Will Medicare pay for a visiting nurse ongoing?

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Hi all, my mother really needs more medical supervision - she still lives alone but barely - someone to monitor whether she's taking her medications (she refuses to allow family to do this), someone to check her blood sugar and blood pressure regularly as she doesn't really do so and lies to her doctor about the values. She had a nurse come in regularly after her last hospitalization for about eight weeks and was then "discharged" and has been on her own ever since. I know the day is coming soon when she can't live alone, but in the meantime is there any way to get a visiting nurse back in there on a regular basis that Medicare pays for?

Answers 1 to 10 of 14
1) Have you discussed this with her doctor? I think that is were the order would have to start.
2) Can Mom afford services over and above what Medicare covers?
3) Is Mom eligible for any social services or for Medicaid?

Sorry to answer with questions, but responders here may be better able to give specific answers if we know a few details.
Given the right set of circumstances Medicare *does* cover 'on-going' nursing visits .. and physical therapy, if she ever had it. But Jeannie is right, the order has to start with the physician. Along with checking her status for Medicaid (your state assisted paid medical/along with Obama care medical), if she or her husband are veterans, she may be eligible through the VA. Worth checking.
The trick is that the only way my mother would accept a nurse coming regularly to her house is if she were "cornered" into it by her doctor ordering it for some reason. She would absolutely refuse to pay for such a service on her own because it was good for her. She's eligible for the Medicaid waiver program but refuses to apply for it. So my hope is that next time there is an opportunity I'll talk to her doctor about whether she can order a nurse to regularly come and it seems to come from the doctor and I had nothing to do with it. I know all this must seem ridiculous, but my mother is next to impossible to deal with rationally and directly and pretty much always has been.

LadeeC, so if I read you right the nursing visits don't have to be limited duration...good to know! She also improved when she had in-home PT, but she graduated from that too and left to her own devices declined again. The doc has ordered that restarted though.
Top Answer
Depending on how long ago she had the PT, the new federal law is that PT may continue, since to deprive it, means a decline of ability. And, yes .. it's possible for home health services/visiting nurses can 'continue' care. A few caveats: the physician and the agency needs to be aware that it's possible, and follow the new guidelines for continued (covered by medicare) visits. Almost any reason can mitigate: recurrent UTIs that need monitoring, bedsores, the use of durable medical equipment that should be monitored .. I'm sure there are loads of other reasons, I just haven't had to deal with them personally ............... yet. Sometimes the nursing will fall back to fewer visits, depending on the patient's needs. Also see if the doc will authorize someone to come in for bathing assistance. Most home health agencies have it set up that the nurse comes out, evaluates the situation, reports back to the doctor and suggests other services available through the agency. One you can specifically request is to have the social services representative come to evaluate the situation and make recommendations.

And talk to your mom some more and figure out her angles: is she too proud to admit she's declining? Perhaps you can suggest that she's worked hard all her life and deserves a break. Or if she likes the idea of someone else picking up the tab? When you do talk to the doc, you might suggest the nurse come for further evaluation, that you're concerned with an onset of dementia, that living alone may be a greater challenge, but it needs to be seen/recorded by a trained observer.

However, before you do, if you don't already have someone in the family with MPOA/DPOA do it NOW. Before she's evaluated and determined to no longer have the faculties to make her own informed decisions. I'm sure you'd rather not go down the road of getting guardianship through the courts.

If the doctor is not cooperative, and doesn't have your mother's permission to discuss her condition with you (HIPAA laws, and all that), then you might need to get your local agency on aging/adult protective services involved.

Keep us posted, please feel free to come vent and get support. That's why we're here.
I hope this isn't a duplicate post. I lost my connection in the middle of my response. Anyway, worth saying again. Kudos to you LadeeC for bringing the recent case changing Medicare's "no improvement, no more care" rule. I followed up on your comment and found the case online. Anyone interested in more details,just google Jimmo v.Sebelius settlement. God bless the lawyers who negotiated this class action settlement on behalf of all Medicare beneficiaries. And God bless you for posting this info. I'm printing out the settlement summary to hand to any provider who tells me they can't continue to provide service because of "no improvement". As long as a doctor certifies that containing care is necessary for a chronic condition, to maintain a person's status and prevent backsliding, care should be continued.





Thank-You Ladee!
I can't believe how completely unhelpful my mothers Dr. has been on this.
After her last stroke she can't walk anymore, but how did he not see that cutting her off from her PT only made her fall more ultimately costing the system more?ANd after this last stroke her refused to write a recommendation for PT again. Oh this Dr. is a long story for another thread, but I am going to print this case out for him! He can't resent me much more than he already does! LOL.
I think it's a case of good news/bad news: there's the good news that PT (and nursing) can be extended, the bad is so few medPros and agencies are aware of it. Like the two of you, it behooves us all to keep them aware or update them. In their defense, it was Medicare that originally determined the parameters of 'improvement' and made the home care specialists/docs discontinue the care. I'm also grateful for the ones who challenged the case in court. Yay!!

And, uh .. you don't really wanna get me started on the whole western medicine thing. *koffs*
LadeeC you are so right about professional health professionals not bring aware of the change. As recently as last week a Visiting nurse told me that Medicare would not continue home care forever. BEST news is that at least we know about the change and can not only protect our loved ones, but tell others of their right to continuing care. Knowledge is power!
I just faxed this PDF to my mums Dr. and he is going to write the order for PT that he was refusing to write before. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf
Did he read the PDF? I doubt it.
You know what I hate? The fact that he dismissed me out of hand when I asked for the Dr. Order. I said, please just give me the order, once I have that I will worry about whether Medicare and her supplement will pay. But without the order, I can't even try. He just smirked at me and said, "if you were private pay, then none of this would be a problem for you." Now that I am venting, off topic and probably out of line, I will indulge and mention that when he gave my mum the fentanyl patches he said; " Well, considering the neighborhood you live in, you'd better lock these up somewhere." I never had anyone to talk to about this stuff, so forgive me if I am all over the map for a little while:/

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