Medicare Caps and Need for More Therapy

[StrokeCaregiver]

My 65 year-old mother had a hemorrhagic stroke in the right perietal lobe - three months ago.  She was in the hospital (acute care for two weeks) followed by 6 weeks of inpatient rehab.  The last month have done out patient OT and PT and now our OT said that our 10 sessions are up and she suggests that we save our last 8 eight sessions for the fall when mom may have more movement in her hand.  She said it is an "act of congress" to get Medicare to pay for extra therapy.  However her PT said that she would qualify and is resuming therapy.  

I guess my question is- has anyone else reached the cap and what do you do to get extra sessions covered?  Also, what can you do after when Medicare no longer pays?  Any advise is wonderful.  I finally caught my breath a little bit and am trying to figure out how to keep her motivated and in therapy for as long as possible!

[sara12345]

I had months of PT for my leg AND my arm. You should be able to get PT for her arm also, unless she has shown no progress at all with it.  Then the therapist cannot continue.  Your mother can try to do the exercises that she did get from her sessions with her hand and arm.  If she is able to make any progress, I think that the therapy would continue.  

I am NOT doing well after my stroke--5 years later.  I have chronic 24/7 headaches which are often severe, caused by my stroke.  I still have difficulty with my arm and leg, but they do function.  My hand does function some, but I am not able to hand write or open things and I am constantly clumsy with it.  But then, I haven't been doing the exercises like I did during the PT.  I need at least 12 hours of sleep since my stroke, which gives me very little time along with my pain issues which are not limited to the migraines.  People make the most progress during the first 6 months after their stroke and even a year afterwards, but they do notice small very gradual improvements even years later.  For example, my speech has gradually improved over time.  I also have other problems caused by my stroke, but I'm grateful for everything that I do have in my life.  Yes, it took awhile, but that's the only way to enjoy your life.  I know that it hasn't been much time yet since your mother's stroke and the shock of it is still with you.  That's understandable.  Celebrate any improvements that your mother makes and don't get overwrought by her disabilities.  She is alive, is conscious, not on a feeding tube, is not in constant pain and is making progress.   Many with strokes are not so fortunate.  You take care.

[StrokeCaregiver]

Thank you for your help.  I am glad you are doing well.  Were you able to regain something back in your arm/hands.  My mom can move her shoulder some - but nothing in her hand.  It just wants to draw in.  We try to keep flat so it won't curl up. Just this week her elbow is wanting to bend in and we are having problems getting her to straighten it out.  I am so glad she is getting such good PT and her walking is improving - just feel lost with what to do with her arm and hand.  PT doesn't address these issues - says it is more for OT.  I guess I feel like OT has just dismissed her arm/hand and she finds the fact that she can't use her hand to grasp the most frustrating.  It has now been a little over three months from her stroke and I just don't want to waste precious time.  I appreciate your encouragement!

Thank you again!

[sara12345]

I don't really know the answers for you.  You could try to get your mother some supplemental insurance in addition to her Medicare which my husband has.  With ObamaCare, either this year or next year, an insurance company can't turn you down for pre-existing illnesses. You could look into it.

If your mother isn't making good progress with her hand, I think the OT therapist gave you some good advice.  And OT is different than PT.  After my stroke, I had months and months of PT, but only had about 4 sessions of OT.

If you don't know how long the PT will last, ask her therapist how long it can last instead of getting upset over something that may not be an issue.  However, if your mother reaches a plateau, meaning that she is not making any progress, no PT therapist is allowed to continue the therapy no matter whether it is paid for with insurance or Medicare.  Good luck with your mother getting as much care as is possible.