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My Mom has had a couple of falls in the past week, one resulting in a sprained ankle. We have noticed that she is leaning back on her heals when she stands up and walks. We have drilled "nose over toes" into her head, so she hunches forward about mid back over her walker, but still leans back on her heels. No matter what direction, encouragement, etc., we give her, it doesn't seem to help. A couple years ago she ended up in a rehab center after a fall, and when they released her, they had physical and occupational therapists coming to her house a couple times a week. Is there a way that we can schedule something like that? How do we do it? Does she need a referral? What is the process?

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Call her doctor and ask her/him to order Home health care services.
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I believe that even if a Dr. orders PT, home PT visits are only covered by insurance/Medicare if the person is either (a) considered homebound and eligible for home healthcare services, or (b) is rehabbing from something acute, and in either case is deemed unable to safely go to PT on an outpatient basis. You mom got in home PT and OT before because she was rehabbing from something acute (the fall). Would she now be considered homebound so insurance would cover in home PT if ordered by her Dr? My husband, like your mom, got in home PT after an acute episode (broken hip), but there came a point where the therapist said he was ready to go for PT on an outpatient basis so couldn't get it at home any more. My husband continued to be covered by Medicare for outpatient PT for a while. Later, we decided to pay privately for in-home PT when Medicare would no longer pay as he had Parkinson's and really benefited from it.
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Kimstark68 May 2023
Yes, she is homebound and eligible for home health. She did have an X-ray of her ankle, which showed no fracture, just a really ba sprain. She currently has an independent care giver who comes in four hours a day. She works with Mom on excercises, etc., but this thing with leaning back has become a problem. Part of the issue is that she resents it when her care giver or any of the family try to help her. She responded beautifully to the therapists that came in before, so I was thinking that might be the way to go. She has both really good private insurance and Medicare. I will reach out to her primary care provider and see what we can do. Thank you for your response!
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Call her doctors office, they may want to see her first but they can order home PT.
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You get her Primary Care physician to order it through a home health care agency if she qualifies under Medicare for the PT and the doctor certifies that she is home bound or would have extreme difficulty going to PT outside of her home.
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Usually PT has to ordered by a doctor, you can't just request it.

Was your Mom taken for imaging after the couple of falls this past week? Are you deciding it is a sprain, or did she go to Urgent Care/ER for xrays? If it wasn't imaged, I wouldn't make any assumptions... it could stilll be fractured. Sprains take a long time to heal.
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I think Medicare allows physically therapy ever few months. We had it to teach Mom how to walk with a walker. She had it at her Daycare center. And at her LTC. All with a drs order.
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In order to get PT in my state, a doctor needs to order it. Make the request to the doctor for at home PT. At first, my Mom could not get at home PT because she had already received PT in the office and her mobility had not significantly changed. (We wanted at home PT because we found a really good PT through a relative.). Then COVID happened, and we got at home PT and have made sure not to do PT in an office.

If there is a specific PT that you want to go to, make sure you tell your Mom’s doctor. Then he can send the referral directly to that person.
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Check out: https://www.foxrehab.org/what-we-do/physical-therapy/
They provide outpatient therapy in the home that is not considered "Home Health" so they can bill under Medicare Part B. I think they are available in most states. They can tell you what is required to use their services.

Check out: https://www.cms.gov/center/special-topic/jimmo-settlement/faqs
Medicare was challenged about limiting therapy and now in some cases provide unlimited therapy when maintenance is needed. It can be more cost effective for them to try and prevent broken hips.
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Make an appointment at her doctors he will examine her and write a script and you can ask for a cane or Rolllater - Medicare will cover one of those . Ask for a VNA to come in if you need help with her medicines .
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Her primary care doctor can refer you. They may want her to come in and be seen by the doc first.
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