Will Medicare pay for any home care medical treatments if deemed necessary by a medical doctor?
My mom is 95. She lives alone in her own home. She has fallen about 7-9 times in the past year. Her falls have not sent her to ER. She has not broken anything. These falls have provoked her to go for testing with her primary doctor. She has had a complete physical and has passed all tests with glowing results. She has elected to not drive anymore so she is somewhat homebound unless a friend calls her to go to lunch. She will not seek help with any senior agency for rides; she will not use a cane to help her walk as she still feels weak in her legs if she stands/walks too long (she's 95-100 lbs); she finds it hard to bathe; and she is very much afraid of asking for help fearing people will now know she is living alone. She says she has cut back cooking bc of afraid of falling near the stove. So she snacks a lot. That's not good. She has missed a couple of Dr appointments bc she won't call or use a cab or any other senior service. So I was told that if I contact her primary Dr and tell her my concerns, the Dr would intervene and get my mom the necessary medical help (rides to appts; physical therapy; etc) and/or have medical personnel come and take her vitals; conduct physical therapy at her home and just ensure she is eating and hygiene is good. Is this true? To look at mom, to talk to mom, people think she had everything under control, but she doesn't. She is a very proud woman, very independent and insists on keeping it that way. We (my brother & I) do not live near my mother. I am out of state and my brother is out of the country. We visit her separately, about 6 times a year for 10-12 days each visit. But that's not enough, we know that. Lately, in talking to my mom, there are times when she is really alert in her mind and than only lately, she seems delayed and at a loss for the correct wording. So what can I do? She will not leave her home. She will not consider outside help because she doesn't want people to know she lives alone. She is very afraid and feels very vulnerable at this point. Any suggestions? I/we are so very fortunate that our Mom has done so well for herself for all these years. We just want to do what's best and without crushing her spirit with harsh words or conversation. In my search for answers, I am hoping that contacting her primary doctor will help. Will it? Thank you.
I deal with this issue every single week.
Mom first was dropped from physical therapy because she failed to continue to improve....the. OCcupational therapy for the same reason. Only way to get it restarted now is to have a new hospitalization that would start the whole process over.
Speech therapy continues because the therapist feels Mom is making progress still.
Yes, you need a doctors order...but that does not mean it will be paid by Medicare.
These means..nurses for medical procedures, therapists for physical, occupational, speech to help her regain lost function from a medical issue that first caused her to be in a hospital for at least 3 days. And then only for as long as she continues to improve.
This might be about an hou a day...and not for anything other than the medical procedures that she needs because of a previous hospitization.
So...for what you want an aide for....no, Medicare will not pay for any of it.
I ask this because my mom used to see her PCP every three months. He always told her everything was fine. All her blood tests were normal and she never told him about her fecal incontinence, her terrible anxiety, her sleeplessness or what became her daily calls to her kids to "rescue" her.
When he found out about all these things, he said "well of course, she can't live alone any more. She needs to be in a facility".
Our parents are great actors.
The posters above are correct. You may need, unfortunately, to wait until your mom has a life threatening fall (so why ISN"T she taken to the ER after a fall?). Once she's hospitalized, you work with the discharge planners to get her what she needs, not what she wants.
It also sounds as though in the short term, she would benefit from seeing a geriatric psychiatrist to get her anxiety under control.
Her doctor cannot order home care without a diagnosis and unfortunately living alone at 95 is not a diagnosis. Especially if as you say she passed a physical with no deficits.
Aren't you worried she will have a bad fall in her home where no one is available for her to call? Does she have a lifeline device? That for me would be the first step - they cost about $30 a month basic service. She can get a pennant necklace to wear and would push a button and someone will be notified if the device is activated and an ambulance will be sent.
I would hire private pay agency staff from an accredited home care agency and pay them yourself. Tell her the doctor ordered them if you have to, as after you talk to him he won't disagree. You can find them for $25/hr average and that's for a CNA or sitter. May be cheaper depends where she lives.
Does she have fire alarms in her home? Stairs? Carbon monoxide alarms? A generator if the power goes out? Who food shops for her? What if she had to exit her home quickly, could she do it?
You can apply for senior transportation through her Dept of Aging in her county and that is sliding scale pay according to her assets. The Department of Aging in her county is a good place to begin. Look into community health nursing services in her area as well. You may get someone once a month to check her vitals if she qualifies, meaning she has a medical condition that warrants it. It's often a lot of paperwork they require so help your mom fill those out. Her eligibility depends on her assets and the agencies do due diligence on checking out finances of applicants.
Her primary care doctor will just tell you the same thing. He can't order care without good reason or insurance won't pay and he may be penalized.
Can't you just tell her her doctor recommends these aides come in to check on her and self pay?
Or try to find housing near you and tell her you worry about her being so far away and you would like her to be nearer to you.
She is not safe where she is now. Good luck to her and you.