care plan for each patient differs from other patients.  The plan is designed with you from start to finish.  From where the trash is placed to how the towels are folded, each patient and home is different.  While staff members are taught certain ways to manage care, they are also taught to adapt to the lifestyle and wishes of the patient and their family.

 

 

Will I be able to reach the caregivers frequently?

Absolutely. Horizon professional staff are issued Agency smart phones.  The Agency is able to reach them quite easily.  You are encouraged to contact the Agency either by phone or the Web Site Live Chat to connect with staff.  We know who is working and where they are.  We can message or call staff quickly. We have staff working 24/7 and will reach out to staff upon your call.  The office is open every day and after hours nurses are available and ready to respond.

 

 

My parents need care, I cannot do it all anymore, they do not want outside help.  What do I do?

This is a statement that the staff hears every day in our Intake Department.  Caring for parents and often times their home can be an exhausting job.  No one wants strangers in their home.  Everyone prefers that family members care for them.  Unfortunately, caring for a very complex spouse or parent can compromise the health of an individual if the need is prolonged or the care is around-the-clock. 

As a caregiver you will need to decide what you can do and what you cannot do.  With kindness you will need to tell the patient what you will be able to do and what outside help will need to be secured to assist with.  

 

 

Hospice

 

 

What is Hospice?

Hospice is comfort care for those facing life-limiting illness.  The goal of hospice is to manage symptoms and provide comfort while helping the patient to live each day with quality and dignity.  Care is provided by a team of hospice professionals: Physicians, Nurses, Social Workers, Chaplains, Health Aides and Volunteers.  The hospice team works together to meet physical, social and spiritual needs.      

 


When does someone start Hospice Care?

Hospice supports those with a life-limiting illness who are no longer benefitting from curative treatment. Each person’s situation is unique.  A common myth about hospice is that a person is close to death when hospice starts.  The philosophy of hospice is to live life to the fullest and with dignity.  Starting services earlier allows for more help and care that benefits both the patient and the family. 

 


Where is Hospice Provided?

Hospice care can be provided wherever you call home: Family/patient home, nursing home, assisted living community, hospital or in-patient hospice unit. The hospice team provides an assessment in the home environment and determines what resources are needed.  

 


Will Hospice provide 24-hour care?

Hospice is not intended for 24 hour care.  The benefit is regulated by Medicare/Medicaid and private insurance plans that generally do not pay for 24 hour care.  Hospice, therefore, depends on and works with a primary caregiver – family, friends, private duty aides or care givers provided by a nursing facility.  

 


How long does Hospice Care last?

Hospice may continue as long as both a doctor and your hospice team certify that Medicare guidelines are met. Sometimes patients in hospice improve to a point of no longer qualifying for hospice.  If that happens you are able to pick up the benefit again when health changes occur that meet the qualification requirements. 

 


What if I am in hospice care and need help in the middle of the night, weekend, or holiday?

Horizon Hospice is available via phone 24 hours a day, 7 days a week.  When you call, a nurse will assess your situation, make suggestions or make a visit. Our chaplains and Social Workers are also on call to provide emotional and spiritual support when needed.  Horizon is available 24/7 for phone calls, emergency visits and crisis care.

 


Can my doctor be involved with my hospice care? Will I continue to have office visits?

Yes. Your hospice nurse will work with your doctor to create a plan of care to meet your unique needs.  Often, scheduled visits to the doctor’s office are no longer needed as a hospice nurse visits you in your home and relays information to your doctor.  

 


What is my doctor's role?

Home care and hospice are health care and Horizon is a licensed provider which means that we work within the parameters of licensure.  Physicians are an integral part of your care and your doctor oversees your care in home care or hospice.  Agency staff is in communication with your primary doctor about your care throughout your time with us.

 


Can I go to the hospital or the emergency room during hospice?

You can go to the hospital or ER for conditions unrelated to the hospice diagnosis.  Hospice must be called before an ER or hospital visit.  Your hospice team will work with you and the hospital to determine next steps.  

 


How is Hospice paid for?

Hospice care is paid for by Medicare, Medicaid, the Department of Veterans Affairs, and most private insurance plans, HMOs, and other managed care organizations.  Medicare and Medicaid pay for 100% of hospice care.  Most insurance also cover at 100%.

 


Do I have to be coming from a hospital to qualify for hospice care?

The requirement to have a hospital stay to qualify for care is a nursing home requirement and does not apply to either hospice or home care.

 


Do you have to be a code status of "Do Not Resuscitate," DNR, to be in hospice?

Signing a DNR means that you do not want to be resuscitated with CPR or other means should your breathing or heart stop.  Preparing an advanced medical directive, and/or Power of Attorney, is strongly encouraged by medical professionals as it helps direct family/patient representative on wishes