Tracy Milius, OT
Patients with dementia diagnosis frequently present with the need for therapy services in skilled nursing facilities, hospitals, outpatient clinics and home health agencies. Sometimes therapists are concerned with treating patients with this diagnosis because therapy may not “rehabilitate or restore lost function.” However, if you refer to the Medicare benefit policy manual, it states that therapy can work with persons who have chronic, progressive diseases – such as Alzheimer’s and related dementias – and even terminal diseases, to help “maintain function.”
This discrepancy between policy and reimbursement was first challenged in 2011 in a class action lawsuit by five national organizations. That lawsuit was recently won, and a settlement ensures that the determining factor for therapy reimbursement depends not on the potential for or level of improvement, but the person’s “need for skilled care.” This outcome is a significant “win” for all dementia patients, and as therapists, we must embrace this ruling and ensure proper therapy interventions are provided.
Read more about the lawsuit in the Alzheimer’s Association’s “Settlement ensures people with Alzheimer’s access to rehabilitative services.”