In this segment, Dr. Shawn Weiss talks about Home Health eligibility. As long as you’re under a physician’s care, Medicare pays for these services. How does someone become eligible? Medicare lifted the home-bound status requirement to be eligible for home health services. You need to be under a doctor’s care, who must certify that you need intermittent (part-time) nursing care, or therapy services (physical, occupational, or speech therapy) for either restorative or maintenance care. Restorative gets you back to your previous level of function, whereas maintenance allows people with chronic conditions to maintain their current level of function.
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*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
The following podcast is by Dr Shaun Wewiss, president of Senior Health and Wellness Group, on the answers for elders radio network. And Welcome back everyone to the answers for outers podcast network with Dr Shaun Weiss from the senior health and wellness network. And we’ve been talking a lot this hour about, you know, what it means to deal with situations, I guess would better face, of mobility, of situations of you know, environment x external factors of how we deal with staying healthy. But now we’re going in a little bit deeper. We’re going to drive in a little bit more of the whole concept of home health. And you know, home health is different than home care and we talked a little bit about what that difference is. But obviously the thing that’s really powerful about home health care is the fact that Medicare pays for it as long as you’re under care of a physician. Is that correct? Seun right? Well, and we get so many questions now because so many more people are needing home care services right now during the pandemic. So we get all kinds of questions. So it’s a great opportunity on this podcast to educate and let people know. How do you become eligible for home care? So a couple things have to happen for Medicare to pay for your services. Right. This is something that you’re not going to have any cost out of your pocket if you are Medicare recipient. I haven’t built a patient in eighteen years and so so if that tells you anything. But in order to do that you have to one be under the care of a physician. Sometimes we run into a situation where grandma has moved back from Florida is living with the daughter and they have an established care with a physician yet. So then that we cannot go out as in skilled agency to see that individual until they have had a visit with a primary care physician. So you do have to have an established relationship with a physician, and in that area, not out of state. So important. And then when you do see the physician, they must certify that you need the following and it has to be you know, they say intermittent, which is part time. So you need intermittent part time nursing care, and the reason why they say part time is because if you need full time nursing care, and they put then you need to be an unskilled nursing facility which would you sing as a nursing home. You need more care, so they need to certify that you need at least part time or partial intermittent nursing care or therapy services, physical therapy, occupational therapy or speech therapy services for either restorative care, and restorative care is a term which this is just typically what skilled home health does. Therapy comes out, you have declined or you’ve had a surgery and we are getting you back to your prior level of function. So that’s what we do, that’s what we are experts in. But there’s also another component to skilled home care and that is the maintenance therapy side and maintenance therapy and Medicare. You know, they coined the terms several several years ago, and allowing people in it with really chronic conditions who really need our services to maintain their current level of function, whether it’s the ability to get up and down out of surfaces and walk to around the home safely or to get out of the home and go to the mailbox safely. Like those certain task we may not expect a lot of improvement or new skills to be learned because of their chronic conditions, for instance Parkinson’s disease, patients chronic arthritis and pain. But certainly the ability to maintain the level that you’re at for a Satany is also considered part of the care. So either restorative or maintenance care, therapy services. The physician will certify that you need those. And then the biggest thing they hear about what you have to be homebound, and that is a that’s a that’s a such a gray area because Medicare does a good job of not really making it very clear. But, believe it or not, if you want to dig through the Medicare manual, there’s it. They get kind of specific and homebound doesn’t mean your bedbound. Homebound does not mean you cannot leave your home. Medically are clearly states and their services manual for eligibility that you can go out of your house a handful of times a week for any type of medical appointments, to attend church, to go to the beauty salon. Yeah, all of therapeutic outings with the family, as long as these aren’t they’re infrequent in nature. You know, it’s not like I’m going to go out every day and I can go walk to the park or drive down. Well, that’s not going to that’s not going to work. You’re not going to be eligible for skill care services because you can get in the car and go down to the outpatient clinic, right. Right. So certainly if you have any type of assist a device need for you, for you to leave the home to where you are unsafe and you need supervision to leave the home, then that’s where we’re looking at becoming eligible for services. There’s a safety need where you need to have assistance and that needs to be, you know, as considerable taxing effort. And of course Medicare doesn’t clearly define what that is. But if you’ve had a decline and you are not safe to leave the home without assistance or somebody needs to drive you to where you need to go, then you’re certainly eligible from home care. Doesn’t mean you can’t leave the home, you just have to leave with somebody. Right. So it’s really important that people understand, not the Homeboundin what might be an example, just I’m just going to throw something out there. What if somebody breaks their arm or their ankle, they can’t necessarily drive their car? Right, that would qualify, correct, because your those are conticular a temporary homebound status. That, yeah, you might have just had any replacement and you’re not allowed to drive and your weight bearing is different than you are temporarily homebound. So, yes, right, but it doesn’t mean your family couldn’t take you out too, absolutely someplace or subsolutely. Absolutely. So it’s not that stringent. Is peopuilt specifically. Now, when you take the burden, the burden of eligibility is always on the home care agency. That’s the very first thing we look at when we come into the home is making sure we are certifying this patient is eligible and meets that criteria right. And sometimes we have patients. So let’s say, you know, like I said, always go back to the Parkinson’s is he’s patients because they are such great their bechnics to keep their function and to keep their string and we do a lot of care with parkinsons patients in the home. But we might go in there and the patient clearly needs