Medicare Home Services, Eligibility and Accessibility

Eldercare on the Air is your trusted resource for navigating elder law, special needs planning, and independent living. Hosted by Michael Amoruso, this podcast provides expert guidance to help you and your loved ones make informed decisions during life’s critical transitions.

In this episode, we welcome Joanne Parliaman, Director of Operations for Tender Loving Care, to discuss the essentials of Medicare home services. Learn about eligibility, accessibility, and how home healthcare and hospice services are helping seniors maintain their independence. Discover how Tender Loving Care, a division of Amedisys, delivers compassionate and professional care across Westchester County and beyond.

Tune in for essential insights on securing the right support for you or a loved one. Listen on 107.1 The Peak or visit amorusolaw.com to download episodes and explore resources.

Transcript

SPEAKER_01 0:00

you've lived well you've worked hard to make your place in this world your dignity and security are earned and well deserved or maybe you have a loved one who needs you more than ever well we can help you help them plan life better empowering you to care for the Welcome

SPEAKER_00 0:33

to Eldercare on the Air, a weekly radio show with guests in the fields of eldercare, special needs, financial services, independent living, and yes, people just like you. Where we will empower you to make sound choices when you're faced with an eldercare or special needs crisis.

SPEAKER_01 0:51

Amoruso, Amoruso, empowering you to care for the ones you love.

SPEAKER_00 1:00

My name is Michael Amoruso, an elder law and special needs attorney with Amoruso& Amoruso in Rybrook, New York, which services clients in New York, Connecticut, Massachusetts, and Florida. We are thrilled to be here at our new home, 107.1 The Peak. But I do encourage you to go onto our website, eldercareontheair.com. That's eldercareontheair.com. Click on the radio show tab you see. And just simply download the episode you'd like to listen to. You see, this show is designed to arm you with the knowledge and tools that you need to make sound choices to help you or a loved one age in place. If you have any questions or would like to hear topics on future episodes of Eldercare on the Air, please send us an email at info at eldercareontheair.com. That's info at eldercareontheair.com. We have an informative episode in store for you this week. Today, I've got someone on our show. Her name is Joanne Parliament. I've known her for many years. She is the Director of Operations for Tender Loving Care. Joanne, welcome to the show. It's good to have you here.

SPEAKER_05 2:18

Thank you.

SPEAKER_00 2:19

So, Joanne, tell us about Tender Loving Care and its affiliation. There's a parent company involved here as well, right?

SPEAKER_05 2:25

Correct. So, Tender Loving Care is a care center with a medicis. And Amedisys was founded in 1982 by a nurse. It's a publicly held company with about 21,000 employees. We deliver care across 38 states, including the District of Columbia. We have home health care and hospice and personal care, over 500 locations. Our location is currently in Westchester County. And we are providing Medicare home care services to the residents of Westchester County.

SPEAKER_00 3:05

Excellent. And tell me this, Joanne, you guys are relatively new here in the county, right?

SPEAKER_05 3:10

Correct. So we received our license from Medicare in November of 2020. We began servicing clients at that time. So we've been open approximately three months. We have a current census of 70 and growing. And we have a nice team of clinicians that provide care throughout Westchester County.

SPEAKER_00 3:35

And in particular, for the clients, what type of care does Tenderloving Care provide?

SPEAKER_05 3:41

So as a certified home care agency, we provide intermittent skilled services to people in their home. What that means is they will receive either physical therapy, skilled nursing services, occupational therapy, social work assistance with long-term planning, and a home health aid assistance if a skill is involved to assist with personal care. So skilled services include nursing, physical therapy, and occupational therapy.

SPEAKER_00 4:15

And Joanne, I think some of the audience out there may get a little confused. I know I first did when I was first introduced to this industry years ago. the difference between what services you can get under Medicare versus other private pay or Medicaid that's out there for your certified agency, which is a Medicare licensed agency. What type of services, how many hours typically can someone get from an agency like yours?

