Medicare Rules Make It Hard for Some to Get Home Health Care

By Briana Vannozzi

Without home health care, doctor’s say 86-year-old Bernie Belenski would likely be in a nursing home. His wife Mary Ann is the primary caretaker, but Bernie has severe diabetes and is completely blind. She says his medical needs are too complex to handle on her own.

“I’m nervous about treating those wounds because they can’t get infected, and that’s why the ladies come,” she said.

The Belenskis’ case is being highlighted by Congressman Leonard Lance and New Jersey’s home health care associations in an attempt to push back Medicare-built barriers that can restrict access to visiting nurses.

“They have to have a face-to-face visit 90 days before being admitted or within 30 days afterwards,” said Visiting Nurse Association of Somerset Hills CEO Ann Painter.

It’s not the doctor’s visit that concerns the agencies, it’s the length of new reports now required by Medicare. They say it places added burdens and frustrations on everyone involved.

“If the physician does not fill out the paperwork effectively, the home health agency can in fact be audited and if the requirements were not met based on the physicians’ documentation then the home health agency will not receive payment for services rendered and currently there are millions and millions of dollars held up in appeals right now just because documentation was not filled out appropriately,” said Home Care Association of New Jersey President Chrissy Buteas.

“I said, ‘What happens if he starts getting those things on his legs?’ and she said, ‘You have to call the doctor. The doctor has to say you need the nurse.’ But before they would send anyone, they came and interviewed us and filled out pages and pages,” Mary Ann said.

There’s also been talk of additional co-pays for Medicare beneficiaries as funding at the federal level continues to be slashed.

“We have to preserve and protect Social Security and Medicare and it’s part of making sure that senior citizens continue to enjoy the high quality of life that they have in their own residence,” said Lance.

The Belenskis say with a fixed and limited income, they didn’t think home health services would even be an option.

“Money circumstances are very tight at this point in time so my concern would be is for people who have paid into the system for so long to burden them with a co-pay on top of that might make them not take the services that they need. It could actually cost the system more dollars though because the patient would be hospitalized eventually,” Painter said.

“I’m grateful that I can stand up and exercise a little bit. I can’t wait until hot, warm weather comes,” Bernie said.

And after 64 years of marriage and 50 years in their home, the Belenskis want to stay here as long as their health allows.