Learn about Medicare’s new approach to focus on Preventative Services rather than coming in after the damage is done, often through a fall. Boca Home Care supports such innovations which can help patients.
Until now, Medicare home health services has addressed mostly short term rehabilitative needs of seniors or the physically disabled. Help would be delivered following an exacerbation of the disease, an accident/fall or an acute illness. Having help come in after an “event” works best for people who have a condition which improves or heals.
The Acute approach doesn’t fully address people who have chronic conditions. Who may have symptoms and illness managed but will likely have ongoing challenges or episodes which will require care.
In October 2012, a class action suit was settled with the Dept. of Health and Human Services. Its intent is to provide people with chronic conditions greater access to health care at home.
Pending a Federal judge’s approval, Medicare home health skilled services (nursing, physical and occupational therapy) won’t have to follow the standard of requiring to show “improvement” as a guideline to receive care.
If the deal goes forward, Medicare Home Health Care can be authorized to help a person maintain their current level of functioning, condition or to slow the progression of the disease.
As these policy shifts take time to take hold, it will be awhile before the “maintenance standard” replaces the “improvement standard”. We will have to see the amount of care the government will authorize.
The hope is that many more people will receive the ongoing care they need instead of starting then stopping, having something go wrong and then restarting. It is also hoped that ongoing services will be cost effective by reducing acute episodes requiring hospitalizations and Rehab stays. A hip fracture can cost up to $70,000 between the hospital and rehab center costs. Routine home visits by a nurse or therapist is potentially tens of thousands of dollars less.
It will certainly benefit people with long term progressive illnesses such as Parkinson’s Disease, Alzheimer’s, Diabetes among others. Stroke patients often face a lenghtly recovery which doesn’t fit into the current Medicare guidelines of 60 day increments with possible 60 day renewals. For seniors or others who have difficulty leaving their home, a professional visit can make a big difference by monitoring medications, diets, nutrition, gait, and cognition. Intermittent home visits can help avoid a major setback or worsening of a condition.
This can cause a real shift in care. If a patient can stabilize and improve sooner, so be it. If they require maintenace visits over a longer time period, this new flexibility in Medicare Home Health delivery will accomodate the more logical and less expensive method of care delivery through a change into maintenance care.