FAQS

Many health care treatments that were once offered only in a hospital or doctor’s office can now be done in your own home. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility. Home health care helps you get better, regain your independence, and become as self-sufficient as possible.

Who is Eligible?

If you have Medicare, you can use your home health benefits if you meet all the following conditions:

  • You need medical care at home, and
  • You are homebound, and
  • You need skilled care from a nurse and or a skilled physical, speech or occupational therapist.

Medicare will only cover home care services when your doctor:

  • Orders the care from a home health agency that Medicare approves, and
  • Documents a face-to-face visit with you up to 3 months before or 1 month after the start of the service,
    and
  • Signs a plan for your care.

What does homebound mean?

Being homebound means it is very difficult for you to leave home because of your condition. For example, Medicare may consider you homebound if you need a wheelchair or someone else’s help to leave home. Or if leaving home means you may be in danger or at increased risk. For example, a person with dementia may be in danger when leaving home because of memory loss or other cognitive impairment.
But, you can still meet the homebound definition even if you sometimes leave your home. You can leave for medical treatment you cannot get at home. You also can leave for non-medical reasons, if the trip is occasional and only for a short time. For example, you can go to religious services or to get a haircut. You also can be called homebound if you go to a medical adult day care program. This is because the medical day care programs are considered medical treatment. You cannot be called homebound if you go to a regular adult day care.


What does skilled care mean?

For you to get home health care, your doctor must say that you need either skilled rehabilitation therapy or skilled
nursing care. This means you must need professionals with special training and knowledge to care for you safely and
well. These may include registered nurses, licensed practical nurses, physical, occupational and/or speech therapists.


What services does Medicare cover for home health care?

If you’re eligible for Medicare-covered home health care, Medicare covers the following services if they’re
reasonable and necessary for the treatment of your illness or injury:

  • Skilled nursing care
  • Physical, Occupational and Speech therapy services
  • Medical Social services
  • Home Health Aide services

What will it cost?

If you qualify for Medicare home health care coverage, you generally pay nothing. Medicare usually does not charge
deductibles or coinsurance for these services. And when you request services from us, you will be informed of the
following:

  • If you must pay any part of your bill, and
  • If Medicare will not cover any of the services

 

How often and how long can I get these services?

You can keep getting home health care services as long as your doctor says you need them. But your doctor must
renew the order at least once every 60 days. Many Alzheimer’s patients need certain ongoing rehabilitation
therapies that Medicare’s home health care benefit covers.

What isn’t covered?

Below are some examples of what Medicare doesn’t pay for:

  • 24-hour-a-day care at home.
  • Meals delivered to your home.
  • Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when
    these services aren’t related to your plan of care.
  • Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the
    only care you need.

How do I start getting home health care?

Your doctor has to write an order for home health care services. After we receive the order, we will set a schedule
with you to visit you at your home and talk to you about your needs and health.
Our staff will work with you and your doctor to write your plan of care. This plan will include:

  • The types of care you need,
  • Which health care professionals should give this care,
  • How often you need care,
  • What medical equipment you need, and
  • The results your doctor expects from your treatment.

Why should I choose Sigma Senior Care, LLC?

There are a number of reasons for choosing Sigma Senior Care and it is important that you are aware of
them.

  • Sigma Senior Care is Medicare and Medicaid Certified. This means that we follow very strict Federal
    guidelines in our operations and when delivering care to you.
  • All of our health care providers have been carefully selected and a thorough background check
    conducted.
  • Sigma Senior Care supervises its employees to provide you with competent, compassionate care.
  • We are licensed, bonded and insured.
  • Sigma Senior Care is an active participant of the Home Health Quality Improvement (HHQI) National
    Campaign. This campaign is a grassroots movement designed to unite home health stakeholders and
    multiple healthcare settings under the shared vision of reducing avoidable hospitalizations and improving
    medication management.
  • And lastly, because we are The Care Professionals.

What are Personal Care and Personal Assistance Services?

Personal care services are non-medical services that are offered in your home. These services include
help with Activities of Daily Living (ADLs), such as:

  • bathing
  • dressing
  • eating
  • getting out of bed
  • walking
  • using the bathroom

They may also include help with Instrumental Activities of Daily Living (IADLs), such as:

  • light housekeeping (dusting, vacuuming, bed making)
  • grocery shopping
  • meal preparation
  • laundry

What costs are associated with Personal Care or Personal Assistance?

Sigma Senior Care charges both per hour and per visit rate depending on the services requested in
your home. With hourly rates, there is a 4 hour minimum that will be billed.
If you meet the eligibility criteria for Medicaid, you may also be eligible for personal care services paid for
by Medicaid. Sigma Senior Care also offers Private Pay for Skilled Services (Nurses, Therapists,
Certified Nursing Aides and Social Workers) which is billed depending on the services requested.
If you have long-term care insurance, your policy may pay for personal care services. Check your policy to
see what it covers.

 

How do I qualify?

To qualify for personal care or personal assistance services under Medicaid, you must first be eligible for
Medicaid, or you must be using a Medicaid Waiver. You must also meet criteria for placement in a nursing
facility or an Intermediate Care Facility for Individuals with Mental Retardation and Related Conditions. You
will be seen by a Pre-Admission Screening Team. Your local health department and department of social
services offer the screening. The screening can be requested by you, a family member, or a health care
professional. Anyone who is concerned about you can ask for a screening.
If you are 60 years of age or older, contact your local Area Agency on Aging. If you have a disability,
contact your local Community Service Board or Center for Independent Living. These agencies may be
able to provide assistance with personal care or assistance services.

 

Where do I apply?

To receive personal care or personal assistance services from Medicaid contact your local department of
social services. If you do not have Medicaid, you can also contact your local department of social services
to get help. If you are currently using a waiver, contact your support coordinator, case manager, or
services facilitator.

 

Where can I find out more?

To find more information about the Personal Care Services under the Virginia Medicaid Waiver Program,
you can go to:

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