How will I pay for senior home care?
- A physician has certified the need for home health care and has developed a care plan with the senior home care provider with input from the care recipient or an authorized family member
- The care is “intermittent,” for short periods of time and only on a part-time basis;
- The person who will receive the care cannot leave the home without difficulty or taxing effort;
- The care to be provided meets all medical criteria identified in the home health manual and is “reasonable and medically necessary”; and
- The home care organization has a Medicare number and will accept Medicare payment
Article about Paying for Senior Home Care and Hospitalization using Medicare and Medicaid
Americans are justifiably worried about obtaining the best possible senior home care — and the care they really want — as they or family members near the end of life. All too often, the care is shoddy or contrary to a patient’s wishes.
Consider what happened when a middle-aged daughter in New York City sought care for her ailing father, only to be frustrated at every turn by rules and institutions that operated at cross-purposes and failed to focus on the needs of the patient. Her ordeal was described by Nina Bernstein in The Times last week.
The woman’s father was bounced back and forth among hospitals, nursing homes and home care agencies that often latched on to the patient when it was in their economic interest to do so but shunted him aside when the profit margins shrank. In the end, he was unable to get home hospice care, as he and his daughter had wanted.
The father was eligible for both Medicare, the federal insurance program for the elderly and disabled, and Medicaid, the state-federal insurance program for the poor, but he confronted a big problem. Once Medicare started paying for his senior home care, bureaucratic barriers made it virtually impossible to have Medicaid continue to pay for aides to perform personal care, such as feeding, bathing and changing clothes. Future patients may fare better. In June 2013, New York State clarified that personal care services can continue while a patient with a life expectancy of six months or less receives hospice services.
Two issues raised by this case seem particularly troubling. Virtually every institution took actions that served its own needs, not the patient’s. And there was no coordination between Medicare and Medicaid.
Patients may soon get help. The state says it will appoint ombudsmen to protect patients’ interests in seeking community or home care, at no cost to enrollees.
The state also has appointed a private company to determine who is eligible for managed long-term care, which will prevent health plans from peremptorily ruling people out. But the plans will still make the crucial decisions about how much care a patient needs, a loophole that leaves patients vulnerable to insurers’ agendas, although they have appeal rights.
Additionally, the state is rolling out a demonstration program in downstate counties in which interdisciplinary teams, including the patient and a family member, will develop a senior home care plan that best meets a patient’s needs. If that works, it may end many longstanding abuses.
The Institute of Medicine, a unit of the National Academy of Sciences, recently called for an overhaul of how care is delivered near the end of life to eliminate the mismatch between what patients and families need and the services they can obtain. It called for new payment systems by public and private insurers to encourage health care providers to integrate medical and social services, coordinate care, and include families and patients in advance planning. That could enhance a patient’s quality of life and make costs for the health care system sustainable. See more of the article by clicking below……………….
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