Frequently Asked Questions.
A child is a candidate for home health or home care if they have a chronic medical condition or physical trauma during discharge from the hospital or doctor’s practice. Some examples of a child who may be appropriate for home care are:
Premature infants: Qualification for home care is possible for a 24-32 week premature infant because of complications.
Respiratory Related Problems: Respiratory-compromised children on Ventilator or have bronchopulmonary dysplasia, traumatic brain injury complications, syndrome-related complications, tracheostomy qualify for home health care.
Heart-Related Problems: Cardiac-compromised children with medical problems including a congenital heart defect, syndrome-related complications, congenital anomaly, and others qualify for home health care.
Neurological Related Problems: Neurologically-compromised children that present with Seizure disorders, cerebral palsy, syndrome-related complications, and more are candidates for home health care
Nutritional Problems: Children that require feeding via Nasojejunal (NJ) tube or Gastrostomy button (G button) are appropriate for home health care.
Evaluation of your child may occur at the hospital or at your home by a qualified iServe Health care staff to determine hours of care and nursing needs.
Under the direction of a child’s primary doctor, a registered nurse becomes a pediatric home healthcare primary provider. The nurse coordinates with other team members to care for your child at home, including physical and occupational therapists, speech pathologists, medical social workers, nutritionists, licensed practical/vocational nurses, home health aides, and personal care aides.
Your pediatrician plays an essential role in the care of your child at home. The pediatrician orders home care services with all necessary information that the nurse needs to create a plan of care for your child. The home care team leader monitors skilled nursing care, private duty nursing, therapies, medication, and equipment required to care for your child: the pediatrician’s new order and plan is possible based on feedback from other healthcare team members.
A pediatrician also assists and advocates for a different insurance plan for your loved one.
- Accessibility: Most rural areas do not have appropriately skilled home health providers, limiting a parent’s type of care for their child. Without home health care with qualified healthcare staff, including respiratory therapists, assessing the airway and continuous suctioning of a child in tracheostomy on a ventilator may be impossible, especially if the parent has no clue how to perform these tasks.
- 24 Hour Care Provision: Due to the differences in time between a parent that has to work, and caregivers who provide care for their child, it could be challenging to provide continuous care. Most agencies have a policy that an adult must be present during the day or night when a caregiver is present at the patient’s home. Failure to provide such a person may result in the family not providing the care they need. Additional options are possible for those families who cannot place an adult at their home during the care of their loved ones.
- Lack of Insurance: Non-uniformity may exist among different insurance plans due to the duration of home health service coverage or no coverage at all.
- Insufficient Payments: The recruitment of staff for home health patients depends on insurance companies’ payment of services. Not receiving the total price for the services means not hiring a new team. Physicians may find it difficult to prescribe home healthcare for a child who needs it or accept a child to their practice if the insurance companies do not pay for services promptly.
The risk of not receiving adequate care at home is high if the family does not have insurance, or insurance companies are simply not playing their role by paying for the services accordingly. The danger of not having insurance or lack of payment by insurance companies includes that a child may experience life-threatening disease and medical complications, an increase in hospital readmissions, high cost of healthcare, and an increase in family burden. The cost of placing a child in NICU, PICU, and other necessary hospital units may also be expensive if the family does not have insurance or no payment of services by insurance companies.
Although rehabilitative care, including physical therapy, occupational therapy, and speech therapy, are the usual home care services for children, it has broadened today to include the following:
- Plans of care implementation that include home medical equipment coordination, pharmacy, and supplies
- Personal care that includes bathing, grooming, feeding, ambulation, dressing, transfer, etc., is possible.
- Administration of prescribed medications administration as ordered by the primary care provider, including intravenous nutrition, antibiotics, and fluids
- Ventilator care, BiPAP, and CPAP as part of Respiratory support
- Tracheotomy care
- Wound care and chronic pain management for the care of a complex medical and surgical patient
- Transfers and mobility assistance for non-ambulatory patients are essential.
- Providing psychosocial support, respite, education, and training enhances the recovery process.
- Provision of hospice care for a child that needs one
An approach to providing comprehensive primary care is what a medical home intends to do. Although your pediatrician may provide direct hands-on care, they represent the medical home. Your pediatrician assists in coordinating and accessing specialty care for your child, home health determination, education about necessary services, admission and discharges from home care, support for the family, and community service for both public and private that help your child live everyday life.
We recommend appropriate training for the child’s care at home for the parent or caregiver before the child’s discharge from the hospital. The caregiver must understand the plan of care and ask as many questions as possible to prevent the inability to perform specific tasks when the child gets home.
The parent or caregiver often facilitates communication between payers sources, service providers, and case managers. when there is a gap in services, parents or caregivers may carryout some functions for the continuation of care for their loved one, including
- Enteral feeding tube use
- Care of Tracheostomy
- Nebulizer and ventilator care for the support of Respiratory treatments
- Wound care with wound vac placement
- Intravenous fluid line care
- Management of medicare, equipment, and supplies
- Cardiovascular resusitation
- Learning overall assessment skills
- Access to Medicaid: Part-time or intermittent nursing services, aide services for home health, medical equipment and supplies, therapy service, and state options are some of the services that Medicaid could provide to assist a patient at home. In other words, Medicaid covers more than ¾ of all pediatric home health. On the other hand, private insurance has limited coverage of care. Nurses may choose not to provide home healthcare because Medicaid authorizes hours for the care of a patient based on medically necessary; it gives pay that is insufficient to cover much of the home healthcare services.
- Limitations to State CHIP: Home health coverage is more evident than private health insurance for non-Medicaid State Children’s Health Insurance Program (SCHIP) plans. Non-coverage of home health services occurs only in one state out of 36 with non-Medicaid SCHIP plans. While the charge of copayment and coinsurance are rare, visit limitations occur by ¼ of these states approximately.
- Limitations of Insurance: The preference for a cost-effective alternative to hospital or outpatient for most private health insurance carriers and managed care plans is a problem for families that need to keep their child at the hospital or outpatient facility. In addition, the insurance companies often authorize less care than ordered by the pediatrician or home health agency. Authorization delays and denial of care by Medicaid and private insurance companies often prevent quick recovery and ill patients.
Limitations of Non-Group Plan: Children’s home health coverage is often absent with non-group plans. The state Title V program is usually where most parents with special healthcare needs seek support. The child’s condition and family income determine gap-filling home health service eligibility. Termination of employment is often common for a parent with inadequate private health to obtain eligibility for their child’s Medicaid coverage.