Once completed physical & occupational therapy, will Medicare pay for mom with Alzheimer's to receive therapy permanently?

This policy frustrates nearly everyone. Medicare has, in the past, stopped therapy when no new improvement could be shown (so people deteriorate). There's been a lawsuit that looks promising trying to get services to maintain what was gained. I'm not sure where that stands now as it's been moving along but I don't the policy has changed yet.

You could hire a private therapist, of course, and many gyms have them available. Check with various human services (social services) non-profits. They may offer some help. Meanwhile, keep checking with Medicare to see if the policy has changed.
Good luck,
Carol

According to the home health care service that comes in for us (we're in California), the doctor ordered at-home care that comes in after an acute episode (hospital stay/ER visit, UTI, bedsores that don't heal, etc.), that lawsuit has already caused medicare to approve continued physical therapy.

For example, we've been having HHC out to the house for nearly a year and a half ... because she's been in and out of the hospital often enough to qualify for the visits. After the most recent episode, our re-evaluation determined that they could continue the RN visits since she has at-risk health issues (recurrent UTIs and bedsore risk), plus PT and a person to bathe once a week. She'll be re-evaluated regularly, but as long as there's a need/benefit, the care can continue:

Typically, the service comes out (with doctor's orders) as follow up to the acute care. The care is authorized if the RN's and/or therapist's evaluation determines a "qualifying" need; for X number of visits, within a limited timeframe (eg: twice a week for 6 weeks, not to exceed 12 hours .. or whatever. And, no, they don't extend the 6 weeks if you miss a week for some reason.). At the end of the authorized visiting period, the therapist will re-evaluate and if it's determined that the client can "benefit" from continued therapy ... not necessarily "improve" ... the PT can continue.

Hurray!! So, get your doctor to approve home health care for your mom. The order has to come from her physician, before the medicare-approved agency can come for follow-up care.

Aside from that, I would strongly encourage you to incorporate as much "PT" and "OT" as you can in all her daily activities: when she needs to get up from a sitting position, encourage a full range of motion .. get her to repeat it. Put stuff just out of comfortable reach, so she has to move her whole body to get there. Some things she'll find more difficult to do: resist the urge to do it for her .. coach/coax her how to do it on her own .. be her cheerleader. Remind her that she's been doing all this stuff for all her life, and her body WILL remember how to do it again. I make almost everything into some kind of exercise: physical and mental. I give her challenges, remind her that getting well/better IS her job ..

If she needs assistance from you to do stuff safely, it's pretty easy to evolve into a little routine. "come on, Mom .. let's stand and sit a few times. Remember, if you're stronger you can do more, without my help." or "let's dance, mom" .. turn it into a fun game. Our therapists always come with handouts of exercises she can do on her own, safely .. with little pictures. We put it all into a book with little tabs "do today .. five times".

Along with that, there are day care facilities where they'll often incorporate PT/OT therapies. These are usually self-pay, but worth it, in the long run. Our local Alzheimer's group(s) provide free-to-anyone weekly PT/OT hours at a sponsoring organization's facility. Ours is one hour sessions, twice a week, at a hospital-affiliated medical facility. So, check with the ALZ orgs and your hospitals for programs.

There ARE resources, we just have to do the work to find them.

Good luck, and let us know how it goes!

This is BIG ! and GREAT ! that Medicare will now approve PT/OT for "benefit", not just "improvement". Before, as was stated, it was a doctors prescription generally following a hospital incident and it was prescribed only for a certain number of days per week for a certain number of weeks. It was a illogical to work so hard getting someone to a stable level and then just drop them. Inevitably, the patient's med backward, especially dementia patients. We caregivers spend so much time guiding them and having to tell them what to do, being the one who also tries to coax them into doing exercises meets with resistance. In my experience, when a stranger in medical scrubs comes in and starts assisting them, they are not only happy to see someone who has come to "visit with them" but are also much more cooperative with the exercises. The results of this lawsuit are very encouraging!

