Friday, May 22, 2009

Are You Confused by What Medicare Pays for?

Many people are confused about homecare and home health care, facility care and what Medicare pays for. The distinction was made in my previous blog "Senior Care Options and Tips", but I will go into greater detail and help you understand the senior care maze that is so frustrating to seniors and their families.

More and more seniors are choosing to stay home and receive care rather than move to a facility. Care is costly no matter which you choose.

Families are generally unaware that Medicare requires a minimum hospital stay of 3 days before they will cover any care in a rehabilitation or skilled nursing facility. If a beneficiary has met the minimum inpatient hospitalization Medicare will cover up to 20 days in a skilled facility. The patient will then be responsible for $128/day for days 21-100. After 100 days patients must pay 100%. If a patient has not been hospitalized for at least 3 days, Medicare will not pay anything for a long term care facility. Medicare will pay for Home Health Care following a change in health status, or discharge from the hospital. To obtain Home Health, you need a physicians order, you must be homebound, and in need of skilled services such as a nurse or physical therapy. Home Health is temporary and limited by Medicare guidelines. It is based on a 60 day certification period. If Home Health is ordered by the physician it will be set up based on 60 days of intermittent visits. The criteria of what care can be received is very strict, and the goal is to decrease visits toward the end of the 60 day period. Some patients may be re-certified for an additional benefit period, but the physician and Home Health professionals must prove an ongoing need. Just as Home Health can be extended, it can also be cut short.

Home Health agencies are limited in the care they can provide covered by Medicare. They cannot provide "Custodial Care", meaning they are unable to assist with ADL's (Activities of Daily Living). Bathing and grooming are considered ADL's and can only be provided by home health if another professional service is necessary and in place, such as a nurse, or therapist, and even then it is very limited to the number of days a week. Home Health cannot provide assistance with meals, medication reminders, housekeeping, laundry, transportation, or errands. They cannot stay with a loved one to keep them safe. The visits are typically 45 minutes to one hour, and the agency must be Medicare certified. For detailed information on Medicare and Home Health, as well as how to decide on an agency, what to expect, and checklists for care, go to

Families are caught in care crisis when their loved one hasn't been hospitalized 3 days, which is becoming typical, they are running out of skilled facility days, or their home health is ending. All too frequently patients are discharged with significant needs that family members don't know how to handle. They are weak, frail, sick or injured. They are trying to figure out how to obtain care at the most reasonable cost.

This is where Visiting Angels can assist at a cost effective price. We care for clients ranging from companionship to total care, for up to 24 hours a day, every day. When I make a home visit to meet a client and family, I assess the person, family, and household as a whole. Not only do I assess for the services we provide, Companionship, Hygiene, Meals, Light Housekeeping, Medication Reminders, Transportation, and Errands, but I also assess for Safety, Equipment, Home Health, Home Physician, and Support needs. Patients are being discharged from hospitals everyday without resources, or information to care for their particular situation. With 30 years experience in senior care and advocacy, I am able to assess, inform, and help set up equipment and additional services to provide the best quality of life at home, with trusted and reliable companies available locally. Most of the equipment and additional services are covered by Medicare.

A typical situation I may assess would be a patient that has just been discharged from the hospital following a fall. They have not been hospitalized for 3 days, and cannot afford a rehabilitation facility. The patient is weakened and unsteady, as well as additional health concerns by the family, such as memory loss. The patient either lives alone, with a spouse or with one of their adult children. The patient is unsafe alone, and the family works or the spouse is unable to care for their loved one. Immediately I know they would qualify for Home Health Care based on the client's recent debilitated condition. They have several safety hazards, and lack the equipment that would further risk their safety. The family is newly dealing with memory loss, is worried, saddened and unsure what the future holds. The emotions are difficult enough without having to investigate all of the options, what is covered, and which companies are good.

In this scenario we would initiate our services so the client/patient is not alone, is being monitored and provided assistance with bathing, meals, medications, light housekeeping, and laundry. It has become much too difficult to get their loved one to a physician, so I inform the family that local homecare physicians can relieve the worry of transporting their loved one, and Medicare will pay. With the care recipient’s recent decline, I offer to initiate Home Health services with a known and trusted provider, for physical therapy and Medicare will pay. I educate the family on safety risks, and recommend some equipment, such as a hospital bed, shower chair, bedside commode, and toilet riser, and inform the family that Medicare will pay for some of the equipment, but I will have a trusted provider contact them to discuss the details. In my assessment I find the client has been diagnosed with early Alzheimer’s so I encourage the family to get assistance and support from the Alzheimer’s Association, so they have support, information, and can learn techniques to benefit their loved one, as well as provide a better coping mechanism for themselves.

All of the services and equipment that we been initiated is at minimal cost to the client and family compared to the cost of repeated hospitalizations, and facility care. The client is monitored closely in their home, they are receiving therapy to improve their strength and balance, and a physician is regularly visiting and available for extra visits if necessary. Lab work is handled in the home as well.

Can you see the relief we bring families? Can you see the coordination of services that can help improve health outcomes?

Visiting Angels is here to help and we pride ourselves on our client’s and families selecting their caregiver prior to service so everyone is comfortable with care. It is our honor and pleasure to bring this relief to families in our community. The Medicare Benefit Guide for 2009 can be found at

For a Visiting Angels office near you visit


  1. Thanks for sharing this. I'm part of what you described as "generally unaware that Medicare requires a minimum hospital stay of 3 days." My parents were hospitalized when I was in high school but never for more than 2 days, so maybe that's why they weren't covered.

  2. The answer to your title: YES. I was confused. That's why I'm doing a bit of research now. Thank you for explaining things! Like your previous commenter, my sister was hospitalized for a week and was covered, then another relative was hospitalized for a shorter time and didn't get covered.

  3. It is good that this resource is out there for the ill educated when it comes to medicare coverage. It has become an increasingly important subject in the care of seniors. Not many know what is covered and what isn't, and how they go about doing it. I like how you lay out what a caregiver does and how this can be in harmony with Physicians, PT's, OT's.

    As always, good job!!


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