The Medicare Maze Leads to Home Care

If you are on Medicare and have the misfortune of being hospitalized, you might find yourself being discharged before you’re well enough to cope in the outside world.

To cut down on skyrocketing Medicare costs, Congress passed a law that rewards hospitals for keeping costs under certain prescribed averages. If the hospital goes over the average, it has to absorb some of the extra costs. If the hospital goes under the average, it gets to keep the surplus.

You can see how this might affect how long you stay in a hospital. As long as you’re still breathing, a hospital might discharge you in order to save money and pick up the incentive reward money.

At the same time that hospitals are being encouraged to discharge patients as soon as possible, the government is talking about freezing or cutting back the post-hospital benefits under Medicare. This means that the availability of skilled nursing home care or home health care services under Medicare might become scarce at the same time you’re shoved out of the hospital, perhaps unable to take care of yourself.


Interpreting the Rules

To add to the squeeze, interpreting Medicare’s eligibility rules for post-hospital care is like reading “Alice in Wonderland” backward.

Sen. John Heinz (R.-Pa.), chairman of the Senate Special Committee on Aging, says older patients are in many cases “being sent out into a no-care zone, without access to the health care they so urgently need.”

If you’re in the hospital you’re covered. If you’re not, you are either not covered or are partially covered.


With all this in mind, you had better understand the ins and outs of lining up home health care. If you can’t recuperate in the hospital, you may have to do it at home.

Under Medicare, you are supposed to get skilled nursing care at home for so many days. It’s not mandatory that you were previously hospitalized.

You must be “homebound,” which means you aren’t able to go out except to medical appointments (plus a few other vital trips). The care must be “intermittent,” which means you can’t be nursed for more than a couple of weeks or so.

On top of what you might be able to wangle out of Medicare, you may also be able to get other services such as “meals on wheels,” and homemaker help.


You can get a copy of “All About Home Care” by sending $1 to: National Home Caring Council, 235 Park Ave. South, New York, N.Y. 10003. You can also get home health care information from your local government agency on aging.