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Dana (C4-5, 31 years post, 51, kC)
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www.medicarerights.org | e-newsletters ![]()
Volume 4, Issue 31: Week of August 1, 2005
Welcome to Dear Marci, a free, weekly newsletter designed to keep you in the loop about health care benefits, rights and options for older Americans and people with disabilities.
Dear Marci is a service of the Medicare Rights Center (MRC) (www.medicarerights.org), the nation's largest independent source of health care information for people with Medicare. A national nonprofit founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
For reprint rights, please contact [EMAIL PROTECTED]
Topic of the Month: Long-Term Care
Long-term care, commonly abbreviated as LTC, refers to a range of medical, personal and social services designed to meet the needs of people with disabilities, chronic illnesses or ongoing limitations in their ability to function independently. LTC may be delivered at home, in a nursing home, adult day care facility or other facility. While Medicare does not pay for most long-term care needs, in the next five issues we will examine the coverage Medicare does provide through the Home Health, Skilled Nursing Facility and Hospice benefits.
Marci's Mailbox
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Dear Marci,
My mother recently qualified for Medicare and did not elect to sign up for Part B. She’s just gone into the hospital after a very bad fall and when she gets out, she’ll need help at home. Is she eligible for home health care?
–Heather (East Thermopolis, WY)
Dear Heather,Medicare provides coverage for home health care under both Parts A and B. Since your mother does not have Part B, she must complete a hospital stay of three consecutive days before she may qualify for home health care coverage under her Part A. (If you have Part B, you do not need to be hospitalized to qualify for home health care.)
In addition to having either Medicare Part A or B, your mother must meet a few additional requirements to be eligible for Medicare to cover home health care. She must:
* be homebound;
* need skilled care on an intermittent or part-time basis;
* get services from a Medicare-certified home health agency (HHA); and
* have a doctor's plan of care.Medicare defines homebound to mean that a person is generally unable to leave home and leaving home requires a “considerable and taxing effort.” Whether or not your mother qualifies as homebound is decided by a doctor’s evaluation over an extended period of time. Leaving home for short periods to get medical care or for special non-medical events, such as a family reunion, funeral or graduation would not disqualify your mother. Attending religious services or taking an occasional trip to the beauty parlor is also allowed.
Skilled care includes either skilled nursing care or skilled therapy services. Skilled nursing includes care from Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Skilled therapy includes care from licensed physical, occupational and speech therapists. Services covered include, but are not limited to, monitoring and evaluation, teaching and training, administration of medications, tube feedings, catheter changes, wound care, therapeutic exercises, gait training, and maintenance therapy.
Before your mother leaves the hospital, the hospital social worker or discharge planner should arrange for a Medicare home health agency to visit your mother and assess her condition to determine if she qualifies for Medicare-covered home health care. If your mother is found eligible, the agency will draw up a plan of care. This plan details the care she will receive and the frequency of services over the next 60 days. If your mother still meets the necessary requirements after 60 days, the home health agency can draw up a new plan of care.
As long as she continues to qualify, there is no time limit on the benefit under Part B. Under Part A, she would be limited to 100 visits. No matter which part you are covered under, Medicare pays the full cost of services.
Stay tuned next week to learn more about the types of skilled and unskilled care provided through the home health care benefit!
–Marci
Have a question for Marci? Click here to e-mail your questions . Please include your city, county and state of residence.
Spotlight on Resources* * * * * * * * * * * *
Use HOMECARE Online, the National Association for Home Care and Hospice Agency Locator, to access a database of more than 20,000 home care and hospice agencies. Qualifications, including Medicare and Medicaid certifications, are noted for each listing.
LongTermCareLiving.com provides consumers with guidance and information on nursing homes, assisted living/residential care and other types of long-term care.
For a general picture of a Medicare-regulated Intermediate Care Facilities for the Mentally Retarded (ICF/MR), visit MR/DD Living. Log onto Medicare for more background on this type of facility.Call your State Health Insurance Assistance Program for more information on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare.
Health Tip of the Week
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Did you know that after the age of 50, you should be ingesting an extra 200 mg of calcium per day? Older adults should aim for a total intake of 1,200 mg per day of calcium, a mineral needed by the body for healthy bones, teeth and proper function of the heart, muscles and nerves. Since the body cannot produce calcium, it must be absorbed through foods. Common sources of calcium include dairy products, dark leafy green vegetables, dried beans, nuts and calcium-fortified food like orange juice, cereal, bread, soy beverages and tofu products.
Low on calcium? Instead of milk, try eating a cactus pad! Edible cactus, also known as nopales (no-PAH-les), can be eaten raw or cooked and is typically available at Mexican grocery stores, specialty produce markets and farmer’s markets. While available year-round, this “vegetable of the month,” according to the Centers for Disease Control and Prevention, is in season from early spring through late fall. When buying, choose small, firm, pale green cacti with no wrinkling.
Cactus pads, which reportedly taste like a slightly tart green bean, are rich in vitamins and minerals and make a great addition to your meal. In addition to calcium, they contain beta carotene, iron, some B vitamins and are a good source of vitamin C.
Go online for a listing of foods and their calcium levels by the USDA.Click here for recipes including edible cactus.
Survey Says* * * * * * * * * * * *
According to the National Center for Health Statistics, in 2000 there were almost two (1.8) female home health care patients for every one male (877,900 vs. 477,400). In fact, women outnumbered men in every age range except for patients under the age of 18. The differences between the sexes are most noticeable for recipients 70 years and older.
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