Wellness

[BalletBabe]

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@reiki604 wrote:

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@BalletBabe wrote:

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@reiki604 wrote:

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@lovesrecess wrote:
The standard Medicare in-home wellness check I had seemed to be the gov’t nosing into my personal business and I will never allow anyone inside my home again for such....ithe male nurse who was sent was very nice, but he began walking around looking at the stairs, rugs, etc and asking me about falling, tripping, even asked to see my bathroom and I said no. Unfortunately, DH was not home and I had no idea it would be a male nurse. Mad me uncomfortable. Took my bp, height and weight...nothing else. My former employer is switching to another insurance company in January, so am sure they will be asking to do the same thing...will not agree to it.

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What you are describing is the initial nursing assessment done to determine the need and safety of a client for home care services that are paid by Medicare. Most other insurances have adopted the same assessment to determine the number of hours and neccesity of home care services. It is something very different than the Medicare wellness check. It determines your homebound status ( required for homecare services), your actual need for services, and your safety in that home. By asking to see your bathroom, they are trying to determine your ability to do personal care and assessing the need for personal care assistance in addition to the nursing or therapy requested by the physcian. If you do not agree to the assessment, you will not receive the services. 

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@reiki604   This is part of the Avantage program and Medicare.  It is governemnt intrusion and no one should let them in their house.  I have a friend in Michigan who they had called regarding her Father.  She told them she did not want them there while Covid was going on.  She left for work and when she got home guess who was in her house?  Her Father is senile and let them in.  Why?  It is all about $$$$$$$$$$$$$$

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Having spent the last 9 years before I retired as the supervisor/manager for large home care agency you are being very shortsighted. The assessment being described was to evaluate for the need of home care services for the elderly and homebound. Of course the caretaker has every right to refuse services but why would someone who needs help in wound care, diabetes management and insulin administation, physical and occupational therapy while homebound deny someone in need those services? One of the Medicare criteria for home care  is that it be short term and necessary. 

I do have to ask, why is a person with dementia who will let anyone into the house beling left alone to let someone in? That might be an indicator for an APS referrral as clearly the person was unsafe at home.

ETA: A home care referral must be made by a physician. The home care agency does not go in there on their own. Obviously your friend's dad's doctor thought he would benefit from the services available.

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@reiki604   No this is a invasive bunch of questions.  Most that are none of their business.  When you have a Advantage program you do not need referrals on a PPO.  She did not want him exposed to Covid and 3 people where there when she got home.  Just to ask the same evasive questions they ask every year.  It is all about money.  There was no care involved , just a bunch of nosey questions.  

[reiki604]

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@BalletBabe 

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@reiki604   This is part of the Avantage program and Medicare.  It is governemnt intrusion and no one should let them in their house.  I have a friend in Michigan who they had called regarding her Father.  She told them she did not want them there while Covid was going on.  She left for work and when she got home guess who was in her house?  Her Father is senile and let them in.  Why?  It is all about $$$$$$$$$$$$$$

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Having spent the last 9 years before I retired as the supervisor/manager for large home care agency you are being very shortsighted. The assessment being described was to evaluate for the need of home care services for the elderly and homebound. Of course the caretaker has every right to refuse services but why would someone who needs help in wound care, diabetes management and insulin administation, physical and occupational therapy while homebound deny someone in need those services? One of the Medicare criteria for home care  is that it be short term and necessary. 

I do have to ask, why is a person with dementia who will let anyone into the house beling left alone to let someone in? That might be an indicator for an APS referrral as clearly the person was unsafe at home.

ETA: A home care referral must be made by a physician. The home care agency does not go in there on their own. Obviously your friend's dad's doctor thought he would benefit from the services available.

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@reiki604   No this is a invasive bunch of questions.  Most that are none of their business.  When you have a Advantage program you do not need referrals on a PPO.  She did not want him exposed to Covid and 3 people where there when she got home.  Just to ask the same evasive questions they ask every year.  It is all about money.  There was no care involved , just a bunch of nosey questions.  

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Any advantage program is either a managed Medicaid or managed Medicare program. Any home care program requires a doctors referral. It is strictly regulated by the federal government department also known as CMS. Any monies paid are coming out of the clients benefit. All must follow the same rules. The patient must be homebound, services must be short term, intermittent and necessary, and the patient must be safe at home. Medicare will only pay for personal care such as bathing feeding and grooming. That normally comes to two hours a day 2 to 3 times a week. Nursing care is dictated by an MD order followed by the nursing assessment called OASIS. The oasis evaluation determines the kind and amounts of services required and is mandated by the Federal government. A plan of care is developed. Wound care, ostomy care or any other ordered service will be provided on the initial visit. 

A managed Medicaid program will provide longer personal care services relative to the patient's needs. 

As I said earlier, a person is free to refuse home care services. It cannot be forced upon you. It is clear you do not understand the intricacies and the requirements of home care services. A person with dementia should not be left alone due to unsafe conditions and should be supervised. Adult protective services can and should be called if a person with dementia is left alone. They can injure themselves or wander outside the home

This evaluation is completely different than the standard annual wellness check done by Medicare in the doctors office. This evaluation is done to determine,by the physician, the patient's medical plan of care. It is totally separate from a home care evaluation which is a nursing evaluation for the patient's total needs. 

If an agency is told not to come by the family, it is reported to the referring physician and the case is not opened. There are too many people who require and welcome home visits to waste resources on those who, for whatever reason refuse what benefits their loved ones require.