SPEAKER_05 4:47

Okay, so to qualify for services under the Medicare regulation, you need to meet certain criteria. You need to be essentially homebound, which means it's a taxing effort for you to leave home. You need to have an acute onset of an illness or an exacerbation of an illness that is impacting your abilities at home, which requires skilled services to either instruct you on how to manage or to do some hands-on care intermittently. You need to have a physician in the community who's willing to collaborate on a plan of care with us. And the services are intermittent, which means five days or less. So to get a referral to us, we get referrals from hospitals directly, patients that have been inpatient, skilled nursing facilities where they might have been there for short-term rehab following a hospital stay, or from physician's offices where patients might have gone and they've had an exacerbation of an illness, i.e. they had heart failure and the doctor is adjusting some of their medications and has concerns about their response to the medications. So they may ask for the nurse to come in and monitor that intermittently and instruct the patient on that. A patient may have a wound that needs the services of a nurse. They may have had an exacerbation of a neurological condition where therapies may be involved to bring them up to their pre-illness functional status or instruct them on home safety equipment or adjust their home environment to adapt to the changes in their illness. So a physician can refer directly to To do that, the doctor would have had to have an encounter with the client within 30 days prior to us seeing them in regards to the illness that they're referring on or 90 days after.

SPEAKER_00 6:58

Or 90 days after. So let's talk about that for a second. So this could be a situation where someone was discharged back home from the hospital, but then within 30 days that same physician says, I think you need services through Tenderloving Care.

SPEAKER_05 7:13

Correct. So for one, if they were discharged from a hospital and they needed services post-hospital stay, the hospital case manager would meet with them at the bedside. And they should give them a list of available agencies that they should pick from. Hopefully they would pick Tender Loving Care. And they would set up the services, which we usually go in the very next day. If the patient leaves the facility and realizes that after they've left, say several weeks later, they're not improving, they go to the doctor, they're concerned about their care, they don't want them to go back to the hospital, the doctor would need to see them within 30 days before to give us an idea of why they need the services and collaborate a treatment plan with them. With the COVID pandemic, CMS has lifted some of the criteria where patients can have encounters via a televideo visit

SPEAKER_00 8:18

with their doctor. So

SPEAKER_05 8:20

they don't have to be exactly face-to-face in the office, but they could do it televideo. Or say, for example, the patient calls the doctor and they say they're having some difficulties. The doctor could contact us and say, I'm going to see Mike next week, but can you please go in there tomorrow just to make sure he's okay until I can see him in the office? And we're ensured that they're going to have that encounter within that 90-day period to meet the criteria.

SPEAKER_00 8:55

Excellent. And Joanne, just so we're all clear, is there a time horizon that this Medicare benefit lasts for or is it infinite?

SPEAKER_05 9:07

So they qualify for Medicare. And when we talked earlier about how often a patient would expect the clinician to come, it really based on their need. But most patients are usually seen a couple of times a week by maybe each discipline that's involved initially. And then it's tapered as they start to progress positively. If they don't progress in the way that we want, but we show that they have potential, We can keep them on. So a Medicare certification period is 60 days. So every 60 days, you would need to recertify somebody. If they continue to have a need for services and meet all those criteria that we talked about earlier, although they don't have to have a new encounter, although we would hope that they would be seeing their doctor, we can keep them on program. As long as they show an improvement, or there is a need for a skilled service in the home. We're not a custodial providing service.

SPEAKER_00 10:13

What does that mean for folks?

SPEAKER_05 10:15

So custodial would mean that you just need somebody in the home to make sure that the patient's safe. Yeah. That, you know, there's concerns that the person's not taking their medications or they're not eating or they need somebody just to help them out of bed, things like that. That's not a service that Medicare provides. That's custodial. That's private pay, which unfortunately Medicare doesn't cover at this time. Some of the managed care companies had talked about that in the past, but I don't see that happening yet. Medicaid does provide that service, which is the state-funded program. But you and I had discussed there's a shortage of home health aides in the area. And also, if somebody needs long-term aid services in Westchester, they need to be on a managed plan, and they may limit the amount of services that they can get as well.

SPEAKER_00 11:10

Sure, absolutely. So I think you just taught me something there. So this recertification of Medicare can just continue. As long as the need is there and they get recertified for the Medicare services every 60 days, this could go on for quite a while.

SPEAKER_05 11:26

Absolutely. I mean, we could have patients that are open for up to six months. As long as the skill is intermittent and we can justify that there's a skill and collaborate with the doctor to ensure that we're providing a service that's showing a positive outcome.

