Does Medicare Cover Home Health Care for Dementia?

Medicare Covers Home Health for Dementia

Written by Amedisys

Medicare covers home health care for patients with dementia if patients have a doctor’s order for it, are considered “homebound” and have a need for intermittent nursing or physical, speech or occupational therapy.

Home health agencies like Amedisys use a comprehensive assessment and interdisciplinary approach to treat patients with psychiatric diagnoses like dementia.

What is Dementia?

Dementia is a general loss of mental abilities, including thinking, reasoning, learning and understanding, that is severe enough to interfere with day-to-day activities.

The most common cause of dementia is Alzheimer’s disease, accounting for as much as 80 percent of cases. It’s a slowly progressing form of dementia that eventually leads to severe impairment.

Another 10 percent of dementia is caused by vascular dementia, relating to strokes or other issues with blood flow to the brain. Some patients may also have Lewy body disease, characterized by a build-up of abnormal protein deposits, or Lewy bodies, in the brain.

Unfortunately, there is no cure for dementia. The goal of treating patients with dementia is to delay the disease from worsening and to manage ongoing symptoms with lifestyle changes and medications.

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What Does Medicare Cover for Dementia Care?

Medicare can cover the following for dementia care:

Cognitive Assessments

As part of Medicare Part B (medical insurance), patients can receive cognitive assessments to investigate potential signs of dementia and confirm any diagnoses as part of annual wellness visits.

This benefit also includes a separate visit with the same doctor or a specialist to review the assessment’s findings and, if necessary, develop a plan of care to manage any symptoms or diagnoses appropriately.

Depression Screening

Those in the early stages of a mental health disorder diagnosis may suffer from depression. Medicare Part B also covers one depression screening per year in a primary care setting.

Prescription Drugs

While traditional Medicare does not cover prescription drugs comprehensively, those with Medicare Part D plans cover a range of prescription drugs dependent on specific formularies.

The most common types of medication for dementia patients include cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists. Some patients may also need antidepressants, anti-anxiety agents, mood stabilizers or antipsychotics.

Home Health Care

Original Medicare also covers home health care for patients who meet the eligibility criteria. Depending on the severity of dementia, some patients may also qualify for behavioral health home care.

How Home Health Care Supports Patients with Dementia

Home health care promotes independence, increases safety, comfort and convenience for patients, provides relief for family caregivers, prevents unnecessary visits to the hospital and provides personalized care. Dementia patients specifically have the following benefits:

Access to a Full Interdisciplinary Team

Home health care can help dementia patients by educating them and their caregivers on how to best manage their disease at home. Specifically, home health teams will:

  • Educate on patients’ specific forms of dementia
  • Promote medication adherence
  • Minimize potential fall or general safety risks from the home
  • Provide nutrition and exercise tips
  • Build a support system through caregivers
  • Help plan for the future

As with all home health episodes, our teams will encourage the patient to articulate their goals of managing their disease. How can they continue to live independently, stay out of the hospital, remain physically active and practice mental stimulation?

Home health aides will support with activities of daily living and serve as eyes and ears to the rest of the clinical team, reporting any changes of conditions or symptoms. Medical social workers provide behavioral health education, psychosocial assessments and can point to financial assistance and community resources.

Physical therapists support patients in developing exercise regimens that improve mental health while occupational therapists implement healthy routines and coping strategies to manage symptoms and medication adherence.

Speech therapists address language and communication disorders that can co-occur with dementia. Specifically, they can help with patients who experience aphasia, or difficulty expressing and understanding language. Speech therapists devise activities and exercises to improve language skills while working with the patient and caregiver on alternative communication methods, including everything from simple picture books to advanced augmentative and alternative communication devices.

Caregiver Empowerment

Caregiver empowerment is also vital. Home health teams can help with stress coping techniques and healthy lifestyle habits.  

Home Safety

Home safety is especially critical for those with dementia. Home health teams will help patients and their caregivers assess their abilities, behaviors and overall health to determine what steps need to be taken.

Just about every room in the house should be inspected for potential safety risks. In the bathroom, grab bars and non-skid mats can go a long way in preventing falls. Unplugging or installing safety knobs on the microwave or stove in the kitchen may be necessary for some, while the refrigerator should be checked regularly for expired food.

Generally, the home should have minimal clutter and decorative objects, sufficient lighting, marked glass doors or windows and working locks on all windows and outside doors.

Diet and Nutrition

As dementia progresses, some patients may experience a loss of appetite, decreased sense of taste and/or smell and difficulty or complete inability to chew and/or swallow. They may also simply forget to eat.

Speech therapists can assist with difficulties like dysphagia, or difficulty chewing or swallowing, while other clinical team members will suggest tips to help during mealtime, including limiting distractions, keeping the table or eating surface simple, using cups with lids, offering only finger foods, etc.

Psychiatric Nursing to Support Patients with Dementia

Some Amedisys locations provide behavioral health or mental health services through a psychiatric nurse. This type of care is specialized in-home care for those with mental health disorders. Eligible patients may include those with:

  • Depression, anxiety, schizophrenia, bipolar disorder, PTSD or dementia with behaviors and other behavioral health conditions
  • Progressive and chronic illnesses such as Parkinson’s disease, heart failure, MS or COPD, with depression or anxiety complicating treatment
  • A newly diagnosed terminal or chronic condition with co-morbid depression, anxiety or grief
  • Chronic pain complicated by depression
  • Difficulty managing a medical condition related to underlying depression, anxiety or other psychiatric illness
  • Unresolved grief and depression related to the death of a loved one
  • Dementia with hallucinations, delusions, agitation or combative behavior, including teaching caregivers how to manage behaviors and care for their loved one
  • Hallucinations, delusions or recent psychotropic medication changes related to schizophrenia

To receive this type of specialized at-home care, patients may meet the criteria for homebound status related to their psychiatric diagnosis, as well as a medical condition.

Psychiatric nurses have special training beyond the standard curriculum for registered nurses and serve as educators, advocates and consultants. They’ll work with patients and their caregivers and doctors to create personalized plans of care.

Each visit includes a psychiatric evaluation and head-to-toe physical assessments. Psychiatric nurses use standard rating scales to assess and measure outcomes and progress on goals. For some patients, they may also administer psychotropic injections and obtain labs.

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