Medical Community

Care that encourages strong, well-informed and independent seniors.

New Ruling: More Patients Qualify for Home Health Care

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Medicare Legal Update - Jimmo v. Sebelius

Patients with chronic diseases like Alzheimer’s, multiple sclerosis, Parkinson’s, stroke, spinal cord injuries and traumatic brain injury will qualify for skilled care more easily.

Medicare coverage for skilled nursing or therapy services can no longer be denied to beneficiaries who can’t show a likelihood of improvement.

The settlement in the Medicare Improvement Standard case, Jimmo v. Sebelius, was approved on January 24, 2013, marking a critical step forward for thousands of beneficiaries nationwide who require skilled nursing and therapy services to maintain their condition.

Coverage should be available now for people who need skilled maintenance care and meet any other qualifying Medicare criteria. People are encouraged to appeal should they be denied Medicare for skilled maintenance nursing or therapy because they are not improving.

The settlement is especially beneficial for patients with chronic conditions like Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries and traumatic brain injury, as they will qualify for services more easily than before. Read more

Geriatric Care Managers Help Families with Challenges of Aging

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Geriatric Care Managers and MedicareFamilies often need help navigating the many services available for their loved ones.

Geriatric care managers are becoming a necessary resource for families that are caring for elderly loved ones. These professionals help families and other caregivers coordinate the care of elderly persons who have physical and/or mental impairments, helping them to meet their long terms care needs, improve their quality of life and maintain their independence for as long as possible.

Typically, geriatric care managers have prior extensive training in nursing, social work, gerontology or another health field and use this expertise to help manage, provide and refer various types of health and social care services. They serve as an advocate for their clients throughout the continuum of care.

For example, families tasked with managing the care of a loved one who has a chronic disease such as congestive heart failure or a form of dementia like Alzheimer’s disease often need help navigating the spectrum of services – including health, financial, and legal – available to them. Read more

When to Refer the ALF Resident to Home Health

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Assisted living facilities can allow their residents to age in place and avoid unnecessary transfers to higher skilled facilities by utilizing home health services earlier in the disease process.

Residents may benefit from home health services if they:

  • Are experiencing an exacerbation of a chronic condition
  • Have a health issue that could get better through therapy
  • Have hard-to-heal wounds
  • Have trouble managing multiple medications
  • Suffer chronic UTIs
  • Make frequent or unscheduled visits to physician offices or emergency rooms
  • Are at risk for falling (Common risk factors for falling include: increasing age, weakness, having suffered a prior fall, incorrect ambulation, foot issues, fear of falling,  medication usage, having a chronic disease/condition, increasing need for assistance with activities of daily living .) Read more