VA versus Medicare - Home Care and Specialists

3. Home-based Care

VA
i) After your appointment with the primary care doctor, the VA will schedule a home visit from a nurse practitioner and a social worker. The nurse practitioner will visit monthly, checking vital signs, renewing prescriptions and adding new medications, if necessary. There is a modest charge for these visits ($15), with an annual cap of $150. The VA offers up to six months of visits by a home care worker for up to 10 hours each week. The problem is that there is a very long waitlist for this service (a year or more, we were told). Patients are not eligible for the VA home-based care program if they are already enrolled in a hospice program.

Medicare
i) It is my understanding that Medicare does not provide in-home care unless your physician orders it for a skilled need (usually PT, RN or SLP). Medicare does not cover custodial care (help with activities of daily living) unless you also have a skilled need. Coverage of custodial and skilled care is very limited.

4. Specialists (neurologists, speech therapists, occupational and physical therapists, pulmonologists, etc.)

VA
i) In the Washington, DC area, the VA hospital provides a one-stop shop. That is, all of the medical personnel who treat PALS are located in one place. After meeting with a new primary care doctor, you are assigned to a neurologist who will give you a comprehensive examination, write prescriptions for medications and medical devices, and refer you to other specialists in the hospital. The Washington, DC VA center has recently established its own ALS Clinic to provide comprehensive, interdisciplinary care for PALS.

Medicare
i) Under Medicare, a one-stop shop option may be available but is not as seamless. PALS can enroll in an ALS clinic such as the one at George Washington University and see a number of practitioners every three months for a half day session. If the patient has both Medicare Parts A and B coverage and the facility is an approved provider under the patient's healthcare program, the medical expenses should be very low. VA would be preferable, however, because there are no billing issues or medical need issues connected with the care that is provided.