60 day sabbatical

[BarbieAlaska]

I am not sure what board to post this to. My SIL has questions about the 60 day sabbatical. Will you tell me what can be done?

Home health is saying that mom needs to take a 60 day sabbatical from care every so many months before it can be reissued. For 60 days she has no in home assistance. I’ve been told that that is a misinterpretation. Can you find in here where she is allowed to have continuous in home care? Maybe not physical therapy, but at least assistance with bathing and such.

 

[Nuts]

I have never heard of that. Ever. I suspect there's a misinterpretation. Has you sister asked the doctor?

 

[maryhahnward]

I never heard this either. Is this through hospice or Medicare or another health insurance?

 

[BarbieAlaska]

This is with Medicare.

I was told that Medicare only pays for care if there is improvement. Since there is no improvement they reevaluate her care and then drop the care since there is no improvement.

 

[Nikki J]

The no improvement standard was disallowed by the courts. Search Jimmo v Sibelius. Roughly stated if a professional service is needed to maintain function Medicare has to pay. This has been the standard for several years

 

[helkat22]

Hmm...there is a 60 day wellness break that needs to occur once you have exhausted your Medicare A before a new benefit period can begin (which also requires a 3 day hospital stay).
But home health falls under Part B benefits, so that's a moot point.

Maybe someone has their info wrong??

 

[helkat22]

She will not get assistance with "bathing and such" (which is provided by a home health aide) unless there is also a SKILLED service being provided (PT/OT/ST/nursing).

 

[gooseberry]

I would call or email for an answer. It seems like there is a lot of confusion

 

[Gorby]

When I read the thread title, I thought "sabbatical" - how fun. In my world a sabbatical means that you get some time off from your regular duties to pursue your own research or upgrade your skills. Nothing like a sabbatical from "bathing and such". I'm Canadian so I can't offer any advice on Medicaid, although I'm sure we have the same crazy stuff happening here. I sure hope you can sort things out.

 

[BarbieAlaska]

If there is not improvement in the skilled services, is that reason for Medicare to drop funding?

 

[BarbieAlaska]

Who do we call? I looked at the Medicare website and mymymy.... did not pursue it....

 

[BarbieAlaska]

How does a person go about challenging this? I am so ignorant of all this, I do not even know what to ask.

 

[helkat22]

Therapy will likely tell you that if there is no improvement, they have to discharge. But there is a maintenance piece as well. Therapy can be provided to maintain function and prevent contractures and things like that. However, with ALS being progressive, it's not expected that the PALS will maintain AND the services that a PT/OT/SLP would be providing have to require the skills of a therapist. If PT was working in range of motion, once the family has been trained on a home exercise program designed to maintain range of motion, then I believe it would be ethical for the PT to discharge.
How is your local ALSA?? They may be able to help you. Or maybe someone here who had been through it can give you some good advice on how to challenge it.

 

[affected]

If PT was working in range of motion, once the family has been trained on a home exercise program designed to maintain range of motion, then I believe it would be ethical for the PT to discharge.

Except that as progression happens you need to adjust how you do all of this and a PT is terribly helpful for this as someone with no knowledge won't know how to adjust from doing ROM on a standing person with 80% in the shoulder to a person who cannot stand, nor lay flat with 30% ROM.

It's not something a PT can teach once then discharge and walk away from leaving unskilled people to work out as the pain levels only increase as ROM decreases.

 

[helkat22]

I totally agree Tillie, and usually teaching needs to happen over several sessions. If there's a decline that warrants a new eval. But that doesn't mean therapists can stay in indefinitely and wait for an decline. That's unethical and it is our license that is on the line, unfortunately. Sometimes it's very, very hard to discharge a patient.