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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
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Since there are so many different answers below and I don't understand Medicare Advantages all that much, I would talk to the Homecare Service the doctor recommends. They should know who pays what. You may end up owing a small amount after Medicare and your suppliment pay their share.
But in my experience with straight Medicare, they pay for Homecare PT/OT, an aide for bathing and an RN to check vitals and do blood draws. A nurse will come to admit the patient so ask questions then too.
Traditional Medicare pays 100%. Your doctor may have a HHC company already established that he gives the order to. Or you can choose a HHC company that you want to use. Perhaps you know someone who is happy with theirs and is already in your area. Call them and discuss your LOs situation. (You can find a list on Medicare.gov and see how they are rated). They will communicate with the doctor for you. It’s what they do. We choose our company because we knew one of the RNs. My mom needed all the services you mentioned. She had them about 6 years. When my aunt (92) needed HH I called the same company. They have been with her about that long now. While both of them had/have great Medigap policies, Medicare pays 100%. I have no personal experience with the advantage plans or Medicaid. EDIT: oh and they DO pay for an aide (CNA) to come twice a week. In my mom’s case they came three times a week. My aunt, only twice. They did make some comments about stopping the bathing (a couple of years ago) because they were worried about changes they had heard rumors about within the program. They didn’t stop. Also when I hired someone to cook they made sure that person wasn’t there to bath aunt. I assured them they weren’t qualified to do that and we got past that hurdle. Over about a 10 yr period that’s the only deviation. They have never said the nurse would stop. But it is an individual matter. Really depends on your LO’s needs. There is a sweet spot where the service is available for those who meet the requirements. People have different experiences. I’m not sure why. But the HHC will know if your LO meets their requirements physically and if your insurance will pay. The nurses or CNAs, or even the therapist, don’t always know about Medicare regulations, again that’s just been my experience. There is a LOT to learn with Medicare.
The member’s insurance company. You may have to make sure he has coverage by calling his insurance company as well. Also if he has a Medicare Advantage Plan he will need to be placed in an “in-network” cardiac rehab center. Any non in-network cost is the patients responsibility.
Medicare will pay for 21 Days of INHOME care after one gets Home from the Hospital. After this, You will either have to Pony up the Pay to keep your Caregiver or Go into a Facility.
Respectfully this is not correct. The 21 days are the amount Medicare pays 100% of in patient rehab; day 22 there is a share of cost with Medicare and whatever the secondary policy will pay. This may cost the patient money out of pocket as well if their insurance doesn’t cover 100% of the 20% Medicare will not pay. As for in home care the length of visits/time Medicare covers is usually not more than 60 days but depends on acuity. If the patient reaches criteria for discharge from homecare services before this, which is the norm, they are discharged from HC services by the RN. PT can still stay in the home if the person is making progress but not more than 60 days. There is a process for recertification but this has to be proven to be really necessary. Homecare staff visits average 30 minutes to 1 hour. They are not in the home to provide 24 hr care.
Go to the Medicare web sight and you can find your answer. When my wife was coming home after she had surgery. She has traditional Medicare and the length of time in a Rehab hospital was limited to 21 days. It can get complicated so the social worker at the hospital, they most everything about Medicare, might be a help also.
The limit is 100 days but Medicare only pays 100% the first 20days. 21 to 100 days is 50% with maybe supplimental paying some. My Mom paid $150 a day some yrs back.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
But in my experience with straight Medicare, they pay for Homecare PT/OT, an aide for bathing and an RN to check vitals and do blood draws.
A nurse will come to admit the patient so ask questions then too.
Your doctor may have a HHC company already established that he gives the order to. Or you can choose a HHC company that you want to use. Perhaps you know someone who is happy with theirs and is already in your area. Call them and discuss your LOs situation. (You can find a list on Medicare.gov and see how they are rated).
They will communicate with the doctor for you. It’s what they do. We choose our company because we knew one of the RNs.
My mom needed all the services you mentioned. She had them about 6 years.
When my aunt (92) needed HH I called the same company. They have been with her about that long now.
While both of them had/have great Medigap policies, Medicare pays 100%.
I have no personal experience with the advantage plans or Medicaid.
EDIT: oh and they DO pay for an aide (CNA) to come twice a week. In my mom’s case they came three times a week. My aunt, only twice. They did make some comments about stopping the bathing (a couple of years ago) because they were worried about changes they had heard rumors about within the program. They didn’t stop.
Also when I hired someone to cook they made sure that person wasn’t there to bath aunt. I assured them they weren’t qualified to do that and we got past that hurdle. Over about a 10 yr period that’s the only deviation. They have never said the nurse would stop. But it is an individual matter. Really depends on your LO’s needs. There is a sweet spot where the service is available for those who meet the requirements.
People have different experiences. I’m not sure why. But the HHC will know if your LO meets their requirements physically and if your insurance will pay.
The nurses or CNAs, or even the therapist, don’t always know about Medicare regulations, again that’s just been my experience. There is a LOT to learn with Medicare.
As for in home care the length of visits/time Medicare covers is usually not more than 60 days but depends on acuity. If the patient reaches criteria for discharge from homecare services before this, which is the norm, they are discharged from HC services by the RN. PT can still stay in the home if the person is making progress but not more than 60 days. There is a process for recertification but this has to be proven to be really necessary.
Homecare staff visits average 30 minutes to 1 hour. They are not in the home to provide 24 hr care.
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