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Questions:

My loved one needs his toenails clipped and is in a nursing home that does not have the equipment for it. Will Medicare pay for this service?
My mother is having gallbladder surgery and lives alone. What conditions have to be met by Medicare for her to receive care in a nursing home?

Questions and Answers:

My uncle is a resident of a nursing home. He has to have his toenails clipped by a doctor. Will Medicare pay for this since my aunt cannot do it and the nursing home doesn't have the proper equipment?
Medicare Part B will cover the services of a podiatrist (foot doctor) for medically necessary treatment of injuries or disease of the foot. If your uncle's foot care is necessary because of a medical condition, such as diabetes or Peripheral Vascular disease and not routine foot care (i.e., needs help cutting toe nails because he cannot reach his feet), Medicare Part B will cover this.

For more information about Medicare Part B coverage in Virginia, you may contact TrailBlazer Health Enterprises, 1-800-552-3423 or contact Medicare at 1-800-Medicare. To find more information on Medicare and a list of local services available to seniors, their families and caregivers, visit www.seniornavigator.org.
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My mother will be having gallbladder surgery soon. She lives alone and will need assistance while she is recovering from the surgery. What conditions have to be met for her to receive care in a nursing home? She has Medicare and I am not certain if this is something that would be covered.
According to information from the Centers for Medicare and Medicaid services, Medicare will cover skilled care only if all these conditions are met:

You have Medicare Part A (Hospital Insurance) and have days left in your benefit period to use.
You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, not including the day you leave the hospital. You must enter the SNF (skilled nursing facility) within a short time (generally 30 days) of leaving the hospital. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.
Your doctor has decided that you need daily skilled care. It must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you are in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week.
You get these skilled services in a SNF that has been certified by Medicare.
You need these skilled services for a medical condition that was treated during a qualifying 3-day hospital stay or started while you were getting Medicare-covered SNF care. For example, if you are in the SNF because you had a stroke, and you fall and sprain your wrist.

For more information or to view local health and aging resources for seniors and caregivers, visit www.seniornavigator.org
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