Tuesday, March 26, 2013

Two Steps Forward, One Step Back

Obtaining good care for a loved one with Alzheimer's can sometimes feel like walking through a carnival fun house, with all of the craziness and none of the fun.

A case in point: as Dad's dementia progressed, he started to fall. A lot. His legs were weak, yes, and he had some balance issues, but it was also because his brain was having trouble remembering how to make his body perform the necessary tasks to enable walking. After his worst falls (i.e., the ones that resulted in trips to the emergency room), physical therapy (PT) would kick in and therapists would work with Dad to restore more normal functioning. It always helped. The problem was, just as Dad would start to do really well, the PT would cease.

One of Dad's many injuries
that resulted from a fall.


Because Medicare said that once a condition improved, it would no longer pay for therapy. Preventative or maintenance therapy was not covered. And, of course, once the PT stopped, Dad would slowly lose ground and end up right back where he started.

The kicker here is that no patient with Alzheimer's, or other forms of dementia, will ever improve permanently. By the very nature of their diseases, these patients are on a continual downward slope with no hope of recovery. Thus, Medicare was able to deny them therapy that could significantly improve the quality of their lives.

Dad is mostly wheelchair
dependent now.
Well, now we have some good news. On January 24th of this year, a federal judge approved a settlement that does away with the Medicare Improvement Standard. Patients are no longer required to show improved or reversed health conditions as a result of therapy. Maintenance is now an acceptable standard of care.

This is welcome news, although perhaps a bit late for my father, whose physical health has deteriorated to the point where it's doubtful he can do physical therapy any more. But it should help many others.

The one drawback is that there is a requirement now for occupational, physical, and speech therapists to obtain specialized education in order to be able to evaluate and treat those with cognitive impairment, otherwise the Medicare coverage, once again, won't kick in.

So the question now is: will memory care/dementia facilities step up to provide this training for their employees so that their residents can benefit from this new ruling?

I can only hope, and pray, that they will.

(You can read more about this topic here and here.)

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