By Mark Harvey
Here’s an exchange that might be helpful to a lot of us. I’ll put it into a “Q&A” format, although that isn’t exactly how it happened. That part doesn’t matter. This part does:
Q: I’m pretty sure that you’ve written about this in the past. In fact, I’m pretty sure that I know the answer, except I can’t seem to apply the “answer” to myself, so here goes: I’m going into the hospital for knee replacement surgery and I’m going to need rehab. I’ve been told that since it’s elective surgery, Medicare won’t cover the rehab. Is that right?
A: No, but let’s back up. First, a lot of us know a lot of things about medical stuff, but when it comes to ourselves, our minds tend to go blank. We could theorize about why that is (I’m in pain? I’ve taught myself to be totally passive in the face of medical professionals? I’m scared?), but it doesn’t matter. It happens to a lot of us, and that’s why it’s critically important to always have a second set of ears and eyes with you, and on your side. Trust me: Medical pros get it, and they don’t mind.
Now, back to the original question: No, that isn’t true. If you’re covered under Medicare and you’re working with a doctor (as opposed to the yahoo uncle who told you it would be a cool idea), your procedure is covered. Remember, in order for Medicare to cover the rehab in a skilled nursing facility (SNF), you’ve got to be admitted into the hospital and spend at least three nights there. You might want to remind your surgeon of that.
By the way, what facility do you want to go to for rehab?
Q: Uh … I hadn’t thought of that. Whatever one I’m told to go to, I guess.
A: Well, OK, if that’s what you want to do, so be it. But I’ll tell you this: All rehab facilities (SNFs) are not the same. They can differ wildly in terms of staffing, location, reputation, ambience, etc., so you might want to consider that.
Q: Well, now I’ve been thinking about it and asking around, and I guess I do have a preference. I’d rather be in Facility X.
A: Great! Will they have any beds available following your surgery?
Q: I assume so.
A: Good luck with assumptions. If it were me, I’d talk to them just in case I needed a backup plan.
Q: OK. What will happen after rehab?
A: That’s a doctor question, not a Mark question.
A few days later…
Q: I talked to my doc, and she said that I’ll need more physical therapy after I’m home. How do I get that?
A: Well, you can go to the therapy or the therapy can come to you. Do you have someone who could help you get to outpatient physical therapy?
Q: Not that I could count on. I guess getting around is going to be tough.
A: I’d imagine so, with a knee replacement. Would your doctor/surgeon order home health?
Q: What’s “home health”?
A: It’s a wonderful service that brings skilled-nursing services and therapy to folks in need, who are at home and who would have a heck of a hard time getting to outpatient services. In the old days, the term was “homebound,” but we’ve gotten beyond that. I think the term now is “taxing and difficult,” or something close to that.
Q: That’s what I’ll need! Perfect! How do I get it?
A: Talk to your doc or surgeon about ordering it for you — and yes, Medicare covers it, assuming the doc will order it. You might just want to check with the home health agency to make sure they have the capacity to get you what you need, when you need it.
Q: Really?
A: I know that probably sounds like overkill, but we do live in rural communities, and we aren’t exactly tripping over physical therapists and speech therapists and occupational therapists. I’d just call them and ask. Know what else? If you get home health therapy, you’d also qualify for some services from a health aide, meaning help with bathing and some household chores.
Q: That would help! What else?
A: Take two aspirin and call me in the morning?
So, is the point of all this “what to do if you’re going to get a knee replacement”? No. The point is that this stuff can get real complicated, real quick; so whenever we have the time to try to think something all the way through — to really understand how it’s going to go — we should. And we need to try to make sure we’re not making assumptions that could come back to bite us in the you-know-what.
My experience with medical professionals has been outstanding. With rare exception, they genuinely care and are very good at what they do — but that doesn’t mean they all know the ins and outs of community resources or local facilities, or even Medicare, so we have to take responsibility for ourselves.
Best case: Keep someone in your corner who can walk through all of this with you — hearing what you hear, knowing what you know, planning with you. You want someone who is willing and able to hang in afterward, too, to help make sure things go well — and to do something about it if they don’t.
That isn’t always possible, I know. But when it is, do it. It’s not a sign of weakness. It’s a sign of smart.
Mark Harvey is the director of information and assistance for the Olympic Area Agency on Aging. He can be reached by email at harvemb@dshs.wa.gov; by phone at 360-532-0520 in Aberdeen, 360-942-2177 in Raymond, or 360-642-3634; or through Facebook at Olympic Area Agency on Aging-Information & Assistance.
