A loved one suffers a stroke, a fall, or has a chronic illness such as Alzheimer’s disease, Parkinson’s disease or multiple sclerosis. Medicare initially covers payment for vital services such as skilled nursing, home health care and physical, occupational or speech therapy. We see improvement as they heal, grow stronger, speak more and become more engaged in life.
Suddenly the bad news is delivered: the patient reaches a “plateau” or doesn’t show “improvement” according to Medicare standards. They will no longer reimburse payment. We beg therapists and doctors to report a possibility of improvement, but invariably the services are cut off.
We see our loved ones rapidly lose the strength, skills and abilities they have worked so very hard to gain.
Soon they can’t get out of a chair, their wounds reappear; they stop speaking. Often another crisis happens. Self-care abilities are lost or their weakened state causes another fall. The downhill slide begins again. Sometimes they will qualify for therapy or nursing assistance again, but the cycle simply repeats itself. Over and over again.
We have lived this cycle repeatedly since my Mom had a stroke more than 20 years ago and my Dad developed Alzheimer’s disease and other health issues. It astounds me because I consistently see the denial of these therapies and services causing much more costly hospitalizations, doctor’s visits and nursing home placements. I see the major difference these services make in my parent’s health, finances and quality of life, and thereby mine as well.
In an attempt to ward off the downhill slide, we try to fill the gaps ourselves with private-pay therapy and home health. It’s difficult to find quality care, and often the services we find are not as effective. Most of the time we can’t afford it at all; it’s broken our budget. We are not alone — most families can’t afford costly private services.But there is a ray of hope in the October air. A proposed settlement to a nationwide class-action suit that challenged the Medicare Improvement Standard may mean Medicare recipients with chronic conditions could receive highly needed home health, nursing and therapy based on need, not ability to “improve.” This major guideline shift would mean coverage of services that enable recipients to maintain a level of functioning or prevent further deterioration.
If this Agreement is approved it will mean a huge change in the mindset of health care providers and, most importantly, it will literally be life-changing for those with chronic illnesses and their caregivers.
Let’s hope common sense prevails.