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I believe Medicare will pay for rehab
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I have tried everything and now my surgeon says I need reconstructive surgery on my left should. I am 73, live alone. I have medicare A & B and Blue Cross/Blue Shield Senior F. I will need to stay 6-8 weeks in an asisted care type place. Will this be paid for?
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My husband is unable to walk-he has had two knee surgeries-he was in rehab for two months and they felt he was not inproving and placed him in the nursing home of their facility. I would like to bring him home and get daytime help and take care of him at night-I have a Sara Lift. Cost of nursing home is very high. Is there help to offset the cost. Is it wise to bring him home-where do I start?
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My husband ,age 67 has metastatic cancer, recently received palliative radiation therapy to the spine and has been placed on immunotherapy which may slow disease progression. We are both aware of the prognosis.I am 63 and have had to cut right back on my work in order to take care of him with subsequent loss of income.I am continuing to attempt to work sufficient hours to maintain my health insurance. I am the sole caretaker with no immediate family nearby. He is no longer driving as he is on chronic pain medication. In addition to medical issues of difficulty walking, fatigue, weight loss, pain control and multiple medications I am beginning to see signs of rapid cognitive decline. I have a home health agency and have had nursing , OT and PT assessments. Recently I took my husband away for a week (needed wheelchair transport and I had to arrange and supervise everything) but agency insisted he be discharged and then re-enrolled. He has Medicare A and B and D with supplemental plans. Recently the homecare agency approved a home health aid who will be starting to come to the house 2 mornings/ week to help with dressing and bathing( which my husband can still do slowly with assistance and reminders and would take me 2-21/2 hours including supervising his medications). Because of his change in mental status I can see that it will soon be very difficult to leave him on his own at home and that I will need more help in the home albeit not necessarily skilled nursing. I am also managing all the finances, care coordination, shopping, meals. I have friends helping out to visit him when I have to work.
So, my questions are
1)Will Medicare cover additional help for him in the home such as a PCA, or companion. I hope to keep him as comfortable as possible at home and envisage ultimately needing hospice care.
He did purchase a long term care policy in his last year of employment. I believe I have to pay for 100 days of care in the home before it activates. If I do start to employ someone to assist him more at home such as meal preparation and companion care how do I find a good agency?
When we do decide on hospice care does Medicare cover and how do we find a hospice care agency that is in line with our religious beliefs ( Traditional Jewish)?
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Medicare will pay for home health care based on whether the individual is considered "homebound." There is a lot of confusion regarding this terminology - "homebound" means a "taxing effort to leave the home." Meaning, if the individual needs to run to the pharmacy to get meds or attend church once a week, that is ok. However, they cannot be driving everyday, shopping, etc. There has to be a significant need for skilled care or therapy. The plan of care is established by an RN who will schedule a visit to the home to do a full assessment - sometimes this can take 1-2 hours - depending on the needs of the patient. (and I do agree, some agencies believe in getting in and getting out - that's why you need to research and ask family, friends and neighbors for a reputable agency -I've heard many stories about "BAD" agencies.) Once the assessment is complete by the qualified registered nurse, the physical therapist, etc. the information gathered, and the suggested frequency for visits, is then submitted to the primary care physician to approve the plan of care. (keep in mind, the initial order for home health care has to come from the physician to start the care - so if you think your family member qualifies or needs home health, ask your physician for an order.) Again, frequency of care is decided based on the nurse and therapy assessment - if at the end of the 60 day period, the patient has not met goals, then the agency can re-certify. If the patient HAS met his/her goals, then the agency SHOULD discharge. I've heard crazy stories about agencies keeping patients on service for years...the goal is to get better. In some cases, I understand that is not possible, such in the case of Alzheimer's/Dementia care and the family is reluctant to place mom/dad in a facility/community...just do your research - just as with any other medical needs - there are good and bad out there. Also, if you are NOT happy with your agency, you CAN request to be DISCHARGED - they can not force you to stay on service- that is illegal. They may intimidate, harass, or persuade you so they can fulfill that billing episode, but if YOU and your family member are not happy with that service, type your request for a discharge, fax it and be done with it. Then find another agency who actually care about their families and patients. (this comes from experience - i've been in home health care for over 8 years) Another tidbit of information, on the flip side, a doctor cannot coerce you into using one particular agency either - and this is a well known tactic - you can decline that agency and intervene by selecting one of your choice -most of the time when a physician suggests an agency - he is the acting medical director for it. Do not be forced or intimidated into selecting a home health care agency before you are able to ask your friends/family/community about others that are available and trustworthy.
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The system is broken and the pts. and their families suffer-our GO. himself handicaped wants to close hospitals and nursing home but has very poor home health care available to people who need it and should be able to get the help-most families would live to keep their loved ones at home but in our state 60 percent of caregivers die before the ones they are caring for accourding to our Elder lawyer -our Govener is a handicaped person himself and always has a passel of people assisting him -he is very non-informed or just does not care-it is a shame I with health problems myself did not get enough help to care for my husband and had to have him placed just before he died -I did not ask for much only 2-3 hours 3 times a week and got 1 hr if lucky a week.
