Education

OP-ED: Home Health Services Under Medicare

Published

11 years ago

July 15, 2013

Medicare covers a variety of heath care services that you can receive in the comfort and privacy of your home.

These include intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy.

Such services used to be available only at a hospital or doctor’s office. But they’re just as effective, more convenient, and usually less expensive when you get them in your home.

To be eligible for home health benefits, you must be under a doctor’s care and receive your services under a plan of care established and reviewed regularly by a physician. He or she also needs to certify that you need one or more home health services.

In addition, you must be homebound and have a doctor’s certification to that effect. (Being homebound means leaving your home isn’t recommended because of your condition, or your condition keeps you from leaving without using a wheelchair or walker, or getting help from another person.)

Also, you must get your services from a home health agency that’s Medicare-approved.

If you meet these criteria, Medicare pays 100 percent for covered home health services for as long as you’re eligible and your doctor certifies that you need them.

For durable medical equipment (like a walker, wheelchair, or oxygen equipment), you pay 20 percent of the Medicare-approved amount, after you pay the Part B deductible ($147 in 2013).

Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by your doctor for your specific condition. Medicare does not cover full-time nursing care.

Skilled nursing services are given by either a registered nurse or a licensed practical nurse under an RN’s supervision.

Nurses provide direct care and teach you and your caregivers about your care. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care.

Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse, isn’t skilled nursing care.

Physical therapy, occupational therapy, and speech-language pathology services have to be specific, safe, and effective treatments for your condition.

Before your home health care begins, the home health agency should tell you how much of your bill Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them.

This should be explained by both talking with you and in writing. The agency should give you a notice called the Home Health Advance Beneficiary Notice before giving you services and supplies that Medicare doesn’t cover.

What isn’t covered? Some examples are 24-hour-a-day care at home; meals delivered to your home; homemaker services like shopping, cleaning, and laundry (when this is the only care you need, and when these services aren’t related to your plan of care);

Personal care given by home health aides like bathing, dressing, and using the bathroom (when this is the only care you need).

If your doctor decides you need home health care, you can choose from among the Medicare-certified agencies in your area. (However, Medicare Advantage plans may require that you get home health services only from agencies they contract with.)

One good way to look for a home health agency is by using Medicare’s “Home Health Compare” web tool, at www.medicare.gov/HHCompare.

This tool lets you compare home health agencies by the types of services they offer and the quality of care they provide.

For more details on Medicare’s home health benefit, please read our booklet, “Medicare and Home Health Caree,” on line at www.medicare.gov/publications/pubs/pdf/10969.pdf.

David Sayen is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii, and the Pacific Territories.

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Activism

A Student-Run Group Provides Critical Support Services to Underserved Residents

Those visiting The Suitcase Clinic can get legal advice, sign up for food assistance, receive housing resources, get medical help, or enjoy a hot, fresh meal. They can also get haircuts and foot washes from the student volunteers. Nilo Golchini, executive director of the clinic, said one of the goals for most of the students working there is helping bridge the gap of trust that exists between many unhoused people and the healthcare and social welfare systems.

Published

5 days ago

December 18, 2024

Oakland Post

UC Berkeley Law Students help a clinic visitor with legal advice at their Tuesday night services. The Clinic offers a variety of resources, including medical, to those in the community who have little access to these services. Photo by Magaly Muñoz

Part One

By Magaly Muñoz

Every Tuesday evening, the dining hall of First Presbyterian Church fills up with dozens of people eating, laughing and moving from table to table, receiving much-needed services from UC Berkeley students – just a few blocks away from the university’s campus.

Individuals seeking support services can be found in this multi-stationed room on the south end of the church talking to law students, student case managers, or receiving medical attention in a corner by healthcare professionals.

This weekly event is hosted by Cal students through a volunteer-run program called The Suitcase Clinic.

The clinic, founded in 1989, was intended to offer free resources to underserved communities in Berkeley and surrounding cities. The majority of the clinic’s clientele are unhoused or low-income people looking for extra support.

