Column: Medicare assistance at home distinguished From Medicaid

The first thing you need to know when searching for assistance at home for a parent, spouse, or other loved one is the difference between help received under Medicare and Medicaid. Because of the similarity of the terms there is often confusion.

Medicare can offer much needed assistance especially after hospitalization but is generally limited in time — up to 100 days and most often much less. Medicaid under the Medicaid Waiver Program may offer help for non-medical at home health care for a longer period of time but is severely limited in Pennsylvania to applicants with gross incomes including but not limited to Social Security not to exceed $2,313 per month based on this year's figures.

This usually means that many Pennsylvanians age 65 and over and those under 65 who are on the Medicare program may have rehabilitation help for a limited period of time after hospitalization (by the way, if under age 65 your specific health insurance might cover it also) but longer term government supported home non-medical home health care assistance is largely out of reach for vast numbers of Pennsylvanians. You pay privately instead. If you apply for Medicaid Waiver it does not matter how much it costs you for the care. What matters for approval is your gross monthly income. There can be exceptions for care under a different program known as the OPTIONS program but this is few and far between.

So, if you just finished your long awaited surgery and decide not to receive rehab in a nursing home or rehab facility, but to go home and need additional help, Medicare may be the answer for a limited period. As noted, if you are not on Medicare, your private health insurance might also have provisions for at-home assistance. Here are some descriptions of the types of help under Medicare available for rehab and what they can or will not offer.

Medicare Assistance After Leaving the Hospital. OT, PT and Home Health Care. The terms in the field are OT (Occupational Therapy), PT (Physical Therapy), and Home Health Care.

Although "occupational therapy" seems to imply it is intended to provide recovery so you can return to work, that is not necessarily the case. Actually, recipients of OT may be and often are retired or homemakers or disabled and not intending to relearn employment skills. Occupational therapy has to do with being able to perform basic tasks such as dressing and showering. It is task related. Physical therapy, on the other hand, concerns regaining strength and capacity. You could be lifting weights or stretching.

Some services may overlap. For instance, while OT is intended to get you to do things on your own, home health aides help you to perform certain tasks. For activities like showering you might have both OT and home health. Think about what is it you would like to do but are unable to perform because of your temporary disability and then discuss this with your occupational therapist.

Visits by Nurses. If your physicians' or hospital's orders include home visits by neighborhood nurses, you might expect periodic visits to have your vital signs taken such as blood pressure, heart and so on. Where appropriate, you may receive instructions on diet and medication. Your nurse might check on wound care or give injections. Nurses who visit the home do not provide non-medical services but can be covered under Medicare.

Hospice. Hospice is a coverage under Medicare Part A. To be eligible for hospice your doctor needs to certify that you suffer from a life-limiting condition with a prognosis for six months or less if the disease runs its normal course. There are other provisions but two important points to note — hospice, by definition can continue longer than any 100 day period and is not limited to patients after hospitalization and, unlike Medicaid, does not have financial limitations such as required by Medicaid at home care.

Non-medical home care. Non-medical at home care other than the above is not covered by Medicare. It can involve feeding, dressing, bathing, assisting with toileting, but also running errands, taking you to the doctors or providing companionship. Although you pay privately, it can be an essential part of your recovery.

What you are looking for in many cases is a plan of care to get you back to where you were or nearly so. The various professionals involved can assist you to achieve that goal.

Janet Colliton, Esq. is a Certified Elder Law Attorney (CELA) by the National Elder Law Foundation who limits her practice to elder law, retirement planning, special needs, real estate, and estate planning and estate administration with offices at 790 East Market St., Ste. 250, West Chester, 610-436-6674, [email protected]. She is with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.