What is private duty care and how is it different from Medicare certified home health care?
This question was asked by the daughter of a 91-year-old homebound patient, Lilly, who had just been discharged from Medicare certified home healthcare. Prior to receiving home healthcare, Lilly had been in the hospital with pneumonia and congestive heart failure. Even though skilled nursing services were no longer prescribed, Lilly still needed regular help since she was no longer able to perform normal activities of daily living without assistance. Because Medicare certified home healthcare covers a single illness or injury and is not continuous, Medicare would no longer pay for Lilly’s in-home care services. Lilly’s daughter, who worked full-time and was also Lilly’s caregiver, was not able to be there as often as was needed for regular care, and she did not have the skills needed to assist with some of her mother’s needs. So, she looked into private duty homecare.

Private duty in-home care (PD) is care that is provided in the patient’s residence that is paid for by either the patient’s long-term care private insurance plan or paid directly by the patient or their family. In some cases, Medicaid will also pay for some services when the patient qualifies. PD can provide care a few hours a week, a few hours a day, or 24-hour care, depending on what is needed. To make it simpler to understand, below is a breakdown of the differences between skilled nursing with Medicare and Private Duty Homecare.

*Not all-inclusive

Covered 100% by Medicare for patients who qualify Not covered by Medicare.
Can be used in conjunction with long-term care insurance, other private insurances, and private pay
Services last over a 60-day period and are prescribed by a physician. Services last as long as they are needed and are determined by patient’s individual needs
Visits are often 2 -3 times a week. Visits range from once a week for an hour, up to 24/7 care provided by an RN.
Visits include nurses, physical therapists and other professionals such as:
⦁ Skilled Nursing
⦁ Physical Therapy
⦁ Occupational Therapy
⦁ Speech Therapy
⦁ Medical Social Worker
⦁ Home Health Aides
⦁ Certified Dietitian
Visits can include both skilled and non-skilled services such as:
⦁ Self-Care – bathing, dressing, etc.
⦁ Companionship
⦁ Help with Appointment Setting
⦁ Housekeeping
⦁ Dietician Assistance
⦁ Medication Management
⦁ Fall Prevention
⦁ Memory Loss Supervision
⦁ Skilled Nursing
Categorized as IHC