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Medicare may cover home care for chronic illnesses

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
http://www.nytimes.com/2012/10/23/u...es-rules-for-some-medicare-patients.html?_r=0


Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicarecoverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration....

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
I'm not clear on what was happening to these people. Would they end up in nursing homes and did
Medicare pay for that ? Or in some cases, did they end up in hospice, because their condition was
terminal within x amount of time, and did medicare pay for that ?

Home care for the disabled is going to be very expensive. Not that going into a nursing home is a
good option either.

Tc .. X
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
No idea about where you are... here in Australia someone needing a lot of care (more then just gov paid home support hours.. dont you guys have agencies which do that where you are??).. sometimes young ones.. can end up in nursing homes, stuck there with just all the elderly. This is something which is currently trying to be changed. Ending up in a nursing home if I crashed extremely bad again, is one of my fears.
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
No idea about where you are... here in Australia someone needing a lot of care (more then just gov paid home support hours.. dont you guys have agencies which do that where you are??).. sometimes young ones.. can end up in nursing homes, stuck there with just all the elderly. This is something which is currently trying to be changed. Ending up in a nursing home if I crashed extremely bad again, is one of my fears.

Under the present rules (which is what has been overturned), you could only get home care if you were expected to get a lot better--in other words, fairly short term. Nursing homes are paid for (very poor nursing homes I believe) for those who have used up all there money, but that is a poor choice if you can be cared for at home. I think it is Medicaid that pays for nursing homes, not Medicare, but I am not sure about this.

When they have done cost studies, it was less expensive to supply home care (for the government) than to pay for a nursing home.

Sushi
 

Hope123

Senior Member
Messages
1,266
Under the present rules (which is what has been overturned), you could only get home care if you were expected to get a lot better--in other words, fairly short term. Nursing homes are paid for (very poor nursing homes I believe) for those who have used up all there money, but that is a poor choice if you can be cared for at home. I think it is Medicaid that pays for nursing homes, not Medicare, but I am not sure about this.

When they have done cost studies, it was less expensive to supply home care (for the government) than to pay for a nursing home.

Sushi

Yes, the majority of nursing home care is covered by Medicaid. Medicare only covers a few weeks usually following say a hospitalization and it's often for extremely specific reasons, like IV antibiotics or complex wound care. Nursing home care where you don't need specialized services but need help with washing yourself, meals, 24-hr. supervision, etc. is NOT covered. The problem is that nursing home care is extremely expensive in the US (on the order of thousands a month, even for poor care) so most people cannot afford it. Medicaid will only step in though when the person/ family has practically spent the majority of their assets and near poverty level.

Most people would prefer to stay home and, as Sushi says, there are studies showing home care is less expensive than nursing home. Supplying someone even with 10 hours of care X 5 days a week = 50 hours while their family works with the family taking over in the evening is much less than 24hour care/ 7 days a week = how nursing homes are constructed even if the person is sleeping and not needing anything.
 

Tammy

Senior Member
Messages
2,181
Location
New Mexico
Here in N.M one can qualify for the Disabled and Elderly waiver.....where you can get help with activities of everyday living for free. The waiting list is quite long. I got on the waiting list.......took 3 years and by the time they called me I was going through a relatively good period and hence turned down the help because I thought others worse off than me could use the help.......boy was that a mistake.
 

Vincent

Senior Member
Messages
126
Location
Baltimore, Maryland USA
Currently you can only qualify for a home health aide if you need skilled nursing care. It would be a godsend if they would change the rules and allow those of us, who can't take care of ourselfss to get the help we need.
 

sparklehoof

Senior Member
Messages
186
Location
North Carolina
Here in N.M one can qualify for the Disabled and Elderly waiver.....where you can get help with activities of everyday living for free. The waiting list is quite long. I got on the waiting list.......took 3 years and by the time they called me I was going through a relatively good period and hence turned down the help because I thought others worse off than me could use the help.......boy was that a mistake.
Hi Tammy,
I'm in RI and would be interested in getting on a waiting list. Could you share the details of how to apply? Thanks
 

Tammy

Senior Member
Messages
2,181
Location
New Mexico
Hi Tammy,
I'm in RI and would be interested in getting on a waiting list. Could you share the details of how to apply? Thanks
I am not sure what is offered in RI. You can google the disabled and Elderly waiver program for you state OR google the COLTS program.............that is what the program's name was changed to in the state where I live. You can also enquire at your local social services office...............this is how I found out about the program. My particular Medicaid that I have doesn't cover home-care so I had to go with this other program.
 
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