I have mentioned about my FIL before who has "progressive dementia." He is 100% disabled and receives VA benefits as such. MIL had surgery recently and needs help with dad, so we checked into the VA program for 14 hours per week in-home care to help give MIL a break and time out of the house. We were told that to receive this benefit that he needs to be termed "home bound" by the VA. If he is termed home bound, then the rules say that he cannot leave the home except for appointments. Not go for a ride in the car or even a walk in the yard. We told them NO with his agreement and mom will not be receiving this help.
More info: He is already considered a fall risk and we have been told that he needs 24X7 supervision. They expect that she will take him to her doctor appointments and the grocery store.
I know very little about VA rules and regulations, so I hope someone who does will come along soon and help. HOWEVER, it seems to me that common sense should dictate here. I realize government regulations/common sense is an oxymoron, BUT if he is 100% disabled AND needs 24/7 supervison, that would seem "home bound" to me. Even home bound people can go outside- he can be wheeled in a wheelchair out to the yard, and who cares if you stop for an ice cream cone for him on the way home from an appointment?
It is just my opinion, but your MIL needs the help, and if classifying him as home bound will get it for her, I would do it. One important point is WHO told you he needs 24/7 supervision. Was it the VA? I think that would be an important factor.
“In order for a patient to be eligible to receive covered home health services under both Part A and Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home. An individual does not have to be bedridden to be considered confined to the home. However, the condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.
If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment.”
A patient’s homebound status is not violated by attendance of religious services or attendance at a State licensed, State certified, or State accredited medical adult day care center.
“Occasional absences from the home for non-medical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home.”
In addition to the information given in our Benefit Policy Manual, we have also addressed this question in a response to an inquiry back in April of 2003. We responded to the query with the following information:
“Homebound status is determined on an individual basis, looking at the patient as a whole. If the net effect of driving indicates that the individual has the capacity to get their health care routinely outside of the home, then it could challenge their eligibility. The fact that a patient is fit enough to drive raises questions as to whether the basic statutory requirement is met. Because individual circumstances can vary greatly, necessitating determinations on a case-by-case basis, we are reluctant to issue a specific policy that relates to driving in every possible occurrence. Inherent in such a policy would be judgments about the particular circumstances under which it may be appropriate for an individual to operate a motor vehicle. We believe that such determinations must continue to be made on a case-by-case basis.”
Mary = has she spoken to a social worker with the VA? If not I strongly suggest it - she may be able to classify him as temporarily home bound with circumstances that due to his wife's condition whom he is dependent on. Also, talk to his PCP regarding this. What may happen is he will have the option of going to a VA facility for a week or two. The VA does allow 2 weeks of respite care per year (I know Whopee!!) and this might be a good time to take advantage of it. That would give her two weeks to heal and get her strength back.
Mom had dad admitted to the VA hospital for an evaluation two days prior to her surgery. He was there three days and they would not keep him as he is "healthy as a horse." They offered to move him to a nursing home locally. Both mom and dad were against this as he had a bad experience the last time he was in the home. He does all of his bathing etc, just needs someone to give his meds, keep him out of stuff and make sure he doesn't pinch off his oxygen. He is highly functional except for almost no short-term memory. DH, Son and I did all the coordinating for family 24X7 and still are. Mom is still experiencing confusion from the pain meds. This should pass in a couple of weeks. DH and I took dad to an appt. at the VA this week. His PCP was the one who told us that to receive the 14 hours per week of in-home care that he (the PCP) would need to term him home-bound. the PCP told us that with this that we can't take him for outings any more and that he can only leave the house for VA appointments. Dad was on top of it enough to tell the doctor NO. We agreed. The doctor told us that because he is a fall risk and also because he messes up his oxygen that he needs constant supervision. Once mom is back on her feet, she will still need time to herself. The PCP was pretty firm about the home-bound designation and what it consisted of. He did order an in-home review for handi-cap changes. These such as a ramp can be done without the home-bound term.
