Here is my principal objection to the way Medicare works. Nursing care, therapy and disability services are not covered unless the expectation from such care is to cure an illness or heal from an injury. Many seniors need care for conditions that are not expected to improve. I love those rare instances, when I can bring you good news.
Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration.
In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.
Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.
Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for skilled care… [emphasis added]
Inserted from <NY Times>
Photo credit: ElderCareAuthority
It may take over a year to implement the changes, but that’s expected. You can be sure of one thing. These changes would never take place under a Republican regime.
8 Responses to “Toward More Sensible Medicare Coverage”
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This is good news for us older folk- a lifesaver for some!
Exactly!
I know a bit about this since my father was going to go to a nursing home but died before he got that far.
First off, he wouldn't agree to going to the home so we would have had to go to court to override his wishes. That would take weeks anyway.
Second, we did have him switched to Medicaid in preparation for this. It wouldn't have cost anything. His whole last week in the hospital was in intensive/intensive care. Essentially, there's a little ward of about five rooms right behind the ER which is where they put people who are in too dire of a condition to even go to ICU.
This last week would have run into thousands of dollars. Bless the Social workers here that they got him transferred to Medicaid as of the day he entered the hospital. All of his care was paid.
When we were still under the idea of him on Medicare, it still would have cost $1000 at minimum ($250 per day for the first four days). We also were not sure, but thought there would be lots of other expenses because of where he was. The slate was wiped clean.
If, however, my mom did have to pay expenses for long-term care, there's an impoverished spouse part of Medicaid that doesn't allow anybody taking the home, most savings, or a vehicle from the spouse.
As it worked out, he died in the hospital so we didn't have to go through all that.
On the other hand, the lady across the street was not as low-income as my parents. She couldn't get her dying husband on Medicaid, so had to pay thousands she really didn't have.
If the Republicans EVEN THINK about getting rid of Medicare/Medicaid, there'll the a lot of seniors storming Congress with pitchforks and torches as soon as those assholes start taking away what they've come to depend on.
The problem is that it's now only a white-washed theoretical bunch of snake oil that older people don't understand the Republicans' desire to leave them homeless and destitute. Those are the freaking idiots like our across the street neighbor with his Romney/Ryan sign. I just want to go slap him around and scream at him how stupid he is. Not, however, a way to win hearts and minds. Gritting teeth until Obama wins on November 6th.
Marva, I so hear you. As one with COPD, I will eventually be facing such a scenario, needing long term care.
This is good news!
I find it appalling that individuals and/or families in the US can lose all their savings, their homes and virtually their lives because they experience a catastrophic illness or injury. And then to be denied coverage for the proper care under Medicare because there is no expectation of improvement . . . that is beyond words to me. I am glad I live in Canada.
As some know, my mother has Alzheimer's and is in a care centre. When she was diagnosed, she didn't need 24/7 close care but it was clear she could not live on her own, and she was most definitely not going to get any better. So we found an assisted living centre where she could get the assistance she needed. The cost was based on her taxable income — 70% — and included a small private suite, 2 meals per day, administration of medications (she pays for meds), light housekeeping, and activities. Now she requires 24/7 care and the cost is 80% of her taxable income and includes a private room, all medications with no payment by mother, 3 meals daily, all laundry, daily linen changes and making the bed, weekly housekeeping, weekly bath, daily assistance washing and dressing, exercise, and being tucked into bed each night with a goodnight kiss. Now that goodnight kiss is not available to everyone, just the special ones! My mother is usually smiling, always giving staff a hug and/or kiss — this is her way of communicating her thanks since she is unable to verbalise much anymore. I cannot conceive of my mother being cared for in the US system.
I see my mother at least once a week, more often if there are medical appointments. She is happy where she is fortunately. But too often, residents don't have enough of the human touch, most appreciatively from their families. The staff always stop and talk with residents, have a friendly pat on the shoulder or back, give hugs, or an endearing hand on the cheek. Last week, one resident was clearly distressed and not feeling well. The staff were looking after others (it was bedtime) so I sat behind this lady in a wheelchair, gently rubbed her shoulders and arms as she leaned back against me, and was able to calm her. When the staff came around about 5 – 10 minutes later, she was asleep in her wheelchair. I mention this only because it is the quality of care and life that is so important and human touch is so vital.
I have heard it said that the measure of a country is shown in its attitude towards its elderly, its disabled, and its animals. Oh how true in my estimation.
Get out the vote!!!!!
Vote Democratic 2012!!!!! Vote Obama/Biden 2012!!!!!
You should be.
Your mom is a perfect example of the people this change will help. At present, Medicare does not cover such care.
Amen.
Amen.
Amen!
We definitely need some Medicare reform but not in the way RepublicanTs want to "reform" it. In their minds the word, reform, means eliminate.
Lynn, in this country, some people care much more for their animals than for their elderly and the rest of their fellow human beings.
You're right on both counts.