uids there are countlesspossibilities for treatment within the home setting. As statedin The Continuum of Long Term Care "Home healthprograms range from formal organizations providing skillednursing care to relatively informal networks that arrangehousekeeping for friends" (p. 185). This has allowed forhome care to quickly become an essential component ofthe health c! are delivery system in the United States. In ahome health care situation the primary care giver is usuallynot the physician. The physician is communicated with byphone and with documentation from the caregivers. Theprimary caregivers are usually the nurses and other teammembers who are involved directly with the patient's care.Although, the original order to begin home care must beinitiated by the physician if skilled care is to be obtained.According to the 1995 Guide to Health Insurance forPeople with Medicare "Medicare pays the full cost ofmedically necessary home health visits by aMedicare-approved home health agency" (p. 5). Thiscoverage must meet specific criteria, but it can be a relief tofamily members to know that their loved ones can be takencare of at home without worrying about the expenses.Unfortunately, if the care to be given within the home istermed "not medically necessary" the expense is notcovered. This can include items such as meal andmedication delivery, a percentage of necessary durablemedical equipment, personal care and homemakerservices. My employment within a home health care agencyhas allowed for review of services that are not covered byMedicare and/or private insurance. Health care servicesthat are not included can become quite numerous. It isoften difficult for family members to understand whyspecific services are not covered especially when theyappear to be necessary for the care of the patient. Thesecosts can add up quite quickly and the impact of the costcan become quite distressing for family members andpatients on a limited budget. In the...