I know from others that the VA will pay for day care - maybe that is an option. He seems with it enough to know what is going on, but if approach that it will only be temp to give his wife time to re-coop he may go for it. she needs to talk with the VA social worker and see if they have any ideas. The in-home evaluation may serve that partly. Tough situation that she is in.
our city, although one of the larger in Montana, does not have day care for the vets. I spoke briefly with the va social work last week. She lead me to believe that dad was eligible for in-home hours. then the PCP tells us differently. I agree that the evaluation might shed some light on the options. Thanks for the advice.
Is it that your VA hospital doesn't have a day care or they don't contract with any day care facilities? I'm in the Chicago area and the VA doesn't have it's own day care but they have contracts with certain facilities. I was given a list of facilities they had contracts with so I could check them out before making a decision. Then I had to let the social worker know which one I chose and she did the paperwork.
I was told that they do not have a contract with a facility for day care in our town, so it is not an option. I am going to take your advice and call the social worker and ask her about the home-bound thing. Your probably right that he is eligible with out this term hooked to him. I'll keep you posted.
Financial limits for day care were never mentioned when I took my husband to be evaluated for day care. I was told that if our income was above a certain level, we would have to pay a copay for each day -- about $15 -- but nothing about net worth. I also think that whatever category for medical care the VA places the vet into has something to do with how much you have to pay. I know that your income is looked at if you apply for the Aid and Attendance benefit along with other medical information.
Isn't that wonderful/sarc. a person who served, now becomes disabled ( my husband is 100% VA disabled) and you earn too much for the VA to help... Between that and the way medicaid regs seem to be, I feel like Snoopy on top of his dog house looking out from under his eyebrows ( you know that look, his steely eyed look), and I feel like revolting. We do all the right things, work hard, save, pay taxes and all our bills on time and then we have to be rock bottom broke for any kind of help..
this is an example of what happens when politicians leave IOU's in the various entitlement accounts (SS, Medicare,etc) instead of the money itself. It is called Greed and the innocet pay the price.
Ok, here is the scoop. I did a telephone interview with his Doctor's nurse today. He does not need to be termed "home bound" for any of this. He is eligible for the 14 hours per week aid care but, at this time, does not require it. Unless he needs help with personal care items, they will not send someone for the 14 hours per week. If this changes, it will only require a phone call from mom or me to get it started. He is eligible also for the 30 visits per year of in-home respite care. Each visit is scheduled for 1 to 6 hours. If mom schedules a three-hour respite, it counts as one visit. This would be two per month with 6 others available. They sent me the three location in town that they contract with. I was told that each may do things differently and that mom should interview all three before she makes a decision. If I can get her to agree, I'm going to suggest that the first aid comes when I am there and I will stay. That way, dad can get used to the person and will think that they are my friend. Then the second time, I will stay and leave for a while and then come back. Hopefully, this will make him more confortable with the new system.
Thanks for all of your suggestions. Now if I can only get mom to agree to try them.
If they say he is entitled to 14 hours a week aid (3 a day)...why do YOU say he does not need that? I may be mistanken, but as I read this last note, it sounds like you are the daughter ...and you suggested that you would eventually be able to LEAVE your mom alone with him. Just having company to talk with is good for those of us who are/were caregivers.
I just read this blog for the first time and I may not have the entire story here.. I just needed to say that when aides came to the house, they were MY onlly visitors for the day. Just having them in the house was so so so so so wonderful. I could take a long soaking bath... make important phone calls knowing I wasn't going to be interrupted, - or just see someone else's face. Take what is offered and don't look back. The time will fly by.
Nancy B, what I was told by the VA social worker was that although he is eligible for the 14-hours in home care due to his 100% disability and dementia that, at the present time, he is not in need of those types of services. They can't justify sending an aid for aid work and then have them only do cooking and house work. If he reaches the point where he needs help with personal items, then the aid can also help with cooking and house work. The type of things that the aid can be sent for is baths, dressing, toleting issues, medication, etc. Right now, dad can do all of his personal things himself. I questioned her about the supervision side of things and she told me that this is where the 30 visit of respite apply. Mom is considered his caregiver and is responsible for caregiver things. She is not required to do all of the aid work, as mentioned above. I still haven't talked to mom about the respite hours. Hopefully today I can get it done. Last night, she was tired and still a little disorented, so I chickened out.
