Medicare Coverage authorized for AD

[Guest guest]

In a First, Medicare Coverage Is Authorized for Alzheimer's

March 31, 2002

By ROBERT PEAR

The Bush administration, in a major change, has authorized Medicare coverage for

the treatment of Alzheimer's disease, which afflicts nearly four million

Americans.

http://www.nytimes.com/2002/03/31/politics/31MEDI.html?ex=1018524581 & ei=1 & en=70d\

feecc078f5f02

[Guest guest]

Lilca,

THANK YOU FOR THIS ARTICLE! If only I had known this earlier. But it

is good to have it now anyway. I have a hunch some people may have been

very aware of it and wonder why AARP hasn't announced it!

Donna

A balanced diet is a cookie in each hand. Courtsey of The-Mouth.com

[Guest guest]

>In a First, Medicare Coverage Is Authorized for Alzheimer's March 31,

>2002 >By ROBERT PEAR

The Bush administration, in a major change, has authorized Medicare

coverage for the treatment of Alzheimer's disease, which afflicts nearly

four million Americans.

<http://www.nytimes.com/2002/03/31/politics/31MEDI.html?ex=1018524581 & ei=1 & en=7

0dfeecc078f5f02>http://www.nytimes.com/2002/03/31/politics/31MEDI.html?ex=101852

4581 & 1 & en=70dfeecc078f5f02

This Medicare issue may be incredibly important to so many of us in the

USA. But WHAT exactly does it mean? They mention mental health coverage,

physcial therapy and home attendant care, as well as hospice. Will Eve be

able to have more prolonged PT? Will home attendants be paid for and under

what circumstances? Does anyone know how to find this info out?

By the way, it was my husband who pointed the article out to me! Imelda

To learn more about Lewy Body Disase, please visit the Lewy Body Disease

Association site at: http://www.lewybodydisease.org

[Guest guest]

In a message dated 3/31/02 6:14:13 PM Central Standard Time, cmram123@...

writes:

> The skilled service can continue until progress is no longer being made.

> When the skilled service is over, the home health aid ends also.

Daryl,

Thank you so much for your very enlightening post. I have yet to need any of

these services, so am very guilty of not having paid enough attention - yet.

My question to you is, what services are available between the

post-hospitalization requirements and hospice, if any? Or even

pre-hospitalization. And under what circumstances? From where I stand it

seems that that is a never-neverland of need. Or am I wrong? Or does income

play a big role?

I am awaiting paperwork to enroll my husband for VA services, which today are

apparently far superior to what I thought they were. If you know, what

comparisons can you make? Where do those of us on " middle ground " stand in

terms of getting help?

Your help is immensely helpful, and probably to many who " lurk, " so thank you

for your input for all of us who have need questions.

How are things going with your MIL? Did the MRI give enough results for the

family to understand what is going on and what may lie ahead? Have been

thinking about you and the implications.

Cheryl

[Guest guest]

Imelda-

I think I may be able to shed a LITTLE light on this issue. I read

the article and I am also a home care nurse (for 12 years.)

Unfortunately, I don't think this will change much of anything for

most of us. Apparently, some medicare " carriers " may have been

denying coverage to certain individuals because they have AD. (It

would be easy to assume that they would not benefit as they will

never get " well " ) There are many different " carriers " throughout the

country and their rules, and how they are executed, vary from one

region to another. What this article is saying is that carriers

cannot deny coverage simply because a person has AD.

The medicare " rule " will still be the same as it is for any other

disease or condition. The rule is very specific, there must be a

need for skilled services and an attainable goal. So, someone was

hospitalized for a few weeks and lost the ability to walk. That

person is entitled to skilled therapy to attain the goal of walking

again. While getting that skilled service, that person, if the need

is there, could have a home health aid to assist with some of his

personal care. The skilled service can continue until progress is no

longer being made. When the skilled service is over, the home health

aid ends also. Skilled service can be defined as PT, OT, speech

therapy or that of an RN. The other big medicare requirement for

receiving services is that the patient is homebound.

As I said previously, I think there will be very few changes that

anyone would see (boo hoo). I have been in home care in CT, PA and

now MN and have never known anyone to be denied home care because

they have AD. Maybe this was more an occurance in nursing homes.

This is all a very confusing issue and does lend itself to many

different interpretations. But I don't think this article is offering

additional services, just saying that AD patients cannot be excluded.

Does this make any sense?