SPEAKER_00 11:45

So one thing that a lot of my clients face when they're in short-term rehab facilities and they're getting skilled care there is, is their Medicare days are ending quickly. There's a Medicare benefit up to 100 days for skilled nursing care in the sub-acute. Typically around day 22 to 34, we tend to see these folks get dropped off and the Medicare appeals aren't working. Is there a different criteria of evaluation for these home health aides?

SPEAKER_05 12:20

I think the criteria for the skilled facility is much more stricter than it is for the home care. I know that there's the two midnight stay that they need to have in a hospital before they can go to a skilled nursing facility, although there's some ways to get around that as well, I've heard. But they have to be pretty sick to go into a skilled nursing facility, and they have to show a rehab potential.

SPEAKER_03 12:49

And

SPEAKER_05 12:50

they need to be able to participate in an aggressive rehab protocol when they're in a skilled nursing facility. In the home, we don't work them as hard as they do in the skilled nursing facility, but we're able to work with them in their home environment so that they're able to manage in an area that they're comfortable with, that they're familiar with. We can adapt it. We can look at moving furniture around, removing throw rugs, setting up grab bars, chairs, lifts, et cetera, in their home, which is much different than the nursing home where their main goal is to get them to a function that they can get them home. And I'm sure they have very strict documentation criteria that they have to meet. in order to keep them...

SPEAKER_00 13:44

To justify them staying at the subacute facility. Absolutely. Yeah, that makes total sense. So what I'm hearing here is tender loving care is uniquely positioned to really help that population that they're not at the 24-hour custodial care level yet. They're having some hiccups in their life and they maybe need some physical therapy or some... at-home occupational therapy, just to help them get over that hump and then maybe manage them as they continue on. But the objective is to keep them independent at home.

SPEAKER_05 14:24

Right. And some of our patients, we transition to outpatient physical therapy as their functional status improves. But there are a lot of people in the community that fall through the cracks. And do not know that they qualify for home care services. And hopefully your viewers can understand the regulations. And if someone is having difficulties and the physician feels that they do qualify, they can absolutely call us. Even if they have a question regarding eligibility criteria, we can discuss with the physician, or even if the client calls our office, we can refer them and give them directive on what we feel that would be the best alternative for them.

SPEAKER_00 15:18

That is an excellent segue into our commercial break here. Joanne just mentioned to all of you out there, take a deep breath. If you have a loved one that's being discharged from the hospital, don't necessarily need to be discharged to a subacute facility or a nursing home for rehab services. There may be this option to bring them home with a home health aide if that's all they're going to really need. So, Joanne, thank you for that information. And if you've missed any part of Joanne's show here, just log on to ElderCareOnTheAir.com. That's ElderCareOnTheAir.com. And her show will be live on that link as soon as we broadcast it. So I'll talk to you all in a few moments.

SPEAKER_04 16:06

We'll be right back here with Joanne. Amoruso and Amoruso, a 107.1 The Peak Ask the Expert partner.

SPEAKER_01 16:24

Amoruso and Amoruso Welcome

SPEAKER_00 16:34

back to Eldercare on the Air. I'm Michael Amoruso, and I'm thrilled to be here again with Joanne Parliament with Tender Loving Care. Joanne, again, welcome to our show. It's good to have you here. And if you miss any part of this episode, just log on to our website after the broadcast, and you'll see Joanne's show there at Eldercareontheair.com. That's Eldercareontheair.com. So Joanne, one thing that I think we were just chatting about during this commercial break that I really want the audience to hear is some advice you have if they're faced with a discharge from a hospital. What would you suggest if they want to go home, but they're not sure if it's going to succeed?

SPEAKER_05 17:15

So when patients are in the hospital and they're looking at a transition home, they should be meeting with the hospital social worker or case manager. If they're on that borderline of whether they want to go home or consider short-term rehab, which might be discussed with them, they can discuss with the case manager that there's a potential dual plan. I'm not sure if I want to go to the nursing home or I want to go home with home care services. To go to a nursing home in New York State, you're required a form called a PRI on screen. You can ask the nursing home I mean the hospital, to complete that form. If you decide to go home and it doesn't work out, there's a time period, and I'm not exactly sure, but say a week later you decide you're not able to manage at home. You need a higher level of care and an intensive rehab in a nursing home. Hopefully the hospital will be able to submit that PRI and screen to the nursing home Or we can help you contact a local nursing home who would be able to admit you and you'd still qualify for Medicare services in a skilled nursing facility as long as you had that two-midnight stay in a hospital. So it's not a cut-and-dry thing. Make a decision if you really think you can try it at home, but you really have to think of, can I transfer independently? Am I going home with an elderly spouse who may not be able to manage me at home? Think about all those criteria before you make your decision of whether you need to go home or to a nursing home to get a little bit more stronger before you go home.

