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As Medicare continues to evolve, efforts to restructure
the program should focus on making the program more responsive
to the unique needs of beneficiaries with Alzheimer’s
disease.
Alzheimer’s can present difficult and intense challenges
for caregivers. As a result of their dementia, individuals
with Alzheimer’s disease may become anxious, aggressive
or agitated. These types of behaviors can lead to misunderstandings,
frustration and tension, particularly between the person
with dementia and his/her caregiver.
Mealtimes can present additional difficulties. A person
with Alzheimer’s may have a poor appetite, a loss
of interest in food and may forget to eat (or that they’ve
already eaten). As Alzheimer’s progresses, the person
with the disease will slowly become less able to take care
of themselves. Caregivers often become responsible for all
personal care activities, such as bathing, toileting and
dental care.
In October 2005, a new policy interpretation by Palmetto
GBA (Medicare Regional Home Health and Hospice Intermediary)
began permitting Medicare payment for home health nurses
to provide teaching and training for families and other
caregivers of beneficiaries with Alzheimer’s disease
and behavioral symptoms. This can include helping a daughter
caring for her mother with Alzheimer’s who is frustrated
because she feels her mother is “uncooperative”
at bath time learn to maintain hygiene and skin care to
prevent chronic skin ulcers and infections.
Other training activities can assist caregivers in maintaining
adequate nutrition and preventing malnutrition and dehydration
for loved ones with Alzheimer’s disease who are losing
weight because they get agitated and do not stay seated
during mealtime. This policy interpretation is only effective
in 16 primarily Southern states.
The Alzheimer’s Association recommends that all Medicare
Regional Home Health intermediaries and other carriers be
required to cover home health training for caregivers to
improve care and manage preventable medical crises.
Next: Removing Barriers to Quality Care
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As Alzheimer’s progresses, the person with the disease will slowly become less able to take care of themselves. Caregivers often become responsible for all personal care activities, such as bathing, toileting and dental care.
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