Medicare

    Major Breakthrough in Medicare Coverage for Chronic Illnesses

    For years we have accepted the fact that Medicare will only cover physical therapy for patients who are continuing to improve. When my mother broke her hip, the therapists informed her doctor that Medicare coverage for rehabilitation would cease after only three weeks of therapy. They told us that she would have to return to her assisted living residence even though she was still not able to walk. Their conclusion: She was no longer improving and it was likely she would never walk again.

    Of course this was complicated by the fact that she had dementia and couldn’t remember the exercises they had prescribed for her a few minutes after she left the therapy room. But we accepted their conclusion without making a fuss and she has been in a wheelchair for the last five years.

    But a major change has recently occurred in Medicare, one that has been kept very quiet but will have a huge impact on patients who have chronic illnesses. Medicare officials updated the agency’s policy manual. This is the rule book for everything Medicare does. They stated that Medicare will now pay for physical therapy, nursing care and other services for beneficiaries with chronic illnesses like Multiple Sclerosis, Parkinson’s and Alzheimer’s disease in order to maintain their condition and prevent deterioration.

    This dramatic change is due to the settlement of a class-action lawsuit filed in 2011 against Kathleen Sebelius , the Secretary of Health and Human Services by the Center for Medicare Advocacy and Vermont Legal Aid, on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action network and the Alzheimer’s Association. The settlement affects care from skilled professionals for physical, occupational or speech therapy and home health and nursing care, for patients in both traditional Medicare and private Medicare Advantage plans.

    The change will have the greatest impact on seniors who want to avoid having to go into an institution to get care. People with chronic illnesses like Parkinson’s or MS may be able to get the care they need and stay in their own homes.

    Existing eligibility criteria for Medicare rehabilitation benefits have not changed, however. To be admitted to a rehab. facility or nursing home for covered care, the patient must have spent three consecutive midnights in the hospital as an admitted patient and the patient must be referred by a Doctor’s order prescribing skilled nursing home care not custodial care.

    For home health coverage, the beneficiary must have a Doctor’s order for intermittent care ( every few days or weeks) provided by a skilled professional or outpatient therapy, social work services or a visiting nurse. Beneficiaries receiving skilled services at home are also eligible for home health care aides for assistance with bathing, dressing and other daily activities.

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    Is A Hospice Program Right For Your Mom Or Dad?

    When the medical director of my mother’s assisted living residence called me I was curious to know what she wanted to talk to me about. After informing me how much everyone at the facility loved my mom she then made a statement that took me by surprise. “I think you mom would benefit greatly by going into a hospice program.”

    My thoughts immediately jumped to “Oh my God, she’s about to die. The end is very near.” The next day a hospice nurse visited me and explained to me what hospice was and whom it could benefit. She did state that in order to qualify for hospice an individual is expected to die in 6 months or less. But she added that some patients have been in hospice for a year or more. And in some cases they have improved so much they are taken off of the program.

    I learned that Medicare would pay for an upgrade to her wheelchair that would make her much more comfortable and provide for any other medical equipment she needed. A nurse would be assigned to her who would monitor her condition weekly, review her medications and report back to us if any changes in her condition occurred. In addition a home health aid would visit her three to four times a week to bathe her or provide any other personal care that would benefit her.

    She would be assigned a social worker that could assist her and our family with any emotional support that was needed. An experienced physician would participate in the development of her care plan and oversee her medical regimen. And all of these services would be fully covered by Medicare.

    Within two days the nurse had visited her, made specific recommendations to changes in her meds and brought in a new mattress and a more comfortable wheelchair for her. I was amazed at how quickly she went into action and how knowledgeable she was about the aging process.

    I had noticed for a few months that my mother had deteriorated significantly but I wasn’t sure how to deal with this and who to talk to. The hospice nurse made it clear to me she was available 24 hours a day, seven days a week if I had any questions or concerns. I immediately felt much more comfortable knowing that someone was watching her situation closely and would be available whenever we needed her.

    If you have a family member who is beginning to show signs of slipping away I would recommend strongly that you find out more about the hospice program and have a hospice nurse visit you to answer your questions. In most cases she will do an evaluation of your loved one at no cost. The website for the National Hospice and Palliative Care Organization will help you find a hospice organization in your area.

