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My husband is rapidly losing strength in his arms and legs. He has multiple medical conditions. Will Medicare cover the cost of him going to stay in rehab? He is currently at home.
It depends. The situation you have described is actually 2 parts....PT and the stay at rehab. Medicare will pay for the PT as long as it is a "new" incident. There are rules for staying at a rehab hospital, which might require you to be admitted to the hospital for a short period of time before going to the rehab facility.
I'd contact his PCP.
In my case, the PT came to my Mom's condo to give her PT; rehab hospital was not considered becaused based on previous experience, the rehab hospital would have not have yielded the results we were after.
And a word of caution: I don't know if this is the case today. Once you go to PT at an office, you can no longer get PT at the house for the same incident. For us, once we were eligible for PT at the house, we kept it at the house, even though she could have gotten in a wheelchair (with difficulty) and had PT in the office.
Contact them directly. Things, politically aka our country's ... "leader (?)" changes his mind hundreds of times a day so we really do not know what is happening or going to happen.
The best we can do is call and keep accurate notes and copies of important information / emails, documents, etc.
You should be able to ask someone in his MD's office (social worker?) for a referral if you cannot local or contact Medicare directly. They should also have more information.
Our Medicare policy covers what it covers, which is normally 20 days of rehab after a hospital stay. Making uncalled for political statements is against A.C. rules.
There is no reason to go to an ER for diagnosis and treatment, and an ER is not equipped to deal with chronic and/or progressive conditions It may also be VERY expensive to go to the ER for any services, and makes sense only for true emergencies. If the OP's husband needs additional diagnosis, his PCP should make appropriate referrals.
What PT/OT services are allowed is determined by Medicare (for people on Medicare), not by whether one has an Advantage plan or a Supplement plan. How the PT is paid for will vary by the kind of plan and by the specifics of a plan, but not whether PT is authorized!
Sorry, thought I was posting this under "Gleaton777" post on 5/14. I wish there was a way we could delete a post in this system.
That is very true whether he has "regular" Medicare or an Advantage Plan.
However, either way, an ER visit should not be necessary as long as his private doctor orders an evaluation. ER visits can wreck havoc on a PD patients well-being and cause setbacks and should only be done when necessary. This can be very true especially when stuck there for hours.
@ JeanLouise - A 3 day hospital stay is only required for in-patient rehab. He may qualify for out-patient rehab without a prior hospital stay. You are right in that he may even be qualified for unlimited PT depending on his diagnoses.
@Lanajb - Ask his doctor for a referral to be evaluated by a PT.
Thanks everyone for your input. He saw his neurologist yesterday and had the dosage of one of his meds adjusted. Home Health will be coming several times a week.
You put this under Parkinsons. Thats a progressive desease. There may not be anything physical therapy can do for him. Talk this over with his neurologist. Maybe "in home" can be ordered. That would mean PT coming to the home. You may get an side for bathing 2 or 3x a week. Maybe she can stay long enough for you to run errands. The therapy may help him not getting contractures. It may be time to decide if he stays home or goes into care.
@JoAnn29 said - "There may not be anything physical therapy can do for him."
That is purely a myth. While PT won't "cure" PD and may not help him "improve" it definitely can do something for him. The purpose is for maintaining a PD patient's abilities longer. Research has shown that exercise can slow the progression of PD and in some cases reverse some of the symptoms. As "Jean Louise" has said, inpatient PD often is lacking because the therapist is limited in the equipment available but it definitely is better than no PT.
The result of PT can often mean the difference in keeping a LO at home longer, at least I have found it has made my job more doable the longer he has therapy.
Most PD patients have a very real symptom called Apathy. This often results in their refusal or non-interest in following through with therapies on their own so working with a PT is a definite must.
When they send an Aide for bathing, they usually don't allow the caregiver to leave because they are on a tight schedule to get to their next client.
He is unlikely to get into rehab without a hospital stay that has necessitated 3 days in-hospital care. I would discuss options with the doctor for either PT and transit to it, or for in home PT.