My mom has been in PT for a couple of months. The insurance company that administers her Medicare will not approve any more visits. When I took her in last week, I was told that if Medicare was her primary coverage they do not need approval for additional visits. The PT has been very beneficial and stopping she will lose everything she has gained and then we will start all over again after taking a break for a couple of months. Stupid...

They also told me at the office that maintenance of what she has gained has been approved by Medicare and would require a once a week appointment. So, I don't understand where the administrator of the health insurance comes in. It should not be any different just because it is administered through mom's retirement benefits.

Medicare and supplemental insurance is a huge, circular MESS, although it sorta makes sense. As best as I understand it:

Medicare, once you're on it, is your "primary" health coverage and care providers (Doctors, hospitals, labs, etc) are bound to abide by medicare coverage rules, if they want reimbursement for their services .. in conjunction with supplemental insurance, if there is any.

Supplemental insurance can be anything from Aetna to veterans' options (like Tricare), and typically pays a portion of the remaining fees for service, NOT covered by Medicare. The balance becomes the responsibility of the patient. Not every health care provider accepts all forms of supplemental insurance (or even medicare), and each supplemental health insurance has its own set of caps and co-pays for the patient.

Hope that helps.

In MI, Medicare will only cover one month of physical and occupational therapy after a hospital admission. after that time, it seems that therapy will not be paid for. So, I have a Mom coming home from rehab, and she has improved some, but, she has dementia, and in the past will not continue therapy even if I work with her every day. I can get her to reluctantly do the motions, but she doesn't put any effort into it, not try to keep or increase her range of motion. I have to do the actual motions and she parrots what I'm doing. If I just tell her, this exercise comes next, she doesn't remember well enough from day to the next to remember how to do the exercise. It's really frustrating. Even though I'm willing to work with her, she doesn't want to make any real, effective effort. It's enough to make you give up and she will, of course, deteriorate. There is only so much you can do. After that, all you can do is watch them deteriorate. That's not encouraging, I realize, but this is how people with dementia respond to therapy. They will not do the follow-up work to maintain themselves.

PT is used to treat conditions when there is a reasonable expectation the condition will abate or improve so a patient can function at a higher level than when they started. I have never heard of a permanent PT order, but stranger things have happened. Your mother's doctor has to write the order, and if he/she is unwilling to do that, then no more PT unless there is a new injury.

Medicare’s ‘improvement standard’ for physical therapy has changed
By Susan Jaffe, Published: June 24, 2013

“The settlement recognizes that Medicare will pay for care to maintain their condition and prevent backsliding.”
The settlement took effect immediately for both traditional Medicare and private Medicare Advantage plans. It applies to care by skilled professionals in outpatient therapy, home health care and nursing homes, Murphy said.
Medicare officials have until January to revise their manuals and launch an education campaign for providers, people who staff the 800-MEDICARE information line and others. The agreement does not require Medicare to tell beneficiaries about the case.

In April, Medicare officials posted on the Web a two-page fact sheet about the case stating that “a beneficiary’s lack of restoration potential cannot, in itself, serve as the basis for denying coverage.”

From what you stated, it sounds like your mother should still be eligible for therapy through Medicare Pt. B. Definitely contact Medicare about getting your mother more rehab.

This adds to Ms. Bursack's statement on Medicare payment policy for rehab. Medicare Part B policy on rehab has been modified as of January 2013.

In the past Medicare would stop therapy prior to that period if the person "plateaued", i.e. did not continue to make progress. As of January 2013 this policy has changed. The new ruling states that a patient can continue therapy in or out of a skilled nursing home as long as the therapy prevents the patient from further deterioration of his or her clinical condition.

This does not mean a person can continue therapy indefinitely. There is still a monetary cap on the amount of rehab Medicare will pay for. That amount might differ by state.


Joanna Leefer, Senior Care Advisor, ElderCareGiving

Yes, Carol is correct. My mother has gone through therapies 3 times. Medicare needs to see documented improvement. Even so, it will only pay for up to 100 days in a skilled nursing facility or home care. Best of luck