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Topic I failed to get Home Health help..... Go to previous topic Go to next topic Go to higher level

By dkleinert On 2009.09.03 00:46
Bandido1: I finally was able to speak with the Home Health/Hospice folks here in my area yesterday, and she basically told me that none of what I wanted was covered by Home Health or Hospice. She said unless there was a specific thing that they could send someone out to teach my husband - such as how to exercise or how to walk better....they could not help me. I asked her if there was any provision for daily showering, dressing, fundamental testing of blood pressure, pulse, etc. or weekly nurses visits and she said "No". So now I don't know what to do. My husband and I wrote up a checklist to help him "remember" what he is supposed to do each day when I am gone, but the key is "remember".....even when I am home, like the last 2 days, I watch him and he forgets to even look at the list or check off whether he has eaten or taken his medications (even though his cellphone alarm reminds him to take his medications - he turns off the phone and continues to watch TV or whatever he is doing and does not go and take his medications) or if he has exercised or.......I am sooo frustrated. Are there key words I need to say to my husband's Neurologist next week when we go for our every other month visit to urge her to write an order for help? Maybe that is the way to make it happen? Have the doctor order it - is that right? Thanks - Donna in NC

By Emma On 2009.09.03 03:25
Donna, I think you're right about asking the doctor to order it. Last week I asked my husband's doctor to order an in-home occupational therapy assessment. I wanted some tips and advice on showering and dressing, information on assistive devices and suggestions on things we could do to make our home safer. Our local Home Health Agency called the next day and now we have not only an OT coming twice a week, but also a nurse and a physical therapist (twice a week each), and a social worker once a week. It's almost too much. I don't know if they all work this way, but the agency told me that they can provide services for nine weeks. I'm assuming that's a Medicare regulation. I'm not sure what you're supposed to do after that if you continue to need services.

Good luck, I know what you're going through. I had similar problems when I was still working. I used to invent so many schedule/reminder systems and none of them ever worked. It really is frustrating.

By susger8 On 2009.09.03 08:57
The problem is that Medicare doesn't cover that kind of help long-term. Medicare covers short-term needs. If the patient's status is expected to improve through the service, they will pay, but for a limited time only. For other stuff, we're on our own.

My dad needs 24-hour care and I work. He has a live-in home health aide (which is cheaper than someone coming in for 8 hours a day). It costs $1000 per week, which we have been paying out of pocket for three years.

The whole thing is just crazy.


By bandido1 On 2009.09.03 20:43
Donna & Emma: yes, you must get an order from your Dr. To satisfy Medicare it would be best if you got orders from both your neurologist and regular Dr.. It is true there are limits on physical therapy and even that can be renewed after a given waiting period. Ii I believe it to be nine weeks. To reiterate, I now have both the nurse's aide and a registered nurse visiting me. The aide showers and dresses me, takes my blood pressure and other vital signs daily. A registered nurse visits weekly, orders prescriptions when necessary, consults with both doctors and even draws blood for a PTNR test every four weeks.

I held the answer to your question for a few hours to allow consultation with my caregiver(who by the way, never makes mistakes). She assures me we have no out of pocket expense for any of these services. Somebody must be missing a link in the chain of communication. Try again! Bob C

By Pearly4 On 2009.09.04 06:09
I don't think I ever got anything accomplished without 1000 phone calls and asking for help everywhere. Keep calling and keep asking. Try again with the physician as has been suggested. Call your Area Council on Aging -- they can help arrange some of those services sometimes too. I got my mother on a waiver through them that provided some of the services through a private agency. Later on she was on the Elderly Waiver through Medicaid. A grant paid for the services at one point -- nothing involved in caregiving is one-stop shopping. It took long days on the phone to get things started and then keep them going.

By dkleinert On 2009.09.05 01:16
Thank you everyone for your comments and suggestions. I only wish I had even $200 a week to contribute to my husband's care. At this point, we just don't have money to spare 'cause lately I am now buying adult underwear and catheters.....all my out of pocket expenses, and now it looks like those will be additional monthly expenses...means I have to work overtime just to pay for those, so whatever help I can get will need to be covered by Joe's United Health Care and Medicare. When we see the Neurologist next week I will start with her, then if she does not help, will go to our family doctor. I will keep knocking on all the doors I can find. By the way I did spend an entire day off one time recently calling the local Council on Aging who sent me to about a dozen different people who said they would be back with me, I sent I don't know how many emails and no one ever got back with frustrating....thanks so much for your input and suggestions. I will let you know what I find out and what happens. Hugs to all of you.

By Pearly4 On 2009.09.05 06:17
Sorry if I sounded critical -- wasn't meant that way. I too had the same response from the agencies the Council sent me too. I finally called a private pay agency and worked backwards through them - they contacted the Council and got payment through a grant from the Council.

Later I kept calling back to the Council and complained to them of the responses I didn't get, and they got more involved -- I think they, like a lot of state funded and volunteer services\agencies, are overwhelmed with requests. By the way, daily care wasn't in the services unless totally debilitated -- we originally were allowed personal aid twice a week for showers, etc. But we were able to stack personal aids with companion aids, etc. to get the coverage we needed.

It's all very complicated and definitely frustrating!

In my case, I was caring for my mother. I don't know the specifics about separating his income/asssets from yours, but could he possibly qualify for Medicaid? Its a lot of paperwork and even more phone calls, but the elderly waiver, for instance, would get him some of those services. They paid for my mother's aid, a nurse, a case manager, equipment, the Day Center, etc.

By dkleinert On 2009.09.11 00:40
Pearly4: What is an "elderly waiver"? I have not heard of that. There is so much for me to learn.....THANKS!

