In the past month alone I have spoken with two clients whose in-home rehab therapy was terminated. The first termination was because the provider did not believe further improvement was possible. This decision conflicted with the patient’s doctor’s recommendation and the patient knew she could improve further.
The second involved termination because the provider said there had to be a four week break. In this case the patient would just get stable on his walker and then would lose it during the four week layoff. It was clear he needed rehab therapy to improve or at least maintain the function he obtained.
The simple law of Medicare is this: Skilled therapy services may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition. Medicare B will cover in-home therapy for an indefinite period where the patient’s doctor recommends it and the record shows the need for a professional therapist.
The moral: get a new provider if they terminate therapy and you and your doctor disagree with the termination.
Denials of care are getting more common. Suppose you hear about a new treatment and your doctor agrees to try it. But, your Medicare Advantage insure will not cover the care. What do you do?
As I have written before the patient needs a patient advocate to get good care. A recent article in Forbes again proves the point. The Aetna Medical Director admitted in a lawsuit that he did not review denials of care. Nurses reviewed the files and made the decisions. The case in point involved a rare condition that the doctor did not know the treatment protocols and did not review the patient’s medical record before denying care. Obviously the nurses did not either and the treatment was denied over the patient’s doctor recommendation. You can read the article here.
The moral is clear. When you receive a denial of care, advocate with your doctor. If your doctor agrees that the denial is wrong go up the appeal ladder with your doctor’s support. Eventually the appeal process requires review with the patient’s doctor and that often results in approval.
The dream of the Alzheimer’s patient: reversal of memory loss. There was an enticing report in 2014 that memory loss could be reversed. These were cases of what some called “type 3 diabetes.” In some patients improper processing of carbohydrates led to loss of cognitive function. In those patients improved diet and exercise restored memory function. Other than a prescription of “health living” the study did not offer hope to other memory loss patients.
Recently another study was published that promised renewal of memory processing lost through brain aging. In the Toronto Centre for Addiction and Mental Health study the scientist found that some cases of memory loss involved loss of brain ‘chemicals.’ When these are depleted memory function declines. When restored by additives memory function returned. The study raises the question whether a pill with the necessary brain chemicals can restore memory function in early stage Alzheimer’s patients.
See the report in Science Daily, https://www.sciencedaily.com/releases/2019/02/190214102504.htm
One Commentator cautioned that the “drug” that would be used is related to the class of drugs called benzodiazepines. These can have dangerous withdrawal side effects.
https://www.inverse.com/article/53312-new-treatments-for-memory-loss-aging-alzheimer-s
Yet, the Canadian study gives new hope of finding and reversing the brain process that leads to memory loss in Alzheimer’s. They tell of a day when these brain changes may be prevented or reversed.
Will there soon be a pill that can prevent and restore memory loss? Miracles seem to await, “down the road.”