Elder Belle's Blessing: Center For Medicare Advocacy

(Photo by Patrice Carlton and published by National Geographic.)

This edition of Elder Belle's Blessing, an award given from time to time to people who have enhanced the rights or well-being of elders, goes to the Center for Medicare Advocacy for their work in getting the government to loosen up a rule for treatment.

Thousands of Medicare patients with severe chronic illnesses like Alzheimer's would get continuing access to rehab and other services under a change agreed to by the Obama administration, advocates said Tuesday.

The proposed agreement in a national class action suit, filed with a federal judge in Vermont, would allow Medicare patients to keep receiving physical and occupational therapy and other services at home or in a nursing home so they can remain stable, said Gill Deford, a lawyer with the Center for Medicare Advocacy.

That's been a problem for some because of a longstanding Medicare policy that says patients must show improvement to keep getting rehab. Deford's group and other organizations challenged it.

"If you have a chronic condition, by definition you are not improving," said Deford, the lead attorney on the case. "Our view is that Medicare regulations were intended to allow people to maintain their health status. They don't have to show they are getting any better. The point is to allow them not to get any worse, if possible."   [Emphasis added]

The original purpose of the rule was to keep unscrupulous health care providers from continuing treatment not reasonably necessary.  The problem is the wording (what's new, eh?):  to justify the ongoing treatment "improvement" must be shown.  That's hard to do with chronic disabilities and illnesses.  Patients are not going to get better.  What these treatments hope to do is maintain the current status or at least slow the decline.

Hopefully the judge will accept the settlement and these valuable treatments will be reinstated. 

Kudos to the Center for Medicare Advocacy.