By Pearly4 On 2009.09.11 06:11
Its kind of a subdivision of Medicaid. You can qualify for Medicaid before or as you can apply for the Elderly Waiver (or Brain Damage, or several other categories). The waiver will provide a case manager who interviews everyone and then applies a certain amount of funds (I think it was around $1200/month but probably defers for states) to the person's care to provide services that would keep that person out of a nursing home. Don't get the impression that they need to be on death's doorstep - my mother was fairly mobile, but needed help or at least a watchful eye in the shower, with her hair, etc., and loved to "go for walks" or shopping. An aid was provided to help with that as well as paying for the day center services, and numerous other things. Some home modifications, like bathroom safety aids, etc. and other equipment can be included as one-time costs. More paperwork, etc. and monthly reviews with the case manager, but they also provided an in house social worker to work with my mother on her anger issues, etc. That alone was worth the paperwork; the support, though not quite as one-to-one as Hospice maybe but definitely a lifesaver for us.

By WitsEnd On 2009.09.11 13:48
Is he a vet?

By dkleinert On 2009.09.11 23:59
WitsEnd and Pearly4: Thanks so much! No, he is not a Vet - 3 days short of that benefit! So I will contact Medicaid tomorrow.....I may need to separate his income from mine, although I only have made about $13K so far this year, in order for him to qualify for Medicaid - am I thinking about this correctly? In order for him to qualify for the Elderly Waiver he must qualify for Medicaid? He is on Medicare now. I so welcome all advice!!! So they helped with anger issues - that would be a GREAT help! THANKS soooo much! I will work on it on Monday....gotta' do something...find something that will help that I don't have to pay for - just don't have the funds at all. Hugs to all.

By Pearly4 On 2009.09.12 05:44
It's the exact same application and while I obviously didn't have to worry about spousal problems with my mother, I do remember some assets are separated out and not figured in, etc. There are Income limits (and I think a lot of things vary state to state), asset limits of $2000 or less, you can own pre-paid burial plans as long as they can't be cashed out, move money to MIller Medical trusts (google that one, we didn't have to use it). Don't be discouraged if denied the first time around, use legal means to distribute assets (don't just GIVE anything away, that won't be allowed). My mother had nothing, it wasn't difficult. We had to cash and use one small life policy that killed her because she'd worked so hard to keep it to leave to us, but the proceeds were easily (and legally) spent on her care, and then she qualified.

You can move between Medicaid and the Waiver -- if her health had declined, we could have used Medicaid to place her temporarily in a nursing home or rehab situation, then moved back under the Waiver to home care. Not a perfect solution - lots of paperwork, visits with case managers and social workers, re-qualifications every year, but it was the only thing we found that was available to us.

Hope it works for you --

By dkleinert On 2009.09.16 00:40
dkleinert here: Update. My husband's Neurologist agreed that we needed Home Health/Hospice to come for an Occupational and Physical Therapy Assessment and she ordered it today!!! Now we will have them come out and see what they can do. Today Joe told me he can no longer shave himself. I have been batheing and helping him dress for quite awhile, but he says he can't do the sweeping motion needed to shave. He can't even use the electric razor anymore......I will let all of your know what happens. I have my list of requests for them when they do come. Bandido1 - I have your list and Pearly4 yours too! :)

By WitsEnd On 2009.09.16 11:23
I'm going to bring up something now that I'm not all that big on....but if you need cash may be an option--reverse mortgage. If you own your home that might help some if nothing else works.

Hang in there.

By dkleinert On 2009.09.17 01:43
Thanks so much to all of your for your great info and suggestions. I only wish my husband was a vet. He served 6 years in Army National Guard, but not a day during war time. Occupational Health and Physical Therapy both come here tomorrow for assessment. Here's hoping!

Witsend: Great suggestion about the reverse mortgage....but we don't totally own our house outright, so I don't think we can qualify. I have thought of it. Wish my husband had a life insurance policy to cash in......back when his PD was raging before the drugs and before we knew what was happening to him, he went thru several months of periods of confusion, and he let his life insurance lapse and could not tell me why or how. I have a $2,500 policy on him thru my job, but that is all I could get, so no life insurance to cash in. What he let lapse was a LOT. I was so upset, but had to let that go......THANKS for all of your help, great insight, and suggestions in getting me this far to have Home Health come out....I am eager for tomorrow.

By Emma On 2009.09.17 13:10
Even though I don't need it yet, and hopefully never will, I'm checking into Medicaid eligibility right now (preparing for the future). I do know that Medicaid varies from state to state so you need to find out the requirements and programs for your state. The rules regarding income and assets are different for a married couple than for a single person too. You could call an elder law attorney, although the one I contacted wanted me to set up several appointments and pay a $400.00 retainer. I think his plan was to have me deplete my assets by giving them all to him. He probably caters to people with substantial assets who want to hide them from the government. That wouldn't be me. At any rate, maybe you could call your local Department of Social Services, or whatever they call it where you are, and talk to a Medicaid worker.

Good Luck!

By dkleinert On 2009.09.17 21:31
Emma: Thanks so much for your post. We also went to see an Elder Law Attorney. He said the cost to set up all of the paperwork so that if my husband (or I) needs to go into an nursing home the one left behind won't lose the house (our only real asset), the car, etc. will cost us $900. I so want to do it, but don't have the $900 extra - am saving for it. Seems like every month all the monthly copays for all the drugs, doctor and hospital copays, adult underwear, catheters, on and on eat up every single penny and there is nothing to save for anything.....our income is just above the Medicaid limit, so we don't qualify for that either. Our house payment is large because I could not sell it, and don't want to move my husband anyway. So that is how it is......thanks for you great comments. Hugs.

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