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    Thank You, Hospice!

    In my last post I mentioned a conversation the medical director of my mom’s assisted living residence had with me. She suggested we enter mom into the hospice program. With some trepidation I agreed and met with the hospice nurse who very gently described to me the program that would follow.

    She informed me that a hospice aide would visit with my mom several days a week to help her in any way needed. She, as the assigned hospice nurse, would check in with mom weekly and give me an update. In addition Medicare would provide her with a much more comfortable wheelchair and mattress for her hospital bed.

    I stopped in to see my mother one day when the hospice aide was with her. The aide had gently combed her hair, put cream on her dry skin and dressed her in a lovely dress with matching scarf and earrings. She looked beautiful. The aide commented on what a lovely woman she was.

    After a number of visits in the following three weeks,I could see that my mother was failing. She had a hard time speaking a full sentence, was asleep most of the day and was becoming increasing unresponsive.

    On Sunday morning, November 30th I received a call from the residence that mom was totally unresponsive and was taking rapid short breaths. I called the hospice nurse, picked up my daughter, who was visiting with us, ( my wife was away at a conference) and rushed to the residence.

    The hospice nurse on call arrived before we did. He had given mom medication to ease her pain and make her more comfortable. He assured me that he would be available all day to help in any way needed. It was clear to me that the end was near.

    My daughter and I spent my mom’s last hours with her. She passed away in comfort, in her own bed, holding my hand. I could not have asked for better circumstances for my mother to leave this life.

    A few days later, I though about what would have happened if mom was not in hospice. She would have been transported to the emergency room in an ambulance. A number of nurses and doctors would probably go into action trying to keep her alive. She would die in strange circumstances amidst all the noise and activity of the emergency room, with my daughter and I witnessing her demise from the background.

    Thank you, Broad Reach Hospice for making the end of my mother’s life, gentle, loving and peaceful.

    High Tech Health Care for Boomers

    As I stated in my book, Passing the Torch, Critical Conversations with Your Adult Children, care for seniors will change dramatically as more and more baby boomers join the retiree ranks. Most boomers never want to go near a nursing home and are very averse to ultimately living in a traditional assisted living residence.

    Research has shown the boomers who will need long term care want to stay in their own homes. They don’t want to be shipped off to some institution. But the problem will be finding the people to provide the care for them at home. The pool of available family caregivers is decreasing as more families require two full time incomes to meet expenses. The daughter or daughter-in-law that you traditionally relied on to take care of mom or dad just can’t do it anymore. She is working full-time as as well as taking care of her own family.

    The alternative is to seek home care aides who work independently or through a home care agency. But these people are generally underpaid, not respected and aren’t rewarded for outstanding performance.

    But now the high tech industry is stepping in to provide a better solution. Seth Sternberg, with the help of Marc Andreessen, Apple stores creator Ron Johnson, former Sen. Bob Kerrey, Yelp CEO Jeremy Stoppleman, Facebook CTO Mike Schroepfer, PayPal co-founder Max Levchin and a long, long list of notable Silicon Valley entrepreneurs and investors has created a firm called Honor.

    Honor will create an online marketplace. Caregivers will be able to list their qualifications, skills, hours they’re able to work and distances they’re willing travel. Seniors will specify the type of help they need, the hours they want and important personal details — that they only speak Mandarin, or that they have cats, or that they live in a multi-story unit. Honor will match caregivers and seniors accordingly, with final approval of the match in the hands of the seniors and their families.

    Honor will also give seniors a custom-built, easy-to-use touchscreen appliance where they will be able to update caregivers on any changes in their needs or condition, so the caregivers will be better prepared when they walk in the door. The devices will also be used to record what services seniors received and for how long, and to allow them to rate the quality of care. Authorized relatives will have access to the information, so they’ll be able to monitor the situation.

    The difficulty for Honor will be to recruit the right people to provide home care services and pay them a reasonable wage. Let’s face it, taking care of elderly, incapacitated people is not an easy job. Honor has brought in Phaedra Ellis-Lamkins, a respected former labor organizer from the South Bay and CEO of an anti-poverty organization, to begin recruiting workers in the San Francisco area. We will keep an eye on this program to see how it develops.

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    PERMISSION TO REPRINT:
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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.