How does Medicare define "confine to home"?

Jah asked...

Will Medicare Part B provide financial assistance for an elderly person? Medicare uses the term "confine to home" as one of many requirements of eligibility to receive home-care. What is the Medicare definition of "confine to home"? Are there specific qualifications/certifications a person must have to perform home-care and meet Medicare standards?

Thank you,


Expert Answer

A patient being "confined to home" is one of several requirements Medicare Part B sets for coverage of in-home care. For purposes of Medicare Part B coverage, confined to home means that the patient can't leave home without difficulty, and to do so needs the assistance of another person or of a medical device such as a wheelchair. However, confined to home does not mean the patient must be bedridden.

In addition to the requirement that the patient be confined to home, Medicare Part B rules require that the patient must need part-time skilled nursing care or rehabilitative physical or speech therapy to help recover from an illness or injury. This care must be prescribed by a doctor. Medicare won't cover in-home care needed because of a chronic or long-term condition, or because of general frailty. If Medicare Part B approves home care coverage, it continues only while the patient is recovering. Once the patient's condition has stabilized, home care coverage will end, regardless of the level of care the patient still needs.

As for the qualifications to be a provider of home care, Medicare Part B only covers home care provided by a Medicare-certified home health care agency.This means that registry nurses, private therapists, independent caregivers, and family members cannot be paid by Medicare to provide home care services, regardless of their individual qualifications.