My mother fell over a year ago and was in the hospital for months. She was released to a rehab facility for OT only to be back in the hospital less than 2 weeks later due to dehydration and a severe UTI. She was then released again to another rehab facility. Days before being released, we found out she had been lying about her progress. She still couldn't walk on her own. We brought her home to a hospital bed and in-home OT was prescribed and was beginning to work, but then we had to take her back to the hospital for another pesky UTI. I thought she had completely lost her mind...seeing people, talking to them, asking where family members were that passed on more than 10 years ago. She was release to one more rehab facility. This time she was able to stay the entire prescribed time and then came home. Her health deteriorated at home to the point we thought she was near death. We had huddled around the bed to say our "goodbyes". Something told me to take her temperature and I found she had a fever. BACK to the hospital. FFWD 3 months. She is home now, we have been able to keep the UTIs away, but she lost so much weight and muscle that she still can't get up by herself. Her doctor asked Hospice to step in to help give me a couple of breaks during the week and we pay a sitter to be with her 3 days a week for 5 hours a day. We were told that Medicare wouldn't pay for in-home OT because we had "used it up" (that was 7 months ago). She is showing awesome improvement but I need someone "licensed" to help her gain strength and increase her walking ability again. Will Medicare pay for another round of in-home OT, even though Hospice makes weekly visits? Her "illness" is not terminal.
Hope everything works out as a win-win situation. Does your Mom still go out to restaurants and tag along for grocery trips?
E.g., given your mother's multiple setbacks yet forward progression now, that might be justification to extend the home PT/OT, IF that provision hasn't been changed or cut due to what is politely known as "sequestration".
I haven't checked the Medicare and You booklet for 2016, nor have I checked Medicare's website. But this possibility is something to pursue. You can also speak with her doctors.
Be persistent; you might have to keep with different doctors before you find one who's agreeable to work with you.
You might also consider choosing a hospital assisted PT/OT program; you would have to drive your mother there, if that's possible, but I've found them to be more flexible than private, commercial PT facilities which are more concerned that they'll be reimbursed by Medicare during extended PT.
"If you stop your hospice care, you’ll get the type of Medicare coverage you had before you chose a hospice program, like Original Medicare, a Medicare Advantage Plan (like an HMO or PPO), or another type of Medicare health plan. If you’re eligible, you can go back to hospice care at any time."
So, it looks like Hospice would have to stop, and the Medicare time-frame for benefits would have to have reset before they would pay for in-home OT again.
Pam, believe it or not, my sister instigated the Hospice by calling mom's doctor and discussing it. She is, relatively speaking, in great health. BP is good, no issues that stand out, other than those UTI's. The doctor admitted to us that he didn't know what else to try to ward them off so Hospice was called "so a nurse can keep a close eye on her and cut down the trips to the hospital". Mom hasn't had a UTI since she got home (knock on wood) and has recently begun TRYING to get back to a semi-normal life, (ie. going out to restaurants, tagging along on trips to the grocery store, etc. in a wheelchair). And believe me, I've been encouraging the behavior. She's getting stronger, there's no doubt. I just lack the specialized motivating and instructions to get her walking again. She also recently began walking with a walker, but I have to stand behind her as a safety net. Long story short, Pam, I hear where you're coming from, and I can respect that scenario. It's just not the case here. I know the Hospice nurse would agree because she told me that she that she wasn't really doing anything, just checking up each time. And the doctor has NEVER mentioned 6 months or less and, yes, I have seen that same time-frame, concerning Hospice, on the Medicare website.
Let me ask you this...Miracles happen. Is the government going to cease helping someone out with Medicare because they ended up SURVIVING or pulling through their situation? Seriously, I don't know. But I'm curious and WOULD like to know.
This sounds a lot like what happened to my Mom, she fell, went to Rehab, had a UTI, back to Rehab, but could not do any of the therapy as her brain just wasn't working correctly so she was transferred to long-term-care. My Mom also lost a lot of weight in the process, and Hospice was called in. My Mom also looked like she was improving, then out of the blue she was back to square one. Mom was on Hospice for a reason, the doctors/nurses and Hospice have seen this hundreds of times.
I don't believe if someone is on Hospice, which Medicare pays for everything related to Hospice care, that Medicare will also pay for occupational or physical therapy.
On Hospice there are no further interventions, no hospital or rehab, just comfort care at home. She is terminal. You are having a very hard time accepting that. Talk to the Hospice nurse about counseling for the family members.