our services. We have a physician’s order for the services, but my son or daughter just has not taken the keys away yet and it’s just an extreme safety situation. So that’s when we are having heart to heart talks with you know what we’re taking the keys away for this period of time. Let’s start with the start small. That way you can get your services. You cannot be out driving one. It’s incredibly unsafe and dangerous and you have no business doing it when you can’t look over your shoulder. But let’s start preparing for what needs to happen down the road, which is, you know, taking the keys away. So, yeah, yeah, home doown. Like I said, there’s a lot of the things we have to certify and all of those things. You know, I’m sure that a primary care doctor understands what the rules are. So when you’re referred to home health, number one you’ll probably be a little bit educated by your doctor, and number two is is really understanding what kind of services you’re going to get. And I know that physical therapy and occupational therapy people may not necessarily know specifically what they are, but I’m you know, do you want to just give us a real brief overview? What type of services? Speech, different language? Right like that. Right for, you know, for whatever the physician fields is necessary, whether it’s, let’s say it’s physical therapy, they’re straightforward. You know, post operative care. That’s certainly one. But you might be having issues from an eurological standpoint to where the doors like when to come into home for physical therapy. So what we do is, once we get the order, we are obligated by federal law actually to be out within forty eight hours of an established referral. So we’re out there in the home doing a full comprehensive head to toe assessment, whether that’s the physical therapist or a nurse. We put a nurse out on every case to do that headed toe, head to toe assessment. So we’re looking everything from skin integrity, full list of we have to have all the medications out and looked at and verified. We’re looking at how you access every area of your home. We’re looking at shortness of breath, respiratory status, the list goes on and on, any type of thing that you would get at your physician’s office. We are doing a thorough, comprehensive assessment. Physical therapy is going to dig in a little deeper and do a very as well as occupational therapy, to a very hands on assessment of your function and that includes your joint mobility, your range emotion, your strength, how are you transferring from surface to surface? Are you safe? As there we’re going to do a fall risk assessment. We’re going to look at your mobility through the home. Are you using an assisted device? If you don’t, do you need an assisted device and those recommendations. So we’re looking at neurological screens. will get balanced testing, all the things. Occupational therapy is going to look a lot of all the activities of daily living. Are you safely performing and do you have this strength and the mobility to perform your activities of day living, that is, getting close out of the dressers and the closets and getting dressed by yourself? Are you able to get in and now the shadower safely? Are you doing all of your grooming task right safely, or do you need? How you sitting down and standing up appropriately? Absolutely, I can you reach for certain items above your head if you’ve got shoulder issues? All those things. I just went through occupational therapy on my head. I know all that S. yeah, to go into a clinic. We have it. We have speech therapy. You know, it goes in also because we have to stroke. That’s important. Strokes there maybe have aspiration risk. Might Diet arry straight changes in Diet? Maybe they need to go on a pure a diet or something like that, where the patient doesn’t have to lead the home to have that assessment done. We can bring the speech their bus and educate the family give them all the tools that they need for that. Right right. Like I said, skilled nursing, of course, for wound care, medication, teaching and management, chronic disease management, all of the above are just wonderful set of services that are here. Are they’re out there for our Medicare nations, sure, and then also something big too, but I have a second. We have enough time, I hope. Yeah, we have a Medicare has changed some things during the pandemic that are still in place in terms of eligibility for home care services. They now allow nurse Practitioners and physicians assistants to Certify Home Care, which has been really, really helpful and wow, buddiness access patients more. And then they have also lifted the home bound requirement during the pandemic, and what that means is maybe you weren’t homebound but now, because of a quarantine or a high risk situation, maybe it’s you have cancer or any other major diagnosis. I don’t that allow of you to have full health and without meeting them her aquirement. Yeah, yeah, right now, you know, and that’s that’s important to note because certainly, you know, a lot of US gained weight. We were not as active, physically active as we were. You know, they’re in the pandemic, pandemic, we sat and Binge, watch TV shows and and a popcorn. You know, it’s R and so and the depression that sets in, and I think that’s the thing that, you know, where we look at and certainly in our next segment we’re going to talk a little bit about cognition. We’re going to talk a little bit about, you know, what’s really happened during the pandemic and how can you help your loved one through this transitionary period when things are kind of still up in the air still, but we’re gonna exactly. Okay, Shawn, I’ll be right back right after this. We would like to thank you for listening to this podcast by Dr Shaun Weiss, CEO of Senior Health and wellness group focusing on wellness and prevention strategies for seniors. As a fall prevention specialist, Dr Weiss provides family support and education to keep your loved one safe. You can learn more by visiting her website at www dot senior health and wellness Dot Org
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Founder and CEO of Answers for Elders, Inc., Suzanne Newman proclaims often, “Caring for my mom was the hardest thing I ever have done, but it was also my greatest privilege.” Following a career of over 25 years in sales, media, and marketing management, Suzanne Newman found herself on a 6-year journey caring for her mother. Her trials and tribulations as a family caregiver inspired an impassioned life mission outside of the corporate world to revolutionize the journey that so many other American families also find themselves on. In 2009, she became the founder and CEO of Answers for Elders, Inc., subsequently hosting hundreds of radio segments and podcasts, as well as authoring her first book. Suzanne and Answers for Elders, Inc. have spent 14 years, and counting, committed to helping families and seniors along their caregiving journeys by providing education, resources, and support. Each week on the Answers for Elders podcast, Suzanne is joined by vetted professional experts in over 65 categories including Health & Wellness, Life Changes, Living Options, Money, Law, and more. Suzanne lives in Edmonds, Washington with her husband, Keith, and their two doodle dogs, Whidbey and Skagit.
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