Christopher B. Kroll & Associates – Elder Law Solutions

      While there are many people that receive home health care services through the Medicare program, the program was designed as a post-hospital benefit for those seriously ill or needing continued rehabilitation.  Medicare will not cover simple personal care services such as assistance with bathing, cleaning a home, or making a meal.

A client qualifies for Medicare home health care services if:

• A physician has signed a care plan.  The plan should include all necessary medical supplies and equipment as well as all necessary home health aides.

• The care will be provided by, or under arrangements with, a Medicare-certified home health agency.

• The client must need:  part-time or intermittent skilled nursing care or the assistance of home health aides

• The client needs physical, occupational, or speech therapy

• The client is home-bound

     In 1987, Congress enacted the Nursing Home Reform Law that has been incorporated into the Medicare and Medicaid regulations.  The law gives residents a number of specific rights, including:

• Residents have the right to be free of unnecessary physical or chemical restraints.

• Facilities must inform residents of the name, specialty, and means of contacting the physician responsible for the resident’s care.  Residents have the right to participate in care planning meetings.

• At the time of admission and during the stay, nursing homes must fully inform residents of the services available in the facility, and of related charges.

• Residents may bring personal possessions to the nursing home, such as clothing, furnishings and jewelry.

• Nursing home residents may not be moved to a different room, a different nursing home, a hospital, back home or anywhere else without advance notice, an opportunity for appeal and a showing that such a move is in the best interest of the resident or necessary for the health of other nursing home residents.

• Residents have the right to gain access to all his or her records within one business day, and a right to copies of those records at a cost that is reasonable in that community

Hospice is a special way of caring for people who are terminally ill, and for their family.  This care includes physical care and counseling. 

 You are eligible for hospice benefits when:

• You are eligible for Medicare Part A (hospital insurance); and

• Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live; and

• You  sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness; and

• You receive care from a Medicare-approved hospice program.

Your doctor and the hospice will work with you and your family to set up a plan of care that meets your needs.  The care the hospice gives you is meant to help you make the most of the last months of life by giving you comfort and relief from pain.  The focus is on care, not cure.

Mr. Jones is a resident in Shady Lawn Nursing Home.  He has applied for Medicaid but has not been approved yet.  Mr. Jones has a sudden medical issue and has to go to the hospital.  He has to stay at the hospital for less than ten days.  On the day he is to be discharged back to Shady Lawn Nursing Home, the nursing home refused to re-admit him.  What options does Mr. Jones have? 

 Because he was hospitalized for less than ten days , Mr. Jones has the right to readmission to the same nursing home.  According to Michigan law, the nursing home is required to hold the bed open for his return and advise him of this before his transfer to the hospital.  If Mr. Jones was hospitalized longer than ten days, he has the right to return to the first available bed.