Everyone needs a little extra help sometimes. That’s especially true if you’re dealing with a serious medical condition or recovering from a procedure. For example, maybe you’re finding it hard to manage your medications or personal care. Maybe standing for long periods of time to cook a healthy meal is too much for you. Or taking care of necessities around the house is simply too tiring right now.

If that sounds familiar, an extra set of hands might be just what you need. That’s where a home health aide can help. A home health aide is someone who can help you with non-skilled care in the comfort of your own home. In other words, they can help you with day-to-day living activities. But not with the services a health care worker like a nurse or physical therapist offers.

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Who’s eligible for a home health aide

You may be able to get a temporary home health aide if you meet all the following qualifications:*

• You were recently discharged from the hospital and need care for that specific condition at home.
   
• You are unable to leave your home without a major effort. To do so, you need help from another person or a device like a wheelchair or a walker. 
   
• You also require skilled care like nursing, or physical, occupational or speech therapy.
   
• You require care for less than eight hours a day and fewer than seven days each week. If you need more than that, you may need a temporary nursing home or other long-term care facility care.

Home health aides through Medicare are available for only up to 21 days. If you need longer-term care, then you may be eligible for a home health aide through your state via a Medicaid waiver, says Nicole Wolf, RN, manager of Clinical Health Services at Aetna®. Your hospital, doctor or insurance case manager can help you find out if you qualify.

What to expect during your in-home visits

Once your doctor or your hospital refers you for home health services, the agency will visit you at home for an evaluation. This usually occurs within 48 hours, says Wolf. The agency will then work with you and your doctor to create a plan of care.

The plan lists any services you need, such as “skilled” nursing, physical, occupational or speech therapy, as well as a home health aide. Skilled care is the type a non-medical person can’t do, such as giving drugs intravenously (through the veins), some injections or tube feedings, or teaching a patient about different prescription medications.*

In general, you can expect Medicare to pay for 20 hours of home health care a week, says Miriam Zucker, LMSW, an elder care consultant in New Rochelle, NY. (Skilled care is not counted as part of those 20 hours.) Zucker explains that a home health aide can do the following:*

• Assist you with all your activities of daily living. They can help you take a bath, dress, eat, go to the bathroom, move from one room to another and prepare meals.
   
• Check vital signs like your blood pressure, heart rate and oxygen levels.
   
• Monitor how much you eat, drink and go to the bathroom.
   
• Remind you to take your medicine.
   
• Check your home to make sure it’s safe.
   
• Do light housekeeping, such as laundry, washing dishes and vacuuming. 
   
• Provide some basic health-related services, depending on your state, such as checking your pulse, temperature and breathing rate, caring for skin and helping with braces and artificial limbs.
   
• Run errands for groceries and to pick up medications or mail.

It’s also important to know your home health aide will be supervised by medical practitioners — typically nurses — who manage and watch over your care. And because home health aides aren't skilled nurses or therapists, there are some things they can’t do. Zucker says they can’t:

• Give you medications
   
• Drive you places
   
• Perform skilled nursing care or occupational or physical therapy

What to look for in a home health aide

You’re allowed to be picky when it comes to your home health aide. After all, you’ll spend a lot of time with them. And they will attend to your most intimate needs. When you first meet your aide, look for the following characteristics:* 

• They are polite and treat you and your family with respect.
   
• They explain your plan of care to you and keep you informed of changes.
   
• They check your physical condition at each visit and keep tabs on how you feel emotionally.
   
• They do a once-over of your home to make sure you’re safe.
   
• The agency itself explains to you what to do if you have a problem with the care you get from your aide. 

What you should know about your rights

If you qualify for a home health aide, you have some control over the process, says Wolf. You are able to:

Pick the home health agency you work with

You can choose an agency from a list of Medicare-certified agencies in your area. All the agencies on the list are certified to ensure they meet certain federal health and safety requirements. 
 
You can also look up an agency on the Original Medicare website to find its quality rating. The rating shows how that home health agency compares to others on different performance measures. For example, how fast they begin a patient’s care, or how often a patient gets better at doing their own daily activities.
 
Your choice should be honored by the doctor or hospital that referred you. Keep in mind that the agency you want may not always be available.*

Switch agencies 

If you’re not happy with the home health care agency you have, you can switch at any time. But keep in mind that Medicare will pay for you to get care from only one home health agency at a time, says Zucker. Let your doctor know you want to make a change so that you can get a referral to a new agency. You should also tell both the agency you’re leaving and the new agency that you’ve made a change.*

If you don’t like your home health aide, you can also request a new one. “Most agencies are very responsive. They are monitored through regular surveys by the respective state,” explains Zucker.

File a complaint

If you’re not happy with the care you have gotten and you feel like the home health agency doesn’t listen to you, you can call one of the following:*

• Your state home health hotline: Your home health agency should have given you this number when you began home health services.
   
• The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your state: To get the phone number for your BFCC-QIO, visit Medicare.gov/about-us/contact-medicare. You can also call 1-800-MEDICARE or ask your care team.

*FOR MEETING QUALIFICATIONS, AIDE CHARACTERISTICS, CHOOSING AND SWITCHING AGENCIES, AND FILING COMPLAINT SOURCE: Department of Health and Human Services. Medicare & home health care. U.S. Centers for Medicare & Medicaid Services. Accessed July 7, 2023.  

*FOR SKILLED CARE SOURCE: Department of Health and Human Services. Home health services coverage. U.S. Centers for Medicare & Medicaid Services. Accessed July 7, 2023.

*FOR WHAT HEALTH AIDE CAN DO SOURCE: U.S. Bureau of Labor Statistics. What home health aides and personal care aides do. Occupational Outlook Handbook. Accessed July 7, 2023.
 

If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).

If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna® Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.

You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).
 

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.  

To send a complaint to Aetna, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week. If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.  

The benefits mentioned are part of special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include Hypertension, Hyperlipidemia, Diabetes, Cardiovascular Disorders, Cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits. 

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