I am so excited to share with you the news I discuss in the video below about a landmark ruling that benefits persons with Alzheimer’s/dementia and their families immensely.

On January 24, a federal judge approved a settlement that overturns the Medicare Improvement Standard. That standard used to require that persons who receive physical, occupational, or speech therapy had to have reversible health conditions that could be improved.
 

With this new legislation, therapists are now more empowered to work with those with chronic/progressive conditions like Alzheimer’s disease and to establish maintenance plans to prevent or minimize problems and progression. In a nutshell, Medicare coverage is now based on whether a person needs skilled care.

While there has been reimbursement language for developing maintenance programs for a long while, the “Improvement Standard” made the path to reimbursement more challenging. Now that that standard has been removed, the path is cleared.

This breakthrough legislation supports the basis of Dementia Capable Care training, which is that we must proactively serve those with Alzheimer’s/dementia by discovering their best abilities to function. Once we do that for the people in our care, we can develop maintenance programs to minimize decline and deterioration. And this wellness approach will help save money and improve quality of life for persons with dementia.

Our concepts and beliefs are firmly entrenched in this landmark decision. No longer must a client have a “reversible health condition that can be improved.” Instead, we can work with those with dementia to establish plans to maintain their function and abilities for as long as possible.

This ruling indicates that lawmakers are recognizing that the old reactive care approach was very costly. The old way of not empowering therapists to intervene to prevent or minimize problems for those with chronic illnesses resulted in high rates of hospitalization and ER visits. A new, proactive wellness approach is now fully supported, but therapists need to have the skills to act. Facilities and organizations must have their therapy staff and care partners skilled up to implement maintenance programs that enable persons with dementia to enjoy function, safety, and quality of life.

Occupational, physical, and speech therapists must obtain specialized education—which is not always a part of college programs—to evaluate and treat those with chronic cognitive impairment. Additionally, Medicare beneficiaries and/or their family members must be informed, and they must be proactive about asking physicians for therapy referrals. Physicians themselves must also become aware of this ruling and its positive potential for their patients.

This team approach to dementia care management, with the occupational therapist having a lead role, is the key for those with Alzheimer's to maintain their health, their function, and their quality of life as best as possible throughout the stages of dementia. And this one-on-one service in which the therapist works with the person with dementia and her caregivers guides and supports families along a journey that is often filled with day-to-day challenges and difficult decisions.

Learn more in “Medicare Will Not Be Able to Use ‘Improvement Standard’ for Denying Therapy Coverage”. And please join me in celebrating this landmark ruling by sharing this wonderful news! Just click the Share button at the bottom of this post.