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I'm posting this here because it may be welcome news to some board members.

http://www.elderlawanswers.com/courts-reject-39urban-legend3...



Courts Reject 'Urban Legend' That Medicare Nursing Coverage Requires Improvement

In welcome news for seniors and the disabled with chronic conditions, two federal courts in the past two months have ruled that Medicare's coverage of skilled care does not require a beneficiary to show improvement. Instead, both courts said that Medicare can pay for skilled care if it is needed simply to preserve a patient's current functioning or prevent further decline.

Home health agencies and nursing homes that contract with Medicare routinely terminate the Medicare coverage of a beneficiary who has stopped improving, adhering to what Medicare advocates have referred to as an "urban legend" that such beneficiaries are receiving "custodial care," which Medicare does not cover. These beneficiaries could include those with chronic conditions and disabilities like multiple sclerosis, Alzheimers disease, ALS, and broken hips.

In terminating coverage, the Medicare contractors are not following the Medicare statute or its regulations, neither of which says improvement is required for continued skilled care....
[end quote]

This is very important because skilled home care can maintain a chronically ill patient in a stable condition, while they could decline into an emergency with lack of care.

Wendy (cross-posted on METAR Board)
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Thanks Wendy, that is interesting, at least for those of us with parents at that age.

I wonder how they distinguish between "custodial care" and skilled care . . . needed simply to preserve a patient's current functioning or prevent further decline. That seems to be a pretty grey distinction, and also wondering about how this would affect the long term viability of medicare.

My interest comes out of my experience with my mother. She was not able to manage her physical therapy after a fall last spring that broke her hip. When she was not able to make any progress, she was told that she would be "self-pay." She was only self pay for a day and a half before they readmitted her to the hospital where she stayed until she died some 45 days later.

I thought it odd that Medicare and Blue Cross paid 100% of her hospital costs for a month and half, but she was self pay at the nursing home. The hospital was probably a magnitude of 20x the cost of the nursing home. She didn't have enough money to self pay for 45 days at the nursing home but had good insurance that covered her stay at the hospital. An odd world.

Eldercare and the costs are staggering.
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Wendy ~

This post is very welcomed by me since I am the sole caregiver of my dear 89 year-old dad. Thank goodness we live together or this, truly, would be impossible.

I have been told that some of his physical therapy had to be stopped because he had gone as far as he could. It is hard to get him to continue
the exercises because they are so tiring. He seems much more willing to do them for the PT than for me or just himself.

He is in the hospital for the second time in less than two weeks. Twelve days ago he fell (yet again) and I had to call 9-1-1 because I simply could not get him up off the bathroom floor and he was wedged in between the commode and bathtub. He had hurt his left thigh and was in a lot of pain. Late Wednesday I took him back to the ER because I detected a worsening Pneumonia in his lungs and I was right. He has a tendency to turn quickly and he wasn't getting better with the antibiotics. Seems he also has fluid in his lungs and we are working on remedying that with adding a product called "Thick-it" to his liquids to make them more the consistency of nectar.

So, all this round about chatter to say that I appreciate you sharing what you have learned. I will keep that info and present it if I have to. I wonder if it includes getting a home health aid so that I can leave the house?

Robyn
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also wondering about how this would affect the long term viability of medicare

While most of us would probably want to stay in our own homes for as long as possible, I think in the next 20 years as the large baby boomer population reaches the high scale of the elderly years, we're going to see that the rest of society cannot afford maintaining so many others to live in homes they no longer can do so without dependence on others.
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<I wonder if it includes getting a home health aid so that I can leave the house>

Medicare has lists of types of caregivers. The new ruling covers "skilled" care, which I think means nurses and physical therapists but not home health aides -- but I'm not sure.

Since you have a very active situation with your father, you would really benefit by researching this thoroughly because that knowledge can help you find and use all the available resources.

Please report back to the LBYM Board when you find out because many people here have similar situations, either for themselves or family members.

I'm sorry to hear about your Dad's serious problems. It's very stressful for you.

{{{Robyn}}}

Wendy
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<While most of us would probably want to stay in our own homes for as long as possible, I think in the next 20 years as the large baby boomer population reaches the high scale of the elderly years, we're going to see that the rest of society cannot afford maintaining so many others to live in homes they no longer can do so without dependence on others. >

This issue is the most challenging facing the U.S., Europe, China and Japan over the next 30 years.

With so many elders and a smaller younger cohort, who will take care of the elders? Who will pay for their care? Especially those who do not have family caregivers?

The U.S. has designed a system where emergency rooms must treat all comers, regardless of ability to pay. This is the most expensive type of care.

Nursing home care is very expensive, though less expensive than hospital.

Assisted living is less expensive than nursing homes.

Living at home, with some help (dependent on others for major tasks such as shopping, cooking and housecleaning, but still able to do personal care such as taking a shower) is less expensive than assisted living.