Those visiting the clinic can get legal advice, sign up for food assistance, receive housing resources, get medical help, or enjoy a hot, fresh meal. They can also get haircuts and foot washes from the student volunteers.

Nilo Golchini, executive director of the clinic, said one of the goals for most of the students working there is helping bridge the gap of trust that exists between many unhoused people and the healthcare and social welfare systems.

During their tenure in the program, many of the students say they become strong advocates for homelessness rights.

Visitors of the Suitcase Clinic can receive haircuts and foot washing by student volunteers every Tuesday evening. Photo by Magaly Muñoz.

“We’re also standing in solidarity with them. So, it’s not saying, ‘I’m going to help you, but I’m also going to stand with you,’” Golchini said.

Student volunteers get extensive training prior to working directly with clients. Those interested have to take a semester-long class to become versed in areas such as outreach, intersectionality, how to interact with unhoused people, how to sign people up for social services. and more.

Volunteers then get to pick from three different clinics: General, Women’s, or Youth and LGBTQ+.

The General Clinic is the most popular among visiting residents, while Women’s and Youth/LQBTQ+ have more specialized services for attendees.

The Women’s Clinic has many of the similar services to General, but also includes nail painting, childcare, and massages.

The Youth and LGBTQ+ Clinic offers a safe space for young people navigating living on the streets, with services that include housing referrals, wellness and recreation classes and employment resources.

Golchini explained that it’s important for them to keep these clinics separate because the different demographics experience poverty and homelessness differently than those who visit the General Clinic.

Suitcase Clinic student workers posing for a photo with a frequent clinic attendee. The Clinic is open to Berkeley unhoused and low-income residents who need medical or legal service, or a hot meal. Photo by Magaly Muñoz.

“We’re able to provide spaces where people can come in and feel safe and not feel like they’re constantly worried that something’s going to happen to them,” she said.

An outreach team also visits encampments every other Saturday in the Berkeley area to provide hygiene kits and encourage people to visit the in-person clinic, if possible.

However, Golchini said engagement has been low for some time now due to a recent decision by the U.S. Supreme Court that allows cities to ban and cite people for sleeping on the streets.

She said a lot of their clientele got displaced to other cities over time, making it difficult to stay in contact with the services the Clinic was providing for them.

But that hasn’t slowed down the students at the Clinic, if anything, it has pushed them to do more for the community they serve.

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Activism

Self-eSTEM Empowers BIPOC Women, Girls in Science, Math

In January 2025, Self-eSTEM will launch digital and generative AI programming, which provides digital literacy and AI literacy training through an entrepreneurial project-based activity. This programming will be a hybrid (i.e. in-person and online). Additionally, thanks to a grant from Comcast, in spring 2025, the organization will have a co-ed series for middle and high school students.

Published

2 weeks ago

December 9, 2024

Oakland Post

Adamaka Ajaelo. Courtesy photo.

By Y’Anad Burrell
Special to The Post

In a world where technology plays an increasingly central role in all aspects of life, the importance of Science, Technology, Engineering, and Math (STEM) education cannot be overstated. Recognizing the significance of STEM for the future, focusing on young women and girls is a critical step in achieving gender equality and empowering the next generation.

Self-eSTEM, an Oakland-based non-profit organization, was founded by Adamaka Ajaelo, an Oakland native who had a successful corporate career with several Bay Area technology and non-tech companies. Ajaelo boldly decided to step away from these companies to give 100% of her time and talent to the non-profit organization she started in 2014 in the belief that she can change the game in innovation and future STEM leaders.

Over the course of a decade, Ajaelo has provided futurist tech programming to more than 2,000 BIPOC women and girls. The organization has an Early STEM Immersion Program for ages 7-17, Emerging Leaders Workshops for ages 18-25 and volunteer network opportunities for ages 25 and up.

While the organization’s programs center on innovation and technology, participants also gain other valuable skills critical for self-development as they prepare for a workforce future. “Self-eSTEM encourages young women to expand on teamwork, communication, creativity, and problem-solving skills. The organization allows young women to enter STEM careers and pathways,” said Trinity Taylor, a seventh-year innovator.

