The Need for Home-Based Medicare Assistance Illustrated

This past year, Mrs. Brown, 85, was feeling exhausted after traveling to visit family over the Christmas holidays. Unbeknownst to her family, she had become quietly malnourished. She then developed pneumonia. Her condition affected her cognition as well, so she did not realize how sick she was.

Fortunately, a visiting relative noticed her poor condition and called an ambulance. She received medical care, home-based physical therapy and a feeding tube through her Medicare coverage.

But that’s not all she needs. Mrs. Brown also takes care of her husband, who needs help with some everyday activities. Mrs. Brown needs to focus on her own recovery, and now her daily chores and personal care are more difficult. What are their options?

Currently, Medicare provides no custodial care for Medicare beneficiaries, regardless of how positive the effects on their overall health. All care must be deemed medically necessary, along with other conditions.

What about community services? Because they live in an aging community in a semi-rural town, volunteer services are limited and stretched very thin. They are able to sign up for Meals on Wheels, which helps a little.

What about a nursing home? The last thing the Browns want to do is go to the nursing home in their town. They wish to stay in their own home. Even if they wanted to, the nursing homes are full in their area, and they have a poor reputation for care.

What about family? Most of their immediate family lives out of state and do not have the room or resources to take both of them in.

Help may be on the horizon for Mr. and Mrs. Brown – and others who find themselves in similar situations – if legislation is passed to allow the Centers for Medicare and Medicaid Services (CMS) to test programs that provide home- and community-based care. There are already successful programs for seniors who qualify for Medicaid.

Funding services that make a difference, but don’t currently qualify as “healthcare,” would allow more seniors to stay in their own homes without having to qualify for Medicaid.

To read more about this legislation, see this article from The Hill by Christine Ayala.

The pilot program would provide data on the potential savings of providing support for seniors before they are seriously ill or injured.

Delaying or preventing hospital or nursing home admissions could save tens of millions of dollars. But more importantly, it would make many people’s lives happier and more fulfilling.

Fortunately for Mr. and Mrs. Brown, they have a 60-year old son living in town. He moved in with them to help out. But his health is not great, either, and he works long hours in construction.

If Medicare started helping seniors with custodial care, it would also give caregivers some relief and potentially save their health as well.

The sooner the better.

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