Daryl

[Guest guest]

Daryl

You have explained exactly what happened to my dad when he was living in

his apartment. When he was falling, I took him to physical therapy for

a short time, and it was covered under Medicare. He did need to meet

requirements like being home bound. There had to be only a small amount

of people checking up on him....basically that meant ME. After so many

sessions of PT, that was cancelled. Then I tried to get a home health

aid in, of course there were more requirements to be met. When that was

passed, the home health aid had a limited time they could come in. With

all of the paper work, checking up to make sure they were doing their

job, trying to keep some consistency (the same aid), and still needing

to fix things that would miraculously end up " broken " without an

explanation.....I opted for nursing home care. Dad was at the point of

not qualifying for in-home care, yet couldn't be left at-home. The 2

sided sword came into effect. Thank you for passing along your hands on

experience to this issue.

Sandie

Des Moines, IA

[Guest guest]

In a message dated 4/1/02 3:41:13 PM Central Standard Time, cmram123@...

writes:

> Whoaaa... this is complicated!

Boy, is it ever!! I wonder how long the " system " will take to recognize the

need to help the caregiver BEFORE things get really bad and she/he becomes

another casaulty of the disease. No wasn't thinking Medicaid - just find the

whole mess confusing. Thank you for taking more time to explain the

complicated.

Am working on using the VA - having to gather some info from a sleeping

husband before completing the enrollment form. I THINK we will be able to

get the old neurologist to consult on my husband's case as part of a research

project in Little Rock. All fingers and toes are crossed.

Yes, he is STILL asleep at 4PM CST! After 4 nights of very little sleep I

think he is starting a cycle of sleeping late into the days.

So glad to see that your husband is considering the possibility of LBD,

Daryl. That should make it easier to put the wheels of care into motion.

Thanks again for your very helpful input,

Cheryl

[Guest guest]

Bertha and Cheryl-

Bertha, you are 100% on the money in calling this issue a " murky

topic. " I can only speak from the aspect of home care services and

not that of a clinic or nursing home. I'm confused about where your

husband received services (home or a clinic) and in any case very

surprised that he has been seen for 1-2 years! There used to be some

conditions in which people were seen for that length of time but

medicare changed how agencies are paid 1-2 years ago and that put an

abrupt end to continuous ongoing services. Aid services (only IF the

patient needs personal care like bathing) should be available if PT

or a nurse is coming to your home. This would NOT include respite

care (to give the caregiver a break) or sitting services.

Cheryl, income should NEVER NEVER have anything to do with services

provided under medicare (are you thinking of maybe medicaid?) There

are no pre or post hospitalization " rules " though people with the

most " needs " are generally getting out of the hospital. But, a

doctor can order home care straight from his office. Again, there

has to be a " need " with an attainable goal. i.e.your LO sits for long

periods of time and you suddenly realize he has a deep sore on his

butt, the MD might order a nurse to treat this sore at home. Because

this nurse is seeing your LO, you could also get an aid IF your LO

requires someone to bathe him. The " need " is the nurse, to see that

the sore does not get worse, is healing etc. The attainable " goal "

is that the sore will heal. Although this person's has a need for 24

hour supervision and cannot be left alone, this is not a medicare

benefit. Now, the sore may heal in 2 weeks or it may take 2 months

but when it is healed, there is no longer a need for the nurse and

the aid has to be stopped also. There are a lot of different kinds

of needs i.e. sudden onset of high blood pressure, a big change in

ambulatory status, swallowing problems that have gotten worse. But as

soon as things improve or the patient can no longer benefit from the

therapy, the service is discontinued. Whoaaa... this is complicated!

I don't know much about VA services at present. My MIL is status

quo. Actually, doing a little bit better at present. We have not

received the results of the MRI yet. I have told my husband about my

suspicions re:LBD and he actually was open to hearing it, so much so

that he mentioned it to his sister!

I have been " lurking " on this board, son't often have time to write

unless I feel I must jump in about a pressing issue. By the way, I

will be attending a seminar on 4/12 called " Geriatric Mental Health:

Delerium, Dementia, and Depression: Differential Diagnosis and

Interventions. " Should be interesting.

Daryl

[Guest guest]

Cheryl

My dad did what your husband is going through. Sleeping through out the day

and was up at night. This was a year ago or longer. The Dr. told us that LBD

people get confused with their days and nights and get switched around. That

is when he put him on Ratline (sp)? He gets 1/2 of a pill in the AM. It

stimulates his brain and keeps him awake. For us, at this point of the

decease, we get a part of what dad use to be.

I thought this might be of interest to you. Good luck and thinking of you.

Debbie C.

Norwalk, IA.

[Guest guest]

Daryl

Please let us know when the MRI test results come in. Curious to know

what it shows. Also, so glad that telling your husband about your

suspicions went well. Also, I am glad he is involving his sister with

the possibilities that their mom may be facing LBD. We can never have

too many people to talk to about this disease. Please pass on any

insightful information you receive from the upcoming seminar. Sounds

like it can be very beneficial.

Sandie

Des Moines, IA