Could physical therapy be performed under palliative care or hospice care?

Sometimes therapy can be physically painful, and patients with dementia are often unable to express their pain. So you might think you’d be solving one problem but you’d be opening up yet another can of worms. Also, they don’t necessarily know therapy is to help them. They think someone is trying to hurt them because they don’t know what’s happening.

MsAtin16: Perhaps your uncle's physician can better assess if he is a candidate for such therapy. His neurologist will be a better judge of his dementia.

My mom was denied PT while on hospice. I wish now I had stopped Hospice and requested speech therapy and PT after her stroke. Her last 6 months she could not talk. You can always restart Hospice.

Request an evaluation from a physical therapist without delay. The longer he is prevented from walking, the harder it will be to re-strengthen those muscles. Your Uncle ultimately may or may not be able to walk again, but if you don't advocate for P/T, no one will offer it.

Psych pills can be used. Mom on namenda for dementia and 50 mg sertraline in morning. Takes little lorazepam at night. Makes her normal and not wanting to get up and run off in sundown mode.

Contact
https://www.foxrehab.org/

This company can probably best answer all your questions. I know others who have used this company during hospice as well as other times when they thought therapy was not covered.

Fox does in home therapy and you don’t have to be “home bound” to qualify.

Also check out…

https://medicareadvocacy.org/jimmo-v-sebelius-federal-settlement-invalidated-medicare-improvement-requirement/

Physical therapy can continue for maintenance in some cases.

There is a lot of misinformation in the area of therapies. Not all providers are aware of the policy changes in Medicare or they may not want to do the documentation required for the services to be covered.

My mother had both PT and OT while in palliative care. She had been in the hospital for awhile, then in rehab for 3 weeks, but her doctor thought she need a bit more strength, so he ordered it.

When determining if PT is appropriate, the physical therapist asks: can the patient be rehabilitated? Is the patient able to respond to queues from the therapist and retain those queues in working memory? If the patient is unable to remember the exercises the therapist is giving and has to constantly be reminded or reinstructed, then the patient does not qualify for rehabilitation. The patient is unable to make measurable progress. So the answer to your question depends on your LO's ability to remember and the diagnosis his hospice company gives him that will make him qualify for the PT.

If you mother is on palliative care, Medicare will pay for physical therapy. When/If she goes under hospice, the physical therapy will no longer be covered.

My 95 yo mother is in that program currently. Even though she qualifies for hospice care because of her dementia, she's not quite at the point where hospice would be of any help and is getting more benefit from weekly physical therapy, so for the mean time I'm keeping her under palliative care, which is still medical and care help as needed 24/7.

My mother had advanced dementia & was constantly trying to get out of her wheelchair, resulting in 95 falls. This was not a sign of her 'improving', but of her dementia advancing to the point where she didn't realize she couldn't walk. Dementia does not improve; it only worsens with time. The tilted wheelchair, for us, was a huge blessing b/c it cut DOWN on her falls and prevented her from trying so hard to get up.

I would think your uncle could be evaluated by his MD and physical therapy to see if it's even an option at this point. What seems to you like improvement could mean something entirely different to the doctors and PTs. Then again, it could indeed mean he's ready for PT and the possibility of improvement, and you could then proceed with your inquiry to hospice.

When my mother was on hospice, physical therapy was not an option. I think once you know where your uncle stands after his MD and PT evaluate him, then you can proceed accordingly. No need to ask hospice the question if he's deemed unfit for PT in the first place. One step at a time, right?

Best of luck to you and your uncle, however this turns out.

You would need to check with your hospice company. Although online Medicare states that therapy is covered while on hospice, the hospice company may not provide it. The hospice companies are not compelled by Medicare to offer therapy so most don’t. I had it for my DH aunt while on hospice but it was privately arranged. Not all hospice companies offer the same services. The hospice company I use for aunt offers baths 7 days a week. That was why I went with them plus I had used the same company for years for Home Health for my mom and DH aunt. Others may only offer 2 or 3 baths a week but they may have another benefit that you need more. Aunt is totally incontinent.
She recently was bedfast for several months. We took her off hospice to take rehab and when rehab stopped, we put her back on hospice. It did help strengthen her for transitions and she is willing to get into her wheelchair now whereas before she would not. So we count it as a win.
Many here on the forum will try to dissuade you from seeking therapy as they feel it is not appropriate for someone who is supposed to be dying within six months. I’m not sure if different states are being monitored to see if expenses are less for those on hospice vs those who go back and forth to the hospital, but it seems less expensive (for the gov)to have hospice even if the patient remains on hospice for years. Aunt has been on hospice for over two years and it was my request to take her off for the rehab, not the hospice company . So there was no push to take her off hospice. She is 95 with dementia and she seems to me she could live for years in her present state.
About having therapy while on palliative care, I have no experience with that. .
About your uncle trying to get up. My FIL did this after having a head trauma from a bad fall. After therapy he was able to regain his total mobility. This took months from fall to mobility. But there was a period of time where he had to be restrained or he would try to get out of bed, or out of his chair. He was very persistent and did fall again while In rehab. Thankfully that fall didn’t set him back and as I said he was able to remain mobile until he fell again 10 yrs later which led to his death.
We have a good bit of discussion about hospice on agingcare.com and posters have had different experiences. There is no One and only rule is what I have come to realize.

Plus insurance companies have different services they will pay for so there is that. The Medicare Advantage plans are different from one another on what they cover and for sure they are all different from original Medicare which is what I deal with. And, of course there are Medicaid plans some are on. So it is difficult to give you a hard and fast rule that all will agree to.
I know it is hard to see your uncle want to get up and not be allowed to do so. Good luck in checking it out for him.

Not normally. Check with his MD and see if coverage of any kind can be done, but Hospice is end of life care. There is no treatment of disease excepting for comfort, normally. You are free to check on this, but I think it will not be.

If he is in Hospice then PT or OT would not be covered.
It may be if he is in Palliative Care.
Now the exception might be ...
If the speech therapy were to help prevent choking, aspiration then it might be permitted under Hospice. (Or pretty sure you could private pay for it) But this might be a question for the Hospice Nurse and even the Hospice doctor. When you ask about it ask suggesting that the therapy might improve swallowing to prevent choking and aspiration. It never hurts to ask.