TIME GOES BY | GRAY MATTERS: Medicare Home Health Care

by Saul Friedman in Time Goes By Blog

I learned the hard way: The greatest and the most predictable danger for older people is falling. Too often, a broken hip can lead to a deep and irreversible decline in one’s health or well-being if you don’t get the best of help quickly. For me, I was laid temporarily low by a mild concussion.

Fortunately, for those of us who are eligible, Medicare and Medicaid have made some advances in fashioning benefits that will keep patients at home to mend instead of keeping them in a hospital which can be dirty, dangerous and expensive, or sending them to a nursing home, where the pampering, diapering and surroundings can be even more debilitating.

I hope this is not too basic, but in case you’re a caregiver or a potential patient and you don’t know, or haven’t read the 2010 “Medicare and You” manual, under the Medicare law, after a hospitalization of at least three days – say, for an accident, a stroke or for a broken or surgically mended hip – a patient is entitled to up to 20 days of rehabilitation and therapy in a skilled nursing facility at no cost. (After 20 days the cost is more than $133 a day). The skilled nursing facility, I should add, is not a nursing home. But nurses and therapists are available to help you bathe and dress until you’re able to do so for yourself.

A very important (and inexpensive) alternative, when leaving the hospital or the nursing facility or if you simply need medical help getting over a wound or illness is home health care, which Medicare covers and will cost you nothing. This is one of the best Medicare benefits, although too few beneficiaries or caregivers know about it.

I learned something about Medicare Home Health Care just a few days ago after I took a serious fall from the steep brick steps leading into my home, which left me with bruises, a minor concussion and further impairment of my right arm and leg, which had been weakened by a stroke six years ago. For those of you who are wondering, even six years into a stroke, therapy can help.

That meant I needed trained professionals to look after my recovery from the concussion and to provide physical therapy to get me back on my feet. All it took to get part-time home health care was a prescription from a savvy emergency room physician who wrote in his Rx that the care was “medically necessary.”

As the manual says, “a doctor must order it and a Medicare-certified home health agency must provide it.” That’s especially important for in past years, Medicare cracked down on fly-by-night agencies who charged but didn’t deliver adequate care.

The hospital may recommend an agency, but you should use one that is recognized. In my area, the best is the Johns Hopkins Home Health group.

The home health services may include medical social services, making sure you have help in the home, and part-time or intermittent home health aide services such as checking on a bandage or an IV, administering drugs or simply keeping track of your vital signs and the healing of a wound or a surgical site. The manual says that “you must be homebound” to receive such services, but that means you can leave home to visit a doctor, go to religious services or even go to adult day care.

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