SPEAKER_00 19:07

I think that's great advice because oftentimes folks are just told, we need a list of names of nursing homes you'd consider going to for rehab. And they may not understand that there is this other option out there to receive these rehab services through a company like yours, Tender Loving Care, at home to see if that works. And your advice about getting that PRI, which stands for patient review instrument, done at the hospital so that they have it in hand or the hospital has it.

SPEAKER_05 19:37

They're not going to give it to them, but at least you know that it's available, that if the nursing home needs it.

SPEAKER_00 19:42

Because if they don't have it and they feel like they do need to get into a nursing home, then they've got to get a PRI done.

SPEAKER_05 19:49

Correct.

SPEAKER_00 19:50

That's great advice that you just gave them. So that's something to keep in your toolbox, folks. Now, tell the audience what really separates tender, loving care from all the other options that are out there.

SPEAKER_05 20:04

So I have to tell you that I've been in home care for many years, and I'm very impressed with this company. They really focus on quality patient care. Our star rating on Home Health Compare for our company averages 4.3. We focus on an interdisciplinary approach to patient care. Our team meets every week to review all the disciplines. the patient's needs and how we're meeting them and if we need to tweak the plan of care, et cetera. The other thing that impressed me with the company is that they are very dedicated to their employees. Their focus is to ensure that employees have a good work-life balance. They send out surveys quarterly to ask suggestions on how to recruit, retain, because we know that right now the healthcare industry has a shortage of employees. And we want to make sure that the employees are happy in the work that they're doing, because that will trickle down to the patients, of course. And I really think the interdisciplinary approach and the conversations that the employees have with each other every day about their patients really improves the outcomes that we have with the clients that we're servicing.

SPEAKER_00 21:31

Now, you mentioned that your company services many states around the country. You're just over a year here in Westchester County. What areas are you actively servicing within the county?

SPEAKER_05 21:43

We're servicing the entire Westchester County, from Yonkers all the way up to North Salem. And You know, we provide services anywhere within the county. Now, Emeticis does have care centers in the area. We service Connecticut, which services from Greenwich all the way past Ridgefield up to Danbury. We have a care center in Garden City, Long Island, one in Medford. Secaucus, Hackensack, New Jersey. So those are the ones closest to Westchester. But they have care centers all over the country, which makes it nice for employees because if they decide to move out of the state, there are employment opportunities for them in other states that they move to.

SPEAKER_00 22:34

Well, that's fantastic. Now, you raise an interesting point. What about if someone's moving? One of your consumers is moving from New York to another state. where Medicis has another organization like Tender Loving Care. Can you help with that transition to the other state?

SPEAKER_05 22:55

We've had that in Westchester because, as you know, many of the people in Westchester are... They bring their relatives here after a hospitalization. We've had a few that have come here and then moved back to their homes in other states. And it's an extremely smooth transition because we're just handing it off to another care center. And they're probably in there the next day or the day after. So

SPEAKER_00 23:21

let's talk about that a little bit because this comes up quite often, even in my law practice, where I may have someone call me from Florida. And they've been in Florida because of the COVID situation up here. And all of a sudden, their loved one fell ill in Florida, but they want to come back to New York. How would your organization assist them getting them?

SPEAKER_05 23:46

In terms of getting home care services

SPEAKER_00 23:48

for them? Yeah, home care services and transitioning it from Florida back to New York. Well, if they

SPEAKER_05 23:52

were with an emeticist company in Florida, then they would be able to transition them. And hopefully they would have a physician in this area who would be following them. If they don't, then their physician could contact a medicis and we would transition the patient up here.

SPEAKER_00 24:13

Excellent. That's something that happens quite often.

SPEAKER_05 24:18

And we do get patients from Florida. We get the snowbirds who are there in the winter and they come back in the summer.