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Medicare covers home care when you are released from the hospital and your doctor prescribes care for up to 30 days. Care will include services such as: speech therapy, physical therapy, occupational therapy and basic nursing services and whatever the doctor deems as necessary. The catch is that is, after a certain amount of time, you will become responsible for the copay if continuing care is needed.

My mom was discharged from the hospital to a skilled nursing facility and medicare covered her for 30 days. After that, her doctor approved her for another month but she was responsible for the co-pay after that. Our father was released from the hospital and went home and he received all three services mentioned above for approximately one month. He also had a caregiver who came to give him a bath once to twice a week.

Fortunately, we have a live-in so he didn't have to wait for long.
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It was our experience, in general, for agencies to aim for the patient that is needing the least services, especially the elderly after hospitalization, etc. Assuming we were ill-informed, the salespeople who hang out at the hospital would put imaginary limits on service, visits, duration, scope, episodes, etc. We would always know they were not qualified to assess properly, were not "clinical" or familiar with actual Medicare guidelines, and would imply that the agency would be in charge of decisions, frequency, etc., when in reality it is the doctor who gives the orders and the agency that must follow the orders. If you ask for any of these wild claims in writing, they will back out. Under Medicare, the Home Health Agency can schedule as many as 28 hours per week, and possibly more, up to 35 hours per week if the patient requires the care. A Medicare Beneficiary is entitled to choose to be at home for skilled nursing care, so the agency is not to "decide" that the patient needs to be in a facility. Later, if the agency accepts the patient, the marketing person who made initial intake is out of the picture and not responsible for the commitments that were made. When the patient needs immediate care, then, the agency can be in the driver's seat and only staff and supply as they wish. In my first (and even second) post, I tried not to sound as negative as our experiences have been, even though I did cite the problems honestly.
Frankly, Medicare has entrusted patient care to agencies who are empowered (or so they think) to be controlling, intimidating, and insensitive to the patient's needs. Our doctor and his assistant are worn out, and I can no longer go to them with the constant problems caused by the agency, although we are unable to just quit, as the patient needs the care. They quit us soon enough. Please know that every HH staff who has come to our home to care for the patient has been kind, professional, and outstanding in every way. The administrators are often not qualified to make decisions about the patient, but do so from a business standpoint only. They are not familiar with the patient's needs or condition, nor do they necessarily have information about the medical facts of the patient's need for service.
The patient is NOT required to stay home and never leave. The patient's family, caregiver, etc., are NOT required to learn and assume the care. The HH can "say" many fancifil things, but if they won't put it in writing, be suspicious. The doctor can and will order an aide, as, under Medicare, if the doctor has ordered skilled care under Medicare, the patient can certainly have an aide as well if necessary. This is NOT a rare case.
The less care they give to the patient, the more funds they get to keep as profit. I haven't met one yet that didn't want us to believe that the imaginary Medicare guidelines they repeated. That's why I suggested that you get familiar with terms and policies as soon as you can.
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In general, Medicare will cover home health care provided by an agency that is Medicare certified and then only when the service provided is considered "skilled' care, ordered by a doctor, and only if the patient cannot reasonably be expected to leave the home. In general, Medicare will not cover "shift work" or assistance with activities of daily living, such as bathing, dressing, grooming, hygiene, incontience care, light housekeeping, cooking, etc., except in rare cases when a home health aide is required in conjunction with the skilled caregiver.
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MK That could have been my answer do you live in the NE by ant chance. Here you have to be in the hospital three days and then you can go to rehab and after that you can get home care from medicare but it is at the whim of the nurse assigned to be in charge of you and if she does not like you for any reason you will get little care even though the RULES are if a nurse sees you once a week you should have an aide three times a week for 3 hrs. and PT and OT and a social worker but lots of luck and believe me they get good money from medicare and your other insurance if you have it-one nurse even reported me for abuse because I was caring for him at home instead of putting him in a nursing home and I had a visit from APS which was frightful but I got a chance to report her to a man running for office and he was involved in social service for our state and he was able to make a formel complaint about this and did follow up on the situation-by the way APS has no attourity in our state they only can put the fear in you they have no power and I was the one being abused. And if you call edicare you will not always get the correct information our county uses two agencies but are going to go with a private company and I think that will be better-and do not be afraid to fight for what you need-I got so sick of calls telling me they could not send me anyone so often that I started to say that was not acceptable and reporting them to someone higher up-- and they usually were able find someone-I could go on and on as I am sure MK could also and would love to hear others tell us their experiences it is so unfair the way I as usually treated there were some great caring nurses who did help at times but more of the uncaring ones-I found and I will speak up whenever I can now that I am out of it since my husband passed- he was disables 16 years and in bad shape the last 10 years,
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I will say - sort of. Between Medicare and Home Health, they have real or imagined "rules" that you can never predict will impede the care your doctor orders. I really shouldn't say much more because, over three years, our experience has been so gruelling that I can't be optimistic for you. I can tell you this though: if your doctor is not able to order skilled nursing for the patient, Medicare will not pay home health companies to come to give custodial care. If there is a skilled need, though, the patient can also receive aide services. Read the special book available online thru the MyMedicare.gov site to try to learn terms, etc. You can also call 1-800-Medicare to ask specific questions about various categories they offer in their recorded message when you call. Aside from these things, you can read my previous comments, bitter as they are. Good luck.
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