Meanwhile do understand that there is bone loss, muscle and tendon loss with a refusal to walk and to move. If hubby is sitting about things will continue to deteriorate until there is an accident and that WILL necessitate getting rehab; but again, without his cooperation little can be done.
Usually the Person goes to the ER Has a Stay and they are sent to PT In a rehab or A Person Can request in Home PT . A Doctor can write a script for PT and Medicare will Pay .
Typically one goes to rehab after a hospital stay if deemed necessary by ones doctor, and since your husband is home and not in the hospital, perhaps it best that his doctor orders in home PT instead.
A doctor can order outpatient PT at any time without having a hospital stay. It doesn't have to be provided in the home... but may be if getting to therapy poses a problem..
The answer may depend upon whether he also has an Advantage plan or supplemental gap plan.
You don't give us enough information so give you any more answers.
Maybe you should call 911 and have him transported to the ER to get a diagnosis and treatment? What other medical conditions does he have that you think he will qualify for rehab and not the hospital or LTC or hospice?
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I'd contact his PCP.
In my case, the PT came to my Mom's condo to give her PT; rehab hospital was not considered becaused based on previous experience, the rehab hospital would have not have yielded the results we were after.
And a word of caution: I don't know if this is the case today. Once you go to PT at an office, you can no longer get PT at the house for the same incident. For us, once we were eligible for PT at the house, we kept it at the house, even though she could have gotten in a wheelchair (with difficulty) and had PT in the office.
Things, politically aka our country's ... "leader (?)" changes his mind hundreds of times a day so we really do not know what is happening or going to happen.
The best we can do is call and keep accurate notes and copies of important information / emails, documents, etc.
You should be able to ask someone in his MD's office (social worker?) for a referral if you cannot local or contact Medicare directly. They should also have more information.
Gena / Touch Matters
What PT/OT services are allowed is determined by Medicare (for people on Medicare), not by whether one has an Advantage plan or a Supplement plan. How the PT is paid for will vary by the kind of plan and by the specifics of a plan, but not whether PT is authorized!
That is very true whether he has "regular" Medicare or an Advantage Plan.
However, either way, an ER visit should not be necessary as long as his private doctor orders an evaluation. ER visits can wreck havoc on a PD patients well-being and cause setbacks and should only be done when necessary. This can be very true especially when stuck there for hours.
Rehab does not always require a facility.
@Lanajb - Ask his doctor for a referral to be evaluated by a PT.
https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/downloads/jimmo-factsheet.pdf
He saw his neurologist yesterday and had the dosage of one of his meds adjusted.
Home Health will be coming several times a week.
That is purely a myth. While PT won't "cure" PD and may not help him "improve" it definitely can do something for him. The purpose is for maintaining a PD patient's abilities longer. Research has shown that exercise can slow the progression of PD and in some cases reverse some of the symptoms. As "Jean Louise" has said, inpatient PD often is lacking because the therapist is limited in the equipment available but it definitely is better than no PT.
The result of PT can often mean the difference in keeping a LO at home longer, at least I have found it has made my job more doable the longer he has therapy.
Most PD patients have a very real symptom called Apathy. This often results in their refusal or non-interest in following through with therapies on their own so working with a PT is a definite must.
When they send an Aide for bathing, they usually don't allow the caregiver to leave because they are on a tight schedule to get to their next client.
I would discuss options with the doctor for either PT and transit to it, or for in home PT.
Meanwhile do understand that there is bone loss, muscle and tendon loss with a refusal to walk and to move. If hubby is sitting about things will continue to deteriorate until there is an accident and that WILL necessitate getting rehab; but again, without his cooperation little can be done.
You don't give us enough information so give you any more answers.
Maybe you should call 911 and have him transported to the ER to get a diagnosis and treatment? What other medical conditions does he have that you think he will qualify for rehab and not the hospital or LTC or hospice?
More info would be helpful.