The longer they can stay in the least expensive domicile, the less they will cost society.

Millions of elderly people (most of them women, many of them poor) will not have family to care for them. Most, if not all, will eventually need some kind of assistance.

Should they be allowed to die? If not, what is the most economical way to keep them alive? The most economical way is to purchase the least amount of assistance commensurate with their needs.

Medicare skilled home care actually saves money because it maintains stability at home. If the person does not have the care, they can have a health crisis that will require expensive emergency care, often followed by expensive hospital stays and expensive rehabilitation.

Once society makes the commitment to keep people alive, the most economical way is by maintenance in place.

I am not disagreeing with you. I'm just pointing out that the fundamental choice is life and death...and everything flows from there.

Many societies in history chose to save resources by abandoning or even killing and eating their elders.


Wendy
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Dear Robyn,
I'm SO sorry to hear about the difficult time you are having with your father and his recent fall. Here I have been piddling around, whining into a cup of coffee, as we move into our sixth week, and you have had a tougher time than I have.

But until you can do more along the Medicare lines, let me tell you about Jewish Family Service.

I looked them up and you have JFS in San Diego.

Here, in the Bay Area, you don't have to have a drop of Jewish blood ANYWHERE, not even your little toe, to use any of their services.

My daughters insisted I get some of their "Seniors at Home" service.

So Mondays and Thursday afternoons, 1-5p.m, a big husky Filipino guy called Manny, comes to give David a more professional bed bath, a decent shave, (not D's left-handed one!) get him out- side in the wheel chair, change the sheets ,do DAvid's laundry, clean his little bathroom,( not that David can use it because he can't,) wipe down the trolley of his "stuff" beside his bed, and generally do whatever is needed. So little is needed that Manny actually sits around quite a bit and reads or feeds the ducks outside our house, but the fact is, I get out for 4 hours, I feel David is very well taken care of, and we both enjoy the break. I do those same tasks daily, except taking the wheel chair down the steep ramp to get outside.

We called JFS. They sent a supervisor to meet David and to see what was needed. They inspected my housekeeping (which is not good!!!), but they saw that basically I need someone to help lift David, or handle the big casts right now. We listed possible tasks, it costs $25 an hour, but nothing else, no transport, no gratuities...nothing..for a person who is vetted and employed not by us, but by JFS. He is also insured to drive David in his ,or my, car, should the need arise.

Yes, it is $200 a week for 8 hours, that we were not paying before, but we don't go out now, we aren't shopping much, no theater, opera, no driving the car, no car insurance on the car that was totalled etc so for us it is worth it. Each person's budget is different.

My daughters were right. Last week, the first real week of Manny's help, I got to have my hair done, go to my own doctor, poke in the plant nursery, and all the time I felt good. David was safe and comfortable. ( He is embarrassed doing awkward bathroom stuff in front of his daughters tho they would help more if he let them)

So may be you could check out JFS just to get one or two breaks. I think there is a 4 hour minimum. You certainly deserve it.

I remember your implying your father had a lot of activities he was still interested in, a while ago, so possibly like DAvid, he has become a bit depressed about being so dependent, and that means he is less himself around you. ....

I warmly recommend trying JFS..and if they don't work there is something called Bright Star who also was willing to do the same tasks for us..with vetted employees. This is all until you get more help from Medicare. We happen to feel that David's situation is temporary..until the ribs heal, the casts some off and he can begin therapy. For others things may take longer.

Please keep us informed, or write to my e-mail. Once again, I am truly sorry I didn't know that you too, were having a worrisome time.

Big Momma
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In our mobile society, often times children are working far away from their aging parents and can't help care for them. Both nursing homes and assisted living places will face a capacity problem when baby boomers require those services.

The optimal solution is home care.
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The optimal solution is home care.

I don't see home care as "optimal" to society if you think of the logistics of home health aides having to drive to disparate homes in the suburbs - how many patients could they actually see? "Optimal" to me would be more shared or community living - whether in a home "Golden Girls" style, or maybe retirement communities will become more popular.
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The optimal solution is home care.

Unless you need the equity to pay for the care.

Both nursing homes and assisted living places will face a capacity problem when baby boomers require those services.

The assumption that everyone will require these services is false. Maybe it's time for 50+ people to plan and work not to need them.

Both concepts are from life, not an article I read.
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The assumption that everyone will require these services is false. Maybe it's time for 50+ people to plan and work not to need them.

Both concepts are from life, not an article I read.



It isn't that easy. Age and past head trauma are the greatest risk factors for Alhemizer. There are no life style changes that are known to make a difference.
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It isn't that easy. Age and past head trauma are the greatest risk factors for Alhemizer. There are no life style changes that are known to make a difference.


Or you end up with something like Parkinsons, which my mom has.
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