[BalletBabe]

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@reiki604 wrote:

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@BalletBabe 

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@reiki604   This is part of the Avantage program and Medicare.  It is governemnt intrusion and no one should let them in their house.  I have a friend in Michigan who they had called regarding her Father.  She told them she did not want them there while Covid was going on.  She left for work and when she got home guess who was in her house?  Her Father is senile and let them in.  Why?  It is all about $$$$$$$$$$$$$$

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Having spent the last 9 years before I retired as the supervisor/manager for large home care agency you are being very shortsighted. The assessment being described was to evaluate for the need of home care services for the elderly and homebound. Of course the caretaker has every right to refuse services but why would someone who needs help in wound care, diabetes management and insulin administation, physical and occupational therapy while homebound deny someone in need those services? One of the Medicare criteria for home care  is that it be short term and necessary. 

I do have to ask, why is a person with dementia who will let anyone into the house beling left alone to let someone in? That might be an indicator for an APS referrral as clearly the person was unsafe at home.

ETA: A home care referral must be made by a physician. The home care agency does not go in there on their own. Obviously your friend's dad's doctor thought he would benefit from the services available.

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@reiki604   No this is a invasive bunch of questions.  Most that are none of their business.  When you have a Advantage program you do not need referrals on a PPO.  She did not want him exposed to Covid and 3 people where there when she got home.  Just to ask the same evasive questions they ask every year.  It is all about money.  There was no care involved , just a bunch of nosey questions.  

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Any advantage program is either a managed Medicaid or managed Medicare program. Any home care program requires a doctors referral. It is strictly regulated by the federal government department also known as CMS. Any monies paid are coming out of the clients benefit. All must follow the same rules. The patient must be homebound, services must be short term, intermittent and necessary, and the patient must be safe at home. Medicare will only pay for personal care such as bathing feeding and grooming. That normally comes to two hours a day 2 to 3 times a week. Nursing care is dictated by an MD order followed by the nursing assessment called OASIS. The oasis evaluation determines the kind and amounts of services required and is mandated by the Federal government. A plan of care is developed. Wound care, ostomy care or any other ordered service will be provided on the initial visit. 

A managed Medicaid program will provide longer personal care services relative to the patient's needs. 

As I said earlier, a person is free to refuse home care services. It cannot be forced upon you. It is clear you do not understand the intricacies and the requirements of home care services. A person with dementia should not be left alone due to unsafe conditions and should be supervised. Adult protective services can and should be called if a person with dementia is left alone. They can injure themselves or wander outside the home

This evaluation is completely different than the standard annual wellness check done by Medicare in the doctors office. This evaluation is done to determine,by the physician, the patient's medical plan of care. It is totally separate from a home care evaluation which is a nursing evaluation for the patient's total needs. 

If an agency is told not to come by the family, it is reported to the referring physician and the case is not opened. There are too many people who require and welcome home visits to waste resources on those who, for whatever reason refuse what benefits their loved ones require.

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@reiki604   His daughter is his caregiver and called and told them NO.  He is fine alone.   They had no business in her house when she said NO.   I happen to know that when you put a Dr. down as your PCP, that Dr. must have certain things done in order to get paid.  Wellness is one of them and that is why it is being shoved down peoples throats.   If a person wants them that is fine but when you say NO and I don't want you in my home for a uneccesary visit when we are in a Pandemic, they have no business in your home. 

[reiki604]

@BalletBabe , you have your mind and beliefs made up as you are entitled to.

I have provided an explaination of the different types of Medicare questionaires and their purposes. 2 different assessments were being discussed. They are as different as oranges and apples.  I hope that those who have read this thread understand the differences and requirements for each.

[Carmie]

@reiki604   I think you did a wonderful job of explainig home heath care and how it works.

Sometimes, people have an idea in their head and no amount of explaining will convince  them to open their minds and accept a different thought.

There are other programs state and federally funded that are not Medicare related.  They are available to low income individuals.

Those programs also send someone to your home and help the patient to be able to live safely in their home.  They might recommend removing rugs and furniture on wheels and  even suggest no putting much used items on a high shelf, etc.

Why some people think this is invasive, I have no idea.  Many elderly people have fallen and end up in personal care homes because their living environment was not safe for them.

I personally know two such people.

[reiki604]

Thank you @Carmie. I have the rules and regulations tattooed into my brain as well as what is covered by insurance (your specialty) and what isn't.

I recognised the questions about rugs, seeing the bathroom etc as being directly from the OASIS assessment to determine the patients ability to be safe and the need for services like PT,OT etc. It was all about the patient. I would never have lasted 35 years as an RN if it wasn't.

[noodleann]

I had months of in-home wound care service, including wound vac dressing changes, PICC line maintenance and blockage removal, and some laughable PT when I was weight bearing.

I had trip hazards all over the place. The visiting nurses never said a word about them. I had my friend take up rugs after they'd visited a couple of times, just to be on the safe side, but that didn't eliminate them entirely.

I really wish people here would stop confusing rules with reality. What's supposed to happen and what actually happens are often very different animals. People do what's expedient. That includes people with letters after their names.

BTW, I had calls from my insurance company to try to schedule a home visit a couple of years before my leg break and the consequent osteomyelitis that occasioned all the home care. The insurance company was going to send a third party. Same kind of nosing around others have described, info they could obtain over the phone. I asked them how this visit was medically necessary, and they had no answer. I said nothing doing and not to contact me again about it. I had no problem getting in-home services when I needed them.