I just hate reading that part about "Mom is considered his caregiver and is responsible for caregiver things". How totally unfair... She's been sick herself...and it sounds like (and it probably IS) their idea is to work her to death, and THEN they will find a person to help him. I understand your frustrations. I truly do. Poor MOM!!!
These agencies can be so wonderful...................... and they can also be so cold and UNCARING. I wish I had some good advice to give you.
DH and I have been spending the night each night. We arrive around 8 pm and leave at 7 am. Mom is herself and "on top" of it most of the time and then other times, she will be confused. We still think that it is the medicine she is on. She had double knee replacement 3 weeks ago. She is actually pretty mobile and is doing well in this area.
I talked to her this morning about the 30 visits of respite that is available to her through the end of the year. I told her that it is up to her to decide as she is dad's caregiver. I told her to think about it and that she did not need to make an immediate decision. She wanted to know how it worked. I told her that first she (with my help) could interview the three companies that contract with the VA and then she could pick a company. She could then chose the type of person she wanted. man or woman, etc. I told her that she and I could stay the first time and then the second time, she could leave and I could stay. I told her that we could ease in to it. She asked how she could use this person. I told her to schedule them for grocery shopping and doctor appointments. Or to just get away, if she has had a hard week. She told me that she would think about.
My DH is leary of the whole thing and thinks that if mom accepts the help that the social workers will put it in their records that she is not able to take care of him and also that they can't be left alone. He is always scared of things like this. and the change of routine is taking a toll on my DH.
I am still setting up their separate pill boxes and being there to give it to them most of the time. Mom finally let SIL do her exercises yesterday. She is suppose to do 3 a day and I am only able to do the evening one. three days a week, the therapist comes to the house in the morning so she needed to let someone else help her. I just hope that in a couple of weeks or a month after the medicine stops that mom will have her mind back. If not, we're in for quite a ride.
FayeBay, the social worker aluded to what you are saying. She really wanted to give him the time. She just couldn't justify it without any aid type duties. She told me that at the end of the year that she could look at it again. Right now what they need is someone to come in from 6 to 8 am and 11 to 2. To help them get ready in the morning and get their breakfast and give mom her pills. Then at 11 to get their lunch, give pills and do an exercise routine. The dinner is almost always covered by DH younger sister and then I show up to do an exercise and give evening pills to both mom and dad.
Thanks for all your comments and advice. Please keep sending ideas.
I thought I would update you all on my DH parents. It has been 5 weeks since MIL surgery. She is still not right in her mind. It is not looking too good about her coming out of this. She is still taking pain pills and pills for leg nerve pain, so we are hoping that things will change when these meds are finished. She seems fine unless she is adgiated or angered about something. Or if she has to think about times and dates, or make decisions. I am still going over after work each day and setting out their medicine for the evening and next day. She is walking great (both knees replaced) and doing really good with her surgery. But, she won't even try to cook and is acting so depressed. I guess that we all would be depressed in this situation. Last night, she was so upset about really nothing that FIL told her that she should calm down as she was upsetting him and me. I agreed with him and she didn't like it. I am still upset from last night. I give her exercises each evening after dinner and she was so upset that she wouldn't do it last night. MY DH talked to her previously about appointing someone to handle her affars in the event that she can't and she won't discuss it.
Her daughter took her to the SS office and to get her hair done today so she probably won't want to do exercises again tonight. I'm going to call her ahead of time and ask her. If so, I can pop in and do the meds and not plan on staying very long.
I really want to be supporative but I sure can't handle more stress right now. and you know me, I'm pretty darn good and handling this stuff. At least with DH, I have a little bit of control. I am the one in charge, kinda. Over there, I have no control at all. It is whatever MIL wants, good or bad.
I would talk to her doctor via phone call or send a letter. Tell he doesn't have to say anything to you, you just want him to know what you see going on. Or maybe the daughter will. You know as well as the rest this is not good. Maybe she enjoys not dealing with her hb, so doesn't want to get better. Whatever is causing the depression, lack of motivation, has to be brought to the doctors attention.