In order to receive benefits, first the client’s doctor has to certify that he or she is sick or injured. He must either require assistance in two or more of the previously mentioned activities of daily living, or he must need constant supervision due to cognitive impairment. In a tax-qualified policy, the client’s doctor must certify that the illness or injury is expected to last at least 90 days.
Second, he must receive care from a person or facility that meets a definition in his policy. In general, a facility must be licensed, maintain records and have the ability to care for him 24 hours a day. If he needs the care of professional caregivers in his home, they must also be properly licensed. If he only requires personal care and services at home and aides, no licensing is needed. Nor does he have to utilize a licensed home health care agency. Some policies reimburse even if care is given by a family member.
Home health care policies often require a written plan of care, designed by a doctor, nurse or social worker and agreed to by the patient. Benefits cover a very wide range of services performed within the plan of care. A social worker is also able to monitor this plan, change it if conditions change, and aid the patient in procuring caregivers. The best policies pay the costs of the social worker’s services.