Medicare and Dementia

After years spent calling insurance reps, Googling, and talking to health insurance agents, I have finally accepted the truth. Until my father received a diagnosis confirming he has dementia, I believed there was something that could be done for him to get the home healthcare he needs.

I explained to every representative what I was looking for. No, I don’t need someone to cook or even to clean. I just need someone to watch him. Make sure he takes his medications. Make sure he doesn’t fall. And every time I received the same answer - "Those are not skilled services ma'am. Those fall under unskilled services and we do not cover those."

Skilled and unskilled services

When I first started down this path I didn’t even understand what skilled or unskilled services meant. In my mind, someone administering medication or monitoring my father's blood sugar meant they had to have some skills or training.

Caring for my father wasn't a job a high school teenager could do. It seemed like a skilled position. The insurance told me they cover up to 20 hours of skilled services per week. I was ecstatic.

I went to the home health agencies and said, "Excuse me, I'd like an order of 20 hours of skilled services per week please. The insurance covers it." I think I almost heard the home health rep laugh on the phone. "Ma'am skilled services means physical therapy, speech therapy, or nursing. And that can only be provided at 1 hour a week."

What is the miscommunication?

One hour a week? What am I going to do with 1 lousy hour a week? So I kept going back to the insurance. I kept asking why there was such a miscommunication between the insurance and the home health agency.

Then I went beyond the insurance company. I went to the Medicare office. Make the insurance company cover this I demanded. They laughed too. But then I thought, maybe it’s because they think his situation isn’t severe enough. I have to get him the proper doctors and tests and prove he truly needs these services.

So then I got him the right specialists, and those specialists ordered the right tests, and the tests all came back saying the same thing - he needs home healthcare. The kind where he is taken care of and monitored. But even then, with a dementia diagnosis, nothing would change. It’s out of pocket or it’s praying like hell he doesn’t fall when he’s home alone.

His care will not be covered

It finally became clear. Medicare will never cover home health care that is unskilled and what I was looking for was unskilled according to the insurance agencies.

There is no situation where Medicare will make insurance companies cover any sort of care that prevents a major disaster. Not sure what my next step is but if anyone has any suggestions, let me know!

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