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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
caregivers who were brought into the home to care for both
Shirley and her husband. During
the several weeks that the nurse was coming to treat Shirley's
legs, an aide was also sent regularly to give Shirley a bath.
When the 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 fairly good condition.
Alice
did not qualify for Medicare Home Care because she did not have
a medical
condition that could be treated.
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.
If
you think your elder might benefit from medical care at home I
will be glad to help you figure out if Medicare might cover some
or all of your needs. Medicare also offers a very complete
21-page booklet, "Medicare and Home Health Care". You
can read and download this, and several other great booklets,
from their website:
http://www.medicare.gov.
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