Show #343 Airing Sunday, 5/28/06
If you or a loved one needs care at home, Medicare might cover the costs. How can you know if you qualify, and what services are available? Here to explain is Susan Galli, business development manager for the Visiting Nurse Association of Cleveland.
Question: Who is eligible for home healthcare services under the Medicare benefit?
Answer: There are three qualifications:
- First, an individual must be homebound (have a difficult time leaving home or it takes a taxing effort to do so). For example, an individual may have difficulty walking and use assisted devices such as a walker, cane or wheelchair. Shortness of breath may be another qualifier for homebound status.
- Second, the person must be under a doctor's care, as homecare services require a doctor's order.
- Finally, they must need skilled intermittent nursing or therapy care.
Question: What qualifies as skilled nursing or therapy care?
Answer:Skilled nursing services can refer to services such as diabetic education and teaching for people who require medications, wound care, post-surgical care.
Help with therapy can include rehab after a total hip or knee replacement to help a person get walking again, rehabilitation following a hip fracture, or just general conditioning and strengthening to improve a patient’s endurance.
Question: How do you choose which services and provider that's right for you?
Answer: The first thing to do is educate yourself. Talk to your doctor. Attend a senior health fair and gather literature. Choose brochures about homecare organizations at your local senior center, and check out their websites. Evaluate what services are offered and how long the agency has serviced your community.
Look for an organization that has a full line of services. A continuum of care (skilled nursing/therapy care, special care/ hospice services as well as personal care assistance).You will have the best opportunity to receive continuity of care along with the highest quality of care if you choose this type of homecare provider.
Under Medicare law you have the right to choose your homecare provider. Even if your doctor recommends an agency, or you are being discharged from a particular hospital system, the final decision is yours.
Question: Once you've made your decision, how do you access those services?
Answer: You can call direct to the homecare agency. At the VNA we have nurses who answer our central intake phone lines and would be able to assist you with your questions and needs.
You can call your physician and request a homecare referral to the agency of your choice.
If you are hospitalized, in a nursing home or assisted living setting, the VNA has a service that allows, free of charge, a nurse coordinator to come on-site and assess your qualifications and needs for homecare. This service would take place after you have chosen VNA as your provider. Our goal at VNA is to keep our patients healthy, safe and independent at home.
Question: Does a home care agency need to be Medicare Licensed or approved?
Answer: Yes. Medicare and Medicaid approved.
Question: If services are covered b Medicare, are all costs paid? Are there co-pays or deductibles?
Answer: Medicare pays for home health care if qualifies. Medicare pays full amount. No added charge.
Question: How long will Medicare cover?
Answer: It is based on individual need. If you meet the qualifications, and get Medicare coverage, it could be years.
If you're homebound, you might be eligible to receive Medicare covered home care benefits. "Home" in on the answers you need, give the Visiting Nurse Association a call. My thanks to Susan Galli.
