Wanted:
50 family caregivers

Home health care includes a range of medical and therapeutic services delivered in a patient’s home. Its goal is to promote, maintain, or restore health; slow a patient’s decline; or to help manage the effects of illness, injury, or disability.

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Home health services are typically provided to patients whose health conditions make it difficult, impossible, or unsafe to leave their homes. They’re designed to ensure patients receive necessary care in a comfortable, familiar environment, out of hospitals or skilled nursing facilities.

Patients who qualify for home health services can receive medical care in the comfort of their home. The frequency of the home health visits depends on the patient’s care needs, but could be one or more times per week. The medical care provided doesn’t replace all of the care that family members may provide. But it provides the welcomed support  and knowledge of skilled medical professionals.

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Covered home health services can include:

• Skilled nursing care (such as wound care, medication administration, and health monitoring)
• Physical, occupational, and speech therapy
• Medical social services
• Patient and caregiver education and counseling
• Assistance with daily activities (bathing, dressing, grooming) by home health aides when combined with skilled care
• Intravenous or nutrition therapy, injections, and other medical treatments

Medicare covers home health services for beneficiaries who are homebound, at risk for future hospitalizations, and need assistance with activities of daily living (bathing, toileting, continence, dressing, eating, transferring).

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Medicare considers a person homebound if both of these statements are true:

• They rarely leave home and when they do, it's just for short appointments or special events.
• Leaving home is difficult due to shortness of breath, pain, limited stamina, or other reasons.

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And one of these statements is true:

• They require an assistive device (e.g., wheelchair, walker, crutches, cane), special transportation, or personal assistance to leave home due to illness/injury.
• Their doctor has recommended that they not leave home because of their condition.

Here’s how RubyWell’s free service works:

1. After you submit the qualification form, you'll be asked to schedule a call with RubyWell so we can better understand the patient's care needs and explain the process to you.
2. If the patient appears to be eligible, we'll provide directions to securely share their Medicare ID number, so we can confirm that they're covered by Original Medicare or a participating Medicare Advantage plan. This way we can help you avoid costly co-pays for unnecessary doctor visits if we learn that they're actually covered by a plan that we can't work with.
3. If they're covered by a plan we work with, we'll provide them with a Home Health Discussion Guide that will help them communicate their care needs clearly with their doctor. They will need to have this discussion in a face-to-face encounter with their doctor (in-person or via telehealth) in order for the doctor to assess if they should provide a home health referral order. The referral order tells Medicare and the home health agency that the doctor believes that certain home health services would be suitable for the patient.
4. Once the patient has a referral order, we'll connect them to our Medicare-certified partner home health agency. The agency may review the referral order, schedule the Medicare-required home visit, and prepare a personalized care plan.
5. The agency will then match the patient with a supervising skilled nurse, and any other therapists that may be indicated on the referral order. Care will start when the care team is staffed and visits are scheduled.
6. You’ll be matched with a Care Navigator at our partner home health agency. They’ll support you as you provide the required between-visit care your loved one needs. This support will start off as brief daily check-ins, and move to less frequent check-ins as you gain experience and comfort with your role.
7. Throughout the study, you’ll be given access to caregiver training videos, personalized for your loved one’s health conditions and care needs. One of the videos will teach you how you will be engaging with RubyWell and our partner home health agency to provide between-visit care.