Home Health in Assisted Living: Does Medicare Cover It?

Quick answer: Yes. Medicare home health in assisted living is covered when a resident is homebound, needs intermittent skilled nursing or therapy, and a doctor or allowed practitioner orders care under a plan of care after a face-to-face visit. Medicare treats an assisted living apartment or board and care room as the resident’s home. Home health does not replace the facility’s personal care, and it cannot be used in a skilled nursing facility.

Many families assume that once a parent moves into assisted living, Medicare home health is no longer available. In fact, home health in assisted living is common. Nurses and therapists visit residents in their apartments or rooms to provide skilled care after a hospital stay, a fall, a new diagnosis, or a decline. This guide explains who qualifies, what home health covers, how it differs from caregiving, how to arrange it, and how it fits with assisted living and board and care.

What is Medicare home health?

Medicare home health provides skilled, short-term care at home, delivered by a Medicare-certified home health agency. Services can include:

• Skilled nursing, such as wound care, injections, medication teaching, and monitoring
• Physical therapy
• Occupational therapy
• Speech-language therapy
• Medical social services
• Home health aide visits, when the patient also receives skilled care

Our guide to home health care in San Diego explains these services in more detail.

Can Medicare home health visit assisted living or board and care?

Yes. Medicare considers a resident’s assisted living apartment or board and care room to be their home. Medicare-certified home health agencies can provide covered services there. The one major exception is a skilled nursing facility, where home health is not covered because skilled care is already provided. See assisted living in San Diego and board and care homes in San Diego.

Who qualifies for Medicare home health?

• Homebound: leaving home requires considerable and taxing effort, often with help or a device, and absences are infrequent or short, such as medical appointments, religious services or adult day care.
• Skilled need: the resident needs intermittent skilled nursing or therapy.
• Doctor’s order: a doctor or allowed practitioner orders care and oversees a plan of care.
• Face-to-face encounter: a qualifying visit related to the reason for home health, within the required timeframe.
• Medicare-certified agency: care is provided by an approved agency.

Many assisted living residents meet the homebound standard, especially after a hospitalization.

What does Medicare home health cost?

For eligible beneficiaries under Original Medicare, covered home health services usually cost nothing. Durable medical equipment may have 20% coinsurance after the Part B deductible. Medicare Advantage plans cover home health but may require prior authorization and in-network agencies.

How is home health different from home care?

• Home health is skilled, medical, short-term care ordered by a doctor and often covered by Medicare.
• Home care is non-medical help with daily activities, such as bathing, dressing and companionship, usually paid privately. See in-home care in San Diego.

In assisted living and board and care, the facility provides personal care. Home health adds skilled services the facility cannot provide.

When is home health in assisted living most helpful?

• After a hospital or rehab discharge
• After a fall, to rebuild strength and balance. See physical therapy in assisted living.
• For wound care or new medications needing teaching
• For a decline in mobility or swallowing
• To manage heart failure, COPD, or diabetes

Home health can also help prevent hospital readmissions by catching problems early.

How do you arrange home health in assisted living?

1. Ask your parent’s doctor or the hospital discharge planner for a home health referral.
2. Choose a Medicare-certified agency that serves the facility’s area and, for Medicare Advantage, is in network.
3. Tell the care home, so staff can coordinate visits.
4. Expect an initial assessment visit and a plan of care.
5. Ask the agency and care home how they will communicate.

How does home health relate to hospice?

Home health focuses on recovery and improvement. Hospice focuses on comfort for people with a terminal illness. Both can be provided in assisted living and board and care, but generally not at the same time for the same condition. See hospice care in San Diego and our palliative care definition.

Frequently asked questions

Can Medicare home health come to assisted living? Yes. Medicare treats an assisted living apartment as the resident’s home.

Can home health visit a board and care home? Yes, if the resident meets Medicare home health eligibility.

Who qualifies for home health in assisted living? Residents who are homebound, need intermittent skilled care, and have a doctor’s order and plan of care.

Does Medicare pay for home health in assisted living? Yes, for eligible residents. Original Medicare usually covers it at no cost.

Is home health the same as home care? No. Home health is skilled and medical; home care is non-medical help with daily activities.

Can home health be provided in a nursing home? Not in a skilled nursing facility, where skilled care is already provided.

Conclusion: home health in assisted living

Home health in assisted living is covered by Medicare for eligible residents who are homebound, need intermittent skilled care, and have a doctor’s order. It adds nursing and therapy to the personal care the facility provides, and is especially helpful after a hospital stay or fall. Ask the doctor for a referral and coordinate with the care home. A free senior care assessment can help you find a home that works well with home health partners.