Understanding Medicare Services

By Jan Howard

The Danbury Visiting Nurse Association (VNA) provides skilled nursing care, rehabilitation therapy, nutrition and respiratory therapy, home health aide, medical social work, and specialty services, such as wound care, for patients recovering from illness at home.

Connie Brescia, a nurse with the Danbury VNA, presented a program May 15 at the Newtown Senior Center on how to be eligible for services under Medicare.

“Home care services are generally by referral by a doctor or hospital,” Ms Brescia said. “We need a doctor’s orders.”

Home health care can be coordinated while a patient is still in the hospital. A team of skilled professionals customizes care to best meet the patient’s individual needs. Physicians receive regular feedback so care expectations are met. The patient will also receive appropriate referrals to support agencies.

To be eligible for Medicare coverage of home care, a person must be 65 and older, homebound, and of limited ambulation, Ms Brescia said.

To be considered homebound, she said, “It must be a taxing effort to get out of your home.” Homebound patients are, however, now allowed to attend church or go out for a haircut because, she noted, “It’s good for a person’s well-being.”

To be eligible for Medicare coverage, a patient may also have an unsteady gait and need a cane or walker, suffer shortness of breath with minimal exertion or mental confusion, and have a fear or refusal to leave the home. He or she may be bed bound or wheelchair bound or need assistance with equipment, such as an oxygen tank or IVs.

“You will get a bill in the mail showing the services provided, but in the end you don’t have to pay for it,” Ms Brescia said.

She explained there are some items, such as shower chairs or prescription medicines, that are not covered by Medicare.

“You can call Medicare and see what you are eligible for, and to make sure that medical equipment and supplies are covered under Medicare,” she said.

When Medicare decides that VNA home care services are no longer needed, the patient is asked to sign a form. The patient may challenge the decision, she noted, but may be required to pay for additional services.

“We try to stay in as long as we can,” she said.

VNA is a not-for-profit organization that helps people in need of services who do not have Medicare or other insurance, Ms Brescia explained.

The Danbury VNA serves towns in the greater Danbury area. In addition to Medicare, it accepts Medicaid, Blue Cross, and other insurance plans. Self-pay is also available. A reduced fee may apply to those who qualify.