As medical professionals serving a large senior population, we often have patients who are in need of short-term or extensive rehabilitation services due to suffering a stroke, becoming critically injured, contracting a severe or chronic illness, or experiencing a cardiac condition. Finding the appropriate rehabilitation facility can be an overwhelming challenge for your patient and her family, from researching which facility to use and determining the types of necessary therapies to learning which services are covered by insurance or Medicare. Medicare Parts A and B will cover most types of services and procedures, but there will soon be revised therapy cap limits for certain kinds of services. These cap limits may also differ depending on certain documentation provided by specific therapists. Healthcare professionals can provide the proper resources, referrals, and vital information needed to walk senior patients through this temporary situation and help ensure their rehabilitation — and a successful road to recovering their independence.
Types of Rehabilitation Centers
Your patient’s medical circumstances will help determine which services are needed at which type of facility. If he has suffered a stroke or substantial injury such as a broken leg or hip, then occupational and physical therapy services may begin in an inpatient skilled nursing facility with continued therapy at an approved rehabilitation center on an outpatient basis. Unfortunately, not all therapeutic services may be available within the same facility. If your patient is fortunate enough to receive a majority of those services at one place, an interdisciplinary team format will be utilized after a comprehensive assessment, consisting of various types of therapists, nurses, and doctors working on a rehabilitation plan together.
Many hospitals have their own cardiac rehabilitation centers for those who have undergone major operations like bypass surgery, heart valve replacement, or heart transplant surgery, which are all covered by Medicare Part B. Your patients also qualify for cardiac rehabilitation coverage if they have recently undergone a coronary angioplasty, have had a heart attack within the last twelve months, or have had a minor cardiac procedure. Upon discharge, patients will typically continue their cardiac therapy with doctor’s orders by returning to the hospital’s facility.
Types of Therapy Services
Since the older adult population has a high rate of fall-related injuries that may require a wide range of therapies for a full recovery, your senior patients should be informed of the several types of rehabilitation services that are available to them. For example, after experiencing a stroke, which could result in brain damage, your patient may need physical, occupational, and cognitive therapy procedures for her rehabilitative program. Ultimately, the main goal of a targeted recovery plan is for her to regain her independence and self-sufficiency. Occupational therapy will assist her in regaining the ability to complete daily living activities such as cooking, dressing, writing, or reading. Occupational therapy can also be used in the case of memory loss through the introduction of computer programs for decision making, problem solving, or abstract reasoning.
Physical therapy is normally recommended after bone or muscle injuries. Injury to a major extremity, for example, could cause a significant delay in recovery. After a senior experiences a fall-related injury, physical therapy (PT) may be the primary activity needed since strength, dexterity, and mobility are vital for independent living. A branch of PT is physiotherapy. This is more focused on aspects of spinal/musculoskeletal/nerve functions and repair with a deep-tissue, hands-on mobilization approach for muscles and joints. For example, physiotherapy may be the preferred treatment for a senior patient who has severe whiplash after a car accident. At most rehabilitative centers, physical therapists will perform the treatment after a physiatrist (rehabilitation physician) conducts an assessment from medical records and prescribes specialized suggestions for techniques to be used beyond basic PT methods.
Aquatic therapy is often used as an integral component of a physical therapy regimen because it provides a source of low-impact exercise for joint rehabilitation. Aquatic exercise can play a vital role in seniors’ overall recovery. If possible, have your patient continue aquatic exercise beyond the point of recovery, as it will provide her with an excellent form of low-impact physical activity.
Cognitive rehabilitation is a common treatment used after severe brain trauma, such as in the case of a major bleeding stroke, when brain damage may be significant. This therapy consists of neuropsychological treatments, counseling, and mental exercises. Cognitive therapy may also be necessary if a patient suffers serious head trauma during a fall.
Your senior patients should also be educated about cardiac rehabilitation, its many components, and the importance of following through. They need to be made aware of the differences between intensive cardiac rehabilitation and regular cardiac rehabilitation. Intensive cardiac rehabilitation programs are covered under Medicare Part B but must be accompanied by a doctor’s order. This rehabilitation normally occurs after major surgeries such as coronary artery bypass, heart valve replacement, or heart transplant. Basic cardiac rehabilitation is more focused on nutritional education and counseling, and is paired with specific exercises and physical activity.
Therapy Cap Limits
It is very important for senior patients and their families to be informed about Medicare coverage changes regarding therapy cap limits that are coming in 2015, which will apply to the costs of occupational, physical, and speech-language pathology rehabilitative services. The limit for occupational therapy alone will be $1,940. Additionally, the limit of combined incurred expenses for physical therapy and speech-language pathology services will also be $1,940. If the costs of these therapy services are projected to exceed the cap limits, then specific documentation will be required from your patient’s therapist for the excess amounts before the therapy is given. Even with this proper documentation, there are still limits on how much Medicare will cover. Your senior patient and his family should also understand that all recommended therapies and procedures must be deemed medically reasonable and necessary through documentation from his therapist before Medicare will pay for services above the $1,940 cap. If some rehabilitative therapies are considered unnecessary, your patient’s therapist can prepare an Advanced Beneficiary Notice of Noncoverage before those services are provided. This document states that the patient agrees to pay for the expense of any therapeutic service conducted that is not approved as a medical necessity.
Medicare and Supplemental Coverage
Medicare Part A (hospital insurance) and Part B (medical insurance) will cover a majority of expenses incurred from the various therapies. At times, however, there will be medical circumstances when certain services, fees, or procedures are not covered. Supplemental medical coverage, a policy created exclusively for covering the costs of gaps left by primary insurance, is a valuable investment to keep out-of-pocket expenses to a minimum. United Healthcare, Medigap, and Humana are just a few of the many Medicare supplemental options available to seniors. Be sure to inform your senior patients and their caregivers to review these supplemental programs carefully before purchasing one since they all vary, each with its own specific exceptions.
Regaining Self-Sufficiency and Independence
Once your patient has recovered enough to regain her independence and self-sufficiency, she may have the option of an in-home therapist for her final phase of rehabilitative therapy. Even if your patient has rebuilt her strength and dexterity to achieve independent living, she may still have a high level of internalized anxiety over being alone. If it is not feasible for a family member or private caregiver to stay with her, this may be a good time to discuss investing in a house-based medical alert system — before any potential accidents occur. Upon a senior’s return home, a wearable alert system may be a valuable asset, since it will be available at all times. An alert system can restore her sense of security and give her family a renewed peace of mind about her safety. Having her home evaluated by a therapist or medical professional for spots that need extra safety measures is another step to take to ensure that the senior’s environment is safe and free of any potential hazards.
Your senior patient’s rehabilitative therapy interdisciplinary team’s primary goal will be for her to regain her strength and restore her independence. As healthcare professionals, we are obligated to ensure that our senior patients and their families are properly informed with updated information and any resources that will help seniors achieve complete recovery. Your patients and their caregivers may need some assistance with choosing the proper facility and with determining which therapy is truly necessary. And when the new therapy cap limits go into effect in 2015, your patients’ therapy costs may be impacted. This could lead to an expensive recovery if rehabilitation services are needed over an extended period of time, so it is important to prepare your patients in advance with details about gaps in coverage and supplemental medical insurance that may be able to lessen out-of-pocket costs. By providing your patients and their families with as much information as you are able, you will show that their best interests and recovery of health are your top priority — a reassurance that could help them along their rehabilitation journey.
A medical alert device can help ensure senior independence. Learn more about how to refer your patient for Philips Lifeline services.