Home Modification

So You Want to Stay in Your Home?

You reared your children there. Time flew by, the kids flew the coop, and your beloved home, always your sanctuary, is showing its years. Heck, so are you. Admit it: On a bad day, climbing that stairway to the second floor seems like scaling Mount Everest. Carrying a laundry basket down the basement stairs is a balancing act, and the thought of lugging it up two floors to make the beds is cause to sit down and rest.

That "little fall" in the bathroom last year left your hip and ego bruised, but it was alarming enough that your children became concerned about your ability to stay safe and independent at home.

Before the "For Sale" sign goes in the front yard, take a few moments to sit down with your loved ones and read through this guide. You’ll learn about the many ways to make your home safer and more livable.

Some involve simple changes that might make you say, "Why didn't I think of that?" Others involve assistive devices and aids to daily living that can make everyday tasks much easier and safer. On yet another level, home modifications can literally create new, safe spaces within your home.

A 2006 study by the American Association of Retired Persons found that 89 percent of respondents wanted to stay in their own homes as long as possible. This guide is intended to help you stay in your own home as long as you wish and on your own terms. It contains useful information about ways to help you get around in your community. We can help you make informed decisions about assistive equipment, and home modifications that can be the difference between staying independently in your home and alternatives that are not nearly as desirable.

Each situation that calls for home medical equipment is unique. Surgery, long and short-term disability, mobility limitations, respiratory disease, aging parents who want to stay in their homes, children with disabilities or medical conditions – each presents its own set of challenges. This guide offers home care product options that can make life easier for both patient and caregiver.

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General Coverage Information

Individuals 65 years of age or older qualify for Medicare, as do people under 65 with permanent kidney failure (beginning three months after dialysis starts), and people under 65, permanently disabled and entitled to Social Security benefits (beginning 24 months after the start of disability benefits).

Medicare Part A benefits cover hospital stays, home health care and hospice services. Medicare Part B benefits cover physician visits, laboratory tests and home medical equipment. Medicare Part D benefits cover prescription drugs. Under Medicare Part B, you can expect to pay the following: (a) a monthly premium, (b) an annual deductible, and (c) a 20 percent co-pay on most approved charges. Your medical equipment provider is prohibited by law from waiving your co-pay under Medicare. Medicare generally covers the basic level of equipment. For Medicare to cover medical equipment in the home, it must be considered a covered item and it must be prescribed by your physician.

Covered items under Medicare must:

(a) withstand repeated use (excludes many disposable items), (b) be used for a medical purpose (meaning there is a condition the item will improve), (c) be useless in the absence of illness or injury (thus excluding any item preventive in nature), and (d) be used in the home (which excludes all items that are needed only when leaving the confines of the home setting). When a medical equipment provider "accepts assignment," he or she agrees to accept Medicare’s approved amount as payment in full. In these cases, you will be responsible for 20 percent of that approved amount.

This is called your coinsurance. You also will be responsible for the annual deductible. There are some items billed to Medicare that require a physician’s order on a special form called a Certificate of Medical Necessity (CMN), and sometimes additional documentation will be required. For some items, Medicare requires your provider to have completed documentation (which is more than just a prescription from your doctor) before they can be provided to you. For most types of equipment, there are options and upgraded features available, and you can elect to purchase the equipment with the upgraded features you desire. In those cases, you have the option to pay a little extra money to get a product that you really want. This upgrading is done via the Advance Beneficiary Notice, or ABN. The ABN details how the products differ, and requires a signature to indicate that you agree to pay the difference in the retail costs between two similar items. Normally when you upgrade through use of an ABN, Medicare pays the cost of basic equipment and you pay the difference between the basic and upgraded equipment.