Coming home again...huh?...I thought Medicare would pay for that (Part II)

A week ago Jane Gross wrote an interesting opinion piece in the  New York Times and in it she correctly opines that there exists a tremendous gulf between what Medicare actually will cover, what consumers believe Medicare covers and what Medicare should cover (in her humble opinion).

The previous post related to the private-pay in-home care market. Today, let's review the Medicare home care benefit.

First things first: Medicare is not in the business of funding custodial care. Yell, kick and scream as much as you want (and I've seen many do so) Medicare will only pay for an aide to assist with personal care (e.g. bathing, grooming, eating, etc.) if you meet four conditions (a physician's order, a relevant plan of care is in place, receive skilled nursing and therapy services,  the home health agency must be Medicare-certified and you must be homebound). Medicare will never pay for homemaker services, meals delivered to your home or 24-hour-a-day care at home. Got that? Never!

Special note. As of 2011 a face-to-face encounter between the physician (or her representative) and the patient must also occur within a specific time-frame. This new requirement is driving up costs to the provider and may ultimately cause some providers to no longer participate in the Medicare program. Look for proposed home health agency rules here.

Nothing about Medicare is easy and my next post will continue this discussion.

What topics would you like to seem me cover?

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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