Just a tip. I used to take my parents to the podiatrist, which was an office visit. Their insurance didn't cover it. Then it turned out the podiatrist would visit their ALF bi-monthly, but it was still very expensive because he had to be paid in cash. At some point I mentioned this to someone at their doctor's office, and they said I could bring them in there instead. Every two or three months I take my dad in and a nurse practitioner trims his toenails and takes care of any corns or calluses, and checks the general health of his feet. She also pays attention to any other health signs and they do a thorough check of his vitals, med review, etc., so in my opinion, this is actually better than taking him to the podiatrist. It's worked out so well that I'm going to have my mom start to see the same PA and have the same things done. Neither of them is diabetic, but they both have thick toenails that I can't possibly cut. I used to take my mom to the salon to get her toenails done, but they started refusing because of the thickness. They thought it looked like she had a fungus, so they didn't want to deal with her any more. I still file and paint her fingernails for her, but I can't even begin to handle her feet. :)
Medicare's coverage of foot care can be a little tricky. "Routine" foot care is not supposed to be covered, but if it's "medically necessary" then it can be covered. Diabetes and certain other conditions often help qualify foot care as medically necessary.
If the older person is enrolled in a Medicare HMO (also called Medicare Advantage), then you have to check and see what type of foot care is covered.
If an NP or PA is doing foot care in a clinic, it is probably because that clinic has figured out a way to get reimbursed for it and has decided they want the provider to do those types of visits.
Always a good idea to start by asking your usual health provider for help with foot care.
Yes check them every day. I used to teach my patients/families to use a hand held mirror so they can see the soles and to especially check for ingrown toe nails. Wear slippers, no barefoot. Wear proper footwear that doesn't rub the skin to prevent breakdown. And see the podiatrist regularly.
I'd ask the doctor about thick toenails. Sometimes, that can be a fungus. I'd explore to see what it is and whether it should be treated.
Is her blood sugar levels under control? That can effect the circulation in the limbs and high levels could cause issues. I'd ask the doctor about that too.
Does she still walk around the house? If so, I 'd be careful that her feet are protected. If she has any numbness, she may not notice a cut or scratch. I always wear shoes, even though, I don't have any numbness in my feet. It's just a safer approach imo.
Never soak the feet! I had to learn that. Diabetics are not supposed to soak their feet.
Our HomeHealthCare still tends to the toenails. The VA NP told me to use a mini-dremel on my DH's toenails - most fungus medications don't work on the typical fungal toenails. You can go to a podiatrist - medicare paid for the one I used for Mom and later for DH. DH said I did a better job and didn't want to go back. She used clippers on their nails (they both had toenail fungus) but the dremel works better as long as you go very slowly.
You didn't say fungal - most people do have thicker nails on their feet. I would start with a podiatrist and see what the diagnosis is first.
The patient MUST see a podiatrist regularly. It is CRUCIAL for persons with diabetes! Toenails are one issue, but the larger issue is the diabetic health of the feet.
My sister-in-law goes to the hospital regularly to have her toenails cut, and Medicare covers it. If a MD orders it, it should cover the foot care. In between, use Gold Bond lotion for diabetics to soften the skin and keep it from itching.
Check them every day. Make sure their kept clean and have the toenails cut by a trusted medical professional. Make sure there is no dirt, etc., collecting under the nail.
You can see the guidelines for fee-for-service Medicare podiatry services here
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicarePodiatryServicesSE_FactSheet.pdf
If the older person is enrolled in a Medicare HMO (also called Medicare Advantage), then you have to check and see what type of foot care is covered.
If an NP or PA is doing foot care in a clinic, it is probably because that clinic has figured out a way to get reimbursed for it and has decided they want the provider to do those types of visits.
Always a good idea to start by asking your usual health provider for help with foot care.
Is her blood sugar levels under control? That can effect the circulation in the limbs and high levels could cause issues. I'd ask the doctor about that too.
Does she still walk around the house? If so, I 'd be careful that her feet are protected. If she has any numbness, she may not notice a cut or scratch. I always wear shoes, even though, I don't have any numbness in my feet. It's just a safer approach imo.
Our HomeHealthCare still tends to the toenails. The VA NP told me to use a mini-dremel on my DH's toenails - most fungus medications don't work on the typical fungal toenails.
You can go to a podiatrist - medicare paid for the one I used for Mom and later for DH. DH said I did a better job and didn't want to go back. She used clippers on their nails (they both had toenail fungus) but the dremel works better as long as you go very slowly.
You didn't say fungal - most people do have thicker nails on their feet. I would start with a podiatrist and see what the diagnosis is first.
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