SPEAKER_00 24:26

We talked a little earlier about this shortage of aides in New York State. And this is something that we've noticed across the board, even with just companies that offer custodial care. Ever since COVID hit, the availability of aides has plummeted here in New York State for home care. Now, what does that mean for the audience out there? Well, it means you may call an agency you know, and they may not have someone that can come out to service you.

SPEAKER_03 25:01

It

SPEAKER_00 25:01

may also mean that because there's such a shortage, maybe you may require eight hours of care, but that managed long-term care company is going to offer you less because they don't have the bodies to fulfill the services that are required for you. How are you guys navigating that?

SPEAKER_05 25:23

Well, for us, for a certified home care agency, our aides are only there for personal care. Under the Medicare regulations, the aid is to be providing 75% personal care during the time that they're there. So the clients only get about one to two hours of an aid a couple of times a week, and it's really just for a shower and maybe work with the home exercise program with them if the physical therapist isn't there, maybe make their bed, wash the dishes that are in the sink. So for us, it hasn't impacted us yet. I mean... We do see that many times people in the community do not understand the Medicare regulation and think that when they come on with the Medicare company that they're going to get somebody to come four hours, five days a week, which is something that we did many, many years ago. But I think the shortage of AIDS has impacted that. The way Medicare pays us has impacted that. So we have to follow the regulations very strictly. And the aid is really an extension of the team who's working with the team to ensure that the patient improves their abilities to perform their activities of daily living. So most patients that we get that require an aid, An occupational therapist is put in with those patients to try and get them to become more independent in their personal care needs so that they won't need an aid. Maybe increase the equipment in the bathroom, adaptive equipment, sponge on a stick, sock aids. et cetera, to help them with their ability to perform their activities of daily living. So again, our services are short term and it's really focused on independence in the home. So for clients that are needing eight hours of an aid long term, unfortunately, that's not something that's provided by a certified agency.

SPEAKER_00 27:29

Yeah, that's not your business model and what you're allowed to do. But what you are allowed to do is supply that aid of, for a short-term basis to get the folks back to independence.

SPEAKER_05 27:41

Correct. Or if they're not, we would provide social work assistance to help them navigate the system, see if they qualify for Medicare services, see if there are other services, VA services, Westchester County's ISEP program, services that they can access to help them in the home once we discharge them.

SPEAKER_00 28:05

Fantastic. Now, Joanne, this is something I've never done on this show before, but I want to do it, only because there is such a shortage of aides out there. Any of our listeners that possibly would want to entertain a career in this area, are you guys looking?

SPEAKER_05 28:22

Absolutely. We're looking for nurses, physical therapists, occupational therapists, speech therapists, social workers, and home health aides. So if anyone is interested in a career with Amedisys, not only at my care center, but other care centers, they can go onto our website, which is www.amedisys.com, and I'll spell that, A-M-E-D-I-S-Y-S.com. They would click careers. They would look for location. If they're looking for Westchester County, they would hit Hawthorne, or they would navigate other care centers that they're looking for location and apply online, and a recruiter would get back to them as soon as they can.

SPEAKER_00 29:11

And Joanne, if you have a consumer out there listening to this show that would like to entertain your services, how can they reach you?

SPEAKER_05 29:19

Sure. Our number to our care center is 914- 205-5708 and they can call us and we can direct them as to what to do. We can have one of our account executives contact their doctor's office to see if we can transition them to our services and if they qualify.

SPEAKER_00 29:47

Well, Joanne, thank you so much for being on our show. And again, if you miss any part of this show, just log on to our website, eldercareontheair.com. That's eldercareontheair.com. And once this broadcast is over, you'll see Joanne's show there. Listen to it because what she is talking about here is another option for all of you to have in your care toolkit. And that is not just acute hospital stay or long-term nursing home or long-term home care as your options. You do have this ability to receive under Medicare certified aides at home helps you achieve independence so that you can stay home. Joanne, thank you again for being here. I thank Tender Love and Care for giving you to us today. It's been a pleasure. Thanks, Mike. And for all my audience, I'll talk to you all next week. Take care.

SPEAKER_01 30:41

Amaruso and Amaruso Empowering you to care for the ones you love

SPEAKER_04 30:51

Amoruso and Amoruso LLP and Rye assists clients with comprehensive estate planning and vital asset preservation tools that reduce financial risks of long-term care. Amoruso and Amoruso, a 107.1 The Peak Ask the Expert partner. Visit eldercareontheair.com for more details.