For most of us who are caregivers there will come a time when we need

help...possibly hands-on help to give a bath, or someone to sit with our loved

one while we get out for necessary errands...or maybe even a nurse to care for a

wound or other medical need. We don't need a whole lot of help, just enough to

give that little extra "something" so we can continue to keep our loved ones at

home.  Eureka!  Medicare offers a Home Health Care benefit!

At least twice a week I hear from frustrated families who have not been able

to get a coherent explanation as to why they aren't authorized to have an aide

come to their loved one under Medicare, when someone "just down the street" has

home care help from Medicare "every day." 

There actually is a good (if a little complicated) explanation. Part of the

confusion lies in the terminology. Medicare uses the term "Home Care" very

specifically to mean (1) skilled medical care, sometimes including the services

of a trained aide; (2) delivered in the home; (3) by an approved Medicare

agency; (4) for treatment of an illness or injury; (5) to an individual who is

homebound; and (6) under the supervision of a physician.

You might see the term "home care" used to cover a broad range of services

provided in the home, such as sitters and companions, homemakers, shopping and

transportation services, as well as personal care services such as bathing,

dressing, or feeding. This isn't Medicare's definition.

Medicare doesn't pay for "custodial care," which is the kind of long-term

help that most caregivers desperately need. If the care provided is not to treat

an illness or injury (even if the need for the care is because of an illness or

injury), then the care is considered to be "custodial" and it is not covered.

Take, for example, two individuals who have needs that seem to be the same,

yet Medicare will looks at them very differently:

Case #1: Shirley

Shirley, 83 years old, lives with her husband in their home. She has fairly

severe dementia. Her husband, who has always been responsible, has Parkinson's

Disease. Shirley is malnourished, and she hasn't had a bath for several

months.  

As a result she has ulcers on her legs that aren't healing.   

Shirley qualified for Medicare Home Care assistance. A registered nurse

visited her regularly for several weeks to treat the wounds on her legs and to

teach the private  caregivers who were brought into the home to care for

both Shirley and her husband.  During the several weeks that the Medicare

nurse was coming to treat Shirley's legs, an aide was also sent regularly to

give Shirley a bath. When the Medicare nursing visits ceased, so did the aide

visits. By that time the caregivers had been taught to provide all of the care

necessary to prevent the recurrence of the leg sores.

Case #2: Alice
When I met her, Alice lived alone in her

own home. She, too, has dementia that is getting worse. She is severely

underweight, and she, too, hadn't bathed for weeks, if not months. However, by

some miracle, her skin is still in good condition.

Alice did not qualify for Medicare Home Care because she did not have a

medical condition that needed treatment. Her inability to care for herself came

about because of her dementia. She has no wounds or any other condition that a

nurse or therapist could successfully treat. Therefore, Alice has to pay

privately for the help that she needs. For the time being Alice remains in her

own home with a full-time companion and with no in-home assistance from

Medicare.