Follow
Share

My mom wishes to have some P/T and O/T because she can't walk and get around anymore. She wants something to feel like she's moving her body. Her primary physician ordered it for her but, the therapist told me she was no longer eligible since she is under hospice care.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
I work for a hospice company in Texas. I am dealing with a pt. and his wife now on PT. He has dementia, has had several falls with pretty severe injuries. His falls are related to his worsening dementia, can barely speak anymore, sleeping pattern irregular. I had PT come out and they said he's not a candidate but taught caregivers how to walk him and recommended he get exercise several times a day.
Problem. Now he thinks he can walk so has had an increase in falls and injuries. Wife thinks he can walk and is fighting for more PT. There are situations where PT becomes a danger, I.e. my pt who fell trying to walk to bathroom at 3 am, broke his hip, and died a week later.
For family members who choose this option please listen to your hospice team. There is a reason dementia pts stop walking and you can't reverse the damage already done to the brain. I tell all of my dementia families that it is to be expected at some point, and while range of motion is promoted, all out PT is not after a certain point...it can be deadly and painful.
Helpful Answer (1)
Report

Every hospice company is a little different. Company I work for does provide PT for patients that would benefit from it. We also provide a restorative aid to help with maintaining current revel of functionality. In Texas medicare gives a bulk of money to hospice companies and they decide how they distribut it so don't let anyone tell you that "medicare doesn't cover it" under hospice. Just find a hospice company that does provide PT, they are out there.
Helpful Answer (1)
Report

There is a grey area when on hospice. For example if the patient is put under hospice care for one condition like Alzheimer's but has previously had a stroke then the patient would be qualified for physical therapy under medicare part B. I work with Divine Care Hospice and we are currently trying to get physical therapy for our patients
Helpful Answer (1)
Report

Rainmom: You were misinformed. There is no requirement under Medicare that the patient must progress in function to receive PT. If PT is necessary to prevent a deterioration of her current state of function, it qualifies. I would refer you to Jimmo vs. Sibelius which was the landmark decision that decided improvement was not a criteria to receive services.
Helpful Answer (1)
Report

While my mother was not in hospice - her PT was cancelled. The insurance/Medicare said that she seemed unable to progress beyond her current level of capabilities so she no longer qualified. I was also told that people living in long/term care facilities did not qualify for PT under Medicare guidelines. Maybe Medicaid and or hospice have a different criteria?
Helpful Answer (2)
Report

It depends on the aim of the PT and OT. Most hospice services will allow it for maintenance of comfort, but not for rebuilding. For example, if someone is bed-bound, then hospice will not cover rehab PT so a person can rebuild strength. But if someone is ambulatory, it is another matter altogether. Even if a person is bed-bound, there is allowance for range-of-motion exercises to keep the muscles and joints as healthy as possible.

Hospice services are covered by Medicare in most states. The PT will be limited to maintenance of comfort and not toward rehabilitation.
Helpful Answer (2)
Report

Medicare in my state will NOT cover hospice and *any* therapeutic treatment. If you are in hospice, you would not benefit from PT, OT, and some medications.
The thinking is that if you are getting better in any sense, you don't qualify for hospice services.

You have to know the rules in your state.

My mom does get music therapy though.
Helpful Answer (0)
Report

The hospice company i used said they have their own therapists that will come out and get her to move around to strengthen her.
Helpful Answer (2)
Report

Thank you guestshopadmin!
Helpful Answer (2)
Report

https://www.medicare.gov/pubs/pdf/02154.pdf is the publication that describes benefit. If you want you can print out to show them as well:)
Helpful Answer (2)
Report

Thank you Rosebush! I'll be making phone calls today!
Helpful Answer (1)
Report

I think they are wrong. I just googled your question and went to medicare.gov and it says physical and occupational therapy are covered under hispice. I would check into this further. It is my understanding that the therapists are provided by hospice provider. I may be wrong but good luck.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.