One of the great frustrations with our medical insurance system, including Medicare, is that it would not know the importance of an ADL (Activity of Daily Living) if the ADL bit the system in the … Well, you know where. This is not only frustrating for us, at Support For Home In-Home Care, but for our clients and families.
The latest example is a conversation I have been having with the daughter of one of our clients for the past few weeks. Her mother needs a lot of support for Activities of Daily Living (ADLs and Instrumental ADLs), including bathing, dressing, toileting, memory care, homemaker services, eating, … That gets expensive.
So, very naturally, the daughter has been talking to folks at Medicare and her mother’s supplemental medical insurance company about whether they will pay some or all of the costs. Unfortunately, I had already been forced to tell the daughter that Medicare and the insurance company were not going to pay (only Long-Term Care Insurance covers these costs, in the insurance world).
However, when the daughter would talk to folks on the phone, they would just confuse the situation. Evidently, those folks, who should be providing expert advice and information to us, as citizens, do not know the difference between home health care (provided by licensed agencies by RNs, Physical Therapists, Speech Therapists and Occupational Therapists) and non-medical home care (ADL support).
So, every time we would talk, I would tell the daughter that we have many, many clients with Medicare and supplemental medical insurance and that not one of them had home care costs covered. Then, she would talk to someone at Medicare or the insurance company, and we would go back around the circle.
Today, I sent the daughter the link to the Medicare document that explains — in language even the Medicare staff should understand (sorry – just frustrated) — that only true home health services, prescribed by a doctor for a period of a few to maybe eight (8) weeks, are covered.
Is it right? In my estimation, no. Home care is vital to the health and well-being of all of our clients — or they would not have it. But, is it the way our system works? Absolutely.
Best wishes. (Call me Frustrated) Bert