“Our journey over the last decade is a testament to the power of community and opportunity, and I couldn’t be more excited for what the future holds as we continue to break barriers and spark dreams,” said Ajaelo.

“By encouraging girls to explore STEM fields from a young age, we foster their intellectual growth and equip them with the tools needed to thrive in a competitive global economy,” Ajaelo says.

Empowering young girls through STEM education is also a key driver of innovation and progress. When young women and girls are encouraged to pursue careers in STEM, they bring unique perspectives and problem-solving approaches to the table, leading to more diverse and inclusive solutions. This diversity is crucial for driving creativity and pushing boundaries in scientific and technological advancements.

Self-eSTEM has fundraising opportunities year-round, but year-end giving is one of the most critical times to support the program. Visit www.selfestem.org to donate to the organization, as your generosity and support will propel programming support for today’s innovators.

You will also find more details about Self-eSTEM’s programs on their website and social channels @selfestemorg

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Black History

Percy Lavon Julian: A Trailblazer and Business Titan in Chemical Innovation

Born in Montgomery, Ala., in 1899, Percy Lavon Julian grew up during a time when educational opportunities for African Americans were severely limited. Despite these challenges, his parents — graduates of what later became Alabama State University — instilled in their children a deep belief in the power of education. Julian excelled academically, graduating valedictorian at Indiana’s DePauw University in 1920.

Published

2 weeks ago

December 8, 2024

Oakland Post

Percy Lavon Julian. Public domain.

By Tamara Shiloh

Percy Lavon Julian was a brilliant American chemist and businessman whose groundbreaking discoveries transformed the pharmaceutical industry.

Known for his innovative work in synthesizing medicinal drugs from plants, he was a pioneer who opened new doors in chemical synthesis. One of Julian’s most notable achievements was being the first to synthesize physostigmine, a natural product used to treat glaucoma. His groundbreaking methods for producing human hormones like progesterone and testosterone from plant sterols revolutionized the steroid drug industry. These methods paved the way for the affordable production of life-saving medications such as cortisone, corticosteroids, and artificial hormones for birth control.

Born in Montgomery, Ala., in 1899, Julian grew up during a time when educational opportunities for African Americans were severely limited. Despite these challenges, his parents — graduates of what later became Alabama State University — instilled in their children a deep belief in the power of education. Julian excelled academically, graduating valedictorian at Indiana’s DePauw University in 1920. While his dream was to pursue a doctorate in chemistry, racial barriers initially stood in his way. Undeterred, he eventually earned his Ph.D. from the University of Vienna in 1931, becoming one of the first African Americans to achieve this milestone.

Returning to the United States, Julian faced discrimination that made it difficult to secure academic or research positions. Despite being denied jobs due to his race — even from prestigious companies like DuPont — he persevered. His big break came at the Glidden Company, where he led the Soy Products Division. At Glidden, Julian spearheaded several important projects. He developed the world’s first plant for industrial-scale production of isolated soy protein, which served as an affordable alternative to milk in various products. During World War II, his refined soy protein was used to create Aer-O-Foam, a lifesaving firefighting foam for the U.S. Navy. This achievement earned him the NAACP’s Spingarn Medal in 1947. Later, Julian turned his focus to synthesizing hormones from plant sterols, revolutionizing the production of cortisone and other critical medications. His cost-effective methods made these treatments more widely available, improving the lives of countless patients worldwide. Eventually, he founded Julian Laboratories, Inc., solidifying his legacy as a leader in steroid chemistry and pharmaceutical innovation. Julian Laboratories chemists found a way to quadruple the yield on a product on which they were barely breaking even. Julian reduced their price per kg for the product from $4,000 to $400. He sold the company in 1961 for $2.3 million (equivalent to $23 million today) and became one of the first Black millionaires.

The U.S. and Mexico facilities were purchased by Smith Kline, and Julian’s chemical plant in Guatemala was purchased by Upjohn. In 1964, Julian founded Julian Associates and Julian Research Institute, which he managed for the rest of his life.

Julian also helped to establish the Legal Defense and Educational Fund of Chicago.