Home Health Pt. Qualifications in AZ.?

[jnette, ASN, EMT-I]

Hi there AZ. nurses! :)

Just got back from Tucson not long ago.. sis lives in Tucson, and Mom lived in Phoenix until recently, when we moved her in with sis, as she is now homebound and no longer able to live on her own.. Alzheimer.

Anyway... I've been telling sis to get her started with Home Health. Pati is not a nurse, and Mom has several other diagnoses as well.. HTN, hyperlipidemia, NIDDM, CAD with stent, severe osteoarthritis in L knee. Thought her doc would recommend HH visits for her, but Pati has asked around and she always gets the same answer there in Az. .... that Mom doesn't qualify for HH as her income is too great. I told Pati perhaps they were confusing that with Medicaid, but she said no... she had specifically mentioned Medicare, and still she gets the same answer from even Social Services, and the Alzheimer Support ppl... something about HH being income based, or she doesn't qualify ???

Well... I'm a HH nurse myself, and I do believe I'm right is saying HH is available on a federal level to ANY patient who is on Medicare and is homebound? Heck, I have patients in my care who have fewer diagnoses than my mom, for heaven's sake!

So what's the deal out there? Is there something I don't know about? Does AZ. do things differently? I don't see how, as Medicare assumes HH SN visit costs to anyone on Medicare, as long as they are homebound.. I mean it's a federal thing, not a state-by-state thing!

If someone can give me some feedback on this, I'd sure appreciate it! :)

Sis is about to pull her hair out, as I'm telling her one thing, and they are telling her another out there.

Thanx a bunch !

[Kabin]

I think you are correct. I found some Home Health/Alzheimer's/Medicare info at this site:

http://www.alz.org/Resources/FactSheets/FSfsmedicare.pdf

Quoting the example question from the site:

7. Will Medicare pay for my father to receive home health care?

Medicare pays for home health care if your father meets certain conditions. He has to be confined to his home and require physical or speech therapy, or intermittent skilled nursing care, which will be provided from a home health agency under his doctor’s plan of treatment.

If your father meets these conditions, Medicare will pay for him to receive any of the following home health benefits as specified in his treatment plan: part-time or intermittent nursing care; physical, occupation or speech therapy; medical social services; part-time or intermittent home health aide services; medical supplies and durable medical equipment. The duration and number of visits will depend on his treatment care plan written by his doctor.

Your father must need a skilled service to be eligible for home health care benefits. Many people with Alzheimer’s disease have significant chronic care needs, but they do not require the services of a skilled professional.

If he does receive home health benefits under Medicare, there are no deductibles or coinsurance payments for which he would be required to pay for these services, except for the durable medical equipment.

[jnette, ASN, EMT-I]

Thanx, Kabin... I'm quite familiar with what the requirements are HERE, and was assuming that since HH is under teh federal Medicare umbrella that it would be the same everywhere. Alzheimer or no, she would benefit from a skilled nurse visit 2-3x/wk just to check her BG, and vital signs. The severe osteoarthritis in her knee may well warrant some PT as well. So as far as I can see, she's a good candidate.

I just don't understand why these ppl out there are saying she wouldn't qualify.... they MUST be thinking mediCAID, but when Pati clarified, they said no, they were takling about mediCARE. Something's wrong... I can't imagine what they're thinking.

Ah well... I might just give the good doctor a call myself and see what I can get going for her.

Any other input is welcome!

And thanx again! :kiss