Re: [QUAD-L] Homecare through Medicare

[David K. Kelmer]

Hi Lori,

 

From the 'Medicare Rights Center.' http://www.medicarerights.org/glossaryframeset.html

 

Homebound: A person whose condition is such that there exists a normal inability to leave home, and leaving home requires "a considerable and taxing effort. A person does not have to be confined to the bed to be considered homebound by Medicare. Leaving home for short periods of time for special non-medical events, such as a family reunion, funeral or graduation, would not exclude someone from being considered homebound. A doctor must certify this condition.

With Love,

CtrlAltDel aka Dave
C4/5 Complete - 29 Years Post
Texas, USA

Lori Michaelson <[EMAIL PROTECTED]> wrote:

Ya...... that stupid requirement IS still in effect.  Dumb!  Send out help to get you up to go nowhere.  And, yes, people were grouping and lobbying to remove this rule "yrs" ago.  I guess to no avail.   Yes, we go places.  We just don't tell.  You know how we all have to 'play the game' some how.  Like Medicaid-eligibles having to hide money, etc.   Lori   -------Original Message-------   From: Eric Olson Date: 07/10/05 12:55:19 To: Lori Michaelson Subject: Re: [QUAD-L] Homecare through Medicare   Lori, What about the home bound rule.  The PDF makes it sound like you can rarely leave.  You and Dave still go places don't you.  Wasn't there a push to get rid of this rule at one time?  Anyway, I think this guy that's looking for this information can drive.  Lori Michaelson wrote: Below is the conversation between me & Dave.  Dave FORTUNATELY chooses AND HAS family help him w/ his routine.   I think I'm the only one on this list whose income is above the eligibility for waivers and Medicaid yet NOT ENOUGH to hire an aide for all my needs. Ya gotta be rich or poor or you're crewed!   My spouse does help when he HAS to but he did not sign up to be my caregiver.  Nor SHOULD he be.  The marriage relationship should be separate from the home caregiver one.   It takes its toll on the "other" over time.  From intimacy to overall well-being.  See WWW.THEFAMILYCAREGIVER.ORG   But I DO have Medicare.  Medicare aide help was easy to get till 1999 when the gov't changed it's payment SYSTEM to agencies.   So NOW (because of the change) agencies don't want long-term cases and cases like quads where the aide has to WORK a little.  They want short-term old folks.  Long story.   I've been fighting for my daily eligibility for 5 yrs now.  In fact I recently turned in my home care agency for causing me so much hassle.    Why not go to another agency?  Now THEY ALL say verbatim "We don't have the staff of resources to help you."  It's all abt money.   In fact most all MediCARE agencies have done away with aides altogether since the payment change.   "Skilled nursing need" --->  indwelling foley catheter, wound, OT or PT, etc.  It's my foley that "makes me eligible" for aide service.   Ok here is the scoop including online resources:   Yes, Dave, "Home Health Aides ARE directly linked with "skilled nursing need."  I have a foley catheter 24/7 so THAT fits the bill.  I thought afterward that YOU might not have a foley.  Therefore, unless you have a wound or other skilled-nursing-need then you're up a creek getting aide help via the agency.   Getting nursing help, supplies, etc is no problem but it's billed differently so money talks!   What is online for the general Medicare handbook is identical to the online one.  You have to request other publications if you want them.  I didn't even know about the one on Home Health Care SPECIFICALLY until a rep told me about 6 yrs ago.   At least it's in writing in THAT booklet on page 12 that those with skilled nursing needs ARE INDEED eligible for the hours.  Why the agencies make it a nightmare is criminal.  Greed but still!   Lori -------Original Message-------   From: David K. Kelmer Date: 06/06/05 15:11:28 To: Lori Michaelson; Quad Subject: Re: [QUAD-L] FOUND IT! - Medicare & Home Health Care   Hi Lori,   It looks like the ''aide'' care is tied to the ''skilled nursing'' care.  home health aide services on a part-time or intermittent basis. A home health aide doesn’t have a nursing license. The aide provides services that give additional support to the nurse. These services include help with personal care such as bathing, using the bathroom, or dressing. These types of services don’t need the skills of a licensed nurse. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury. pg 13 I would think a SCI would require skilled care so the aide services should be allowed too.    With Love, CtrlAltDel aka Dave C4/5 Complete - 29 Years Post Texas, USA Lori Michaelson <[EMAIL PROTECTED]> wrote: Ok, Dave I see the "regular booklet" is vague on pages, 19, 25 and 41-42.  But is specified in another booklet.... read on ....   I know I'm not going crazy.  At one time I requested their booklet on "Home Health Care" and maybe it was in there.    FOUND IT! Page 12 on this site http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=10969   I quoted it below in big purple letters (below).  I knew I wasn't crazy!  :-)   Ok..... as a start this info though .........   "Some home care can only be given by licensed health workers, such as if you need skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) or a licensed therapist. Remember, Medicare only pays for home care if you meet certain conditions. For more information, look at the Medicare booklet, Medicare and Home Health Care. You can also hire a home health care agency for care in your home if Medicare doesn’t cover it. In this case, you will need to pay for this care on your own. Home care costs can vary depending on where you live, the type of care you need, and how often you need care. Usually home care is charged by the hour. To locate home health agencies that provide services in your area, look at Home Health Compare on this website. You can also look at the National Association for Home Care website to get information about home care and hospice. This website includes information on how to find a home care or hospice agency and how to prepare for care. The following home health services may be available in your community: Skilled nursing care Homemaker/Health aides Personal care aides Respite care Medical equipment Home repair and modification Hospice " I found at http://www.medicare.gov/LongTermCare/Static/HomeCare.asp  ..  AT LEAST it DOES SAY Health Aides and PCAs.   ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------   The Medicare and Home Health Care booklet is clickable above.  When AT it note that page 9 says what your agency must provide and guides you to pages 19-20.   The 4 criteria to get home health is stated on page 11.  I meet all four as I have a foley cath as my "skilled nursing need." Page 11 begins describing number of hours as well.   PAGE 12 says home health aides or nurses LESS THAN 8 HRS A DAY!  And 28 or fewer hours each week.   "Based on your need for care, on a case-by-case basis, the weekly total may be increased to up to 35 hours."     My needs remain the same and I'm only asking for 10 hours a week.  My Dr writes the orders and they should be followed.   Lori One who refuses to let these well-paid services I NEED and AM ELIGIBLE FOR be taken care of!  People doing their job ... imagine that!!!       -------Original Message-------   From: Eric Olson Date: 07/08/05 13:10:58 To: quad Subject: [QUAD-L] Homecare through Medicare   Lori and Dave K,   What was the final word on getting home care through Medicare?  A woman my fiancee works with has a quadriplegic husband.  Currently, he is covered under her insurance which provides no home care and she is getting burnt out.  So, they were wondering about him switching to Medicare so she could get some help.  What do I tell them?  I thought something was said about 25 hours /week supposedly if you had a skilled nursing need.  What qualifies as skilled nursing?  He has a supra pubic.  Where is this in the Medicare handbook?  Who should he contact? Is any of this information on the web somewhere?  Thanks