The justification for no CGM coverage in a facility is that it is double-dipping, meaning that you have nursing care and don’t need CGM. Yeah, right… I don’t know whether assisted living is also considered a facility or whether it is just nursing homes and hospitals. I do know someone who was denied her monthly CGM order because she was in a rehab facility after a hip replacement.
Your comment about Medicare not covering Dexcom equipment if you are in a senior care facility, @Laddie, sent me looking for more details. I feel like there are more details about this that are not yet clear to me. Here is one Medicare source that addresses this issue.
When does Original Medicare cover DME?
Original Medicare covers DME under Part B when your doctor
or other health care provider (like a nurse practitioner, physician assistant, or clinical nurse specialist) prescribes it for you to use in your home. A hospital or nursing home that’s providing you with Medicare-covered care can’t qualify as your “home” in this situation. However, a long-term care facility can qualify as your home.
Note: If you’re in a skilled nursing facility (SNF) as part of a stay covered under Medicare Part A, the facility is responsible for providing any DME you need while you’re in the facility for up to 100 days. [bold emphasis is mine]
It seems the Medicare policy is built on the fact that if you’re in a facility that provides you with Medicare-covered care then that facility is responsible for providing any needed durable medical equipment like a continuous glucose monitor. It could be that these facilities are not competent at providing CGMs under Medicare.
I’ve read in the past that Medicare has been ripped-off by many scams and has responded with new policies that protect them against the scam artists but then make it difficult for beneficiaries.
I wonder if the experience with covid patients, many probably medicare, who were STARTED on dexcom during covid care will be a game changer at how they help the staff in addition to patients.
@MM1 – Yeah, I think many medical and care providers will be introduced to Dexcom CGMs in the hospital during the Covid-19 era. This FDA emergency approval for hospital use will certainly give a nice introduction to many hospital professionals who have never seen a CGM in action before. That will benefit us in the long run.
As usual, you all make a lot of good points during this discussion.
I, too, am hopeful that a lot of the in-hospital CGM experience will be an eye opener for Medicare, hospitals, and, I hope, many senior facilities.
After this is behind us, I expect that there will be a lot of after-the-fact analysis on what went wrong in so many, but by no means all, senior living facilities of all flavors. I’m hopeful that this will ultimately result in improved standards of care, better oversight, and improved training and wages for the people that staff these facilities.
My mother, who passed away at age 94 in 2012, spent the last two years of her life in a very nice, well-managed for-profit facility. She was in both their assisted living and skilled nursing facility. Even there, we saw serious issues that were so deeply embedded that they were hard to address in a meaningful way, even if family were there on a nearly daily basis. I shudder to think about those who did not have regular on-site advocates or what things must be like in less well-run facilities.
Certainly considering and discussing these issues here, will likely benefit us all as we make future choices.
Very interesting discussion. Huh.
Put it on her phone!
She might be curious from time to time and can just look for herself.
Yeah, people pick up my receiver…or my phone. People ARE interested.
She might not know how interesting it is to her until she has access, lol.
My husband doesn’t want to know what my sugar levels are unless I’m getting irritable and he thinks I’m crashing, then he’ll just ask. He’ll also ask me if my BG level is okay to make spaghetti, but look at my CGM, not hardly.
The few times he has, when I’m in the shower and it starts beeping, then he knows I’ll have to get out of the shower to look, usually after attempts of me trying to shout at Siri what’s my BG level. That’s more of he knows I’ll be yelling and that I want to know than he actually wants to know what number I am at.
Now my dogs, he scans all the time to keep track of what her BG level is doing. But that’s because she can’t take care of herself and sometimes she needs corrections or food. Me he figures I’ll tell him if he needs to know for some reason, but curious, interested, not at all.
Nursing or other long term care homes are no different from the medical profession. They do use a limited number of test strips to monitor BGs. However, the resulting actions are based on doctors’ orders which are mostly sliding scale or the use of a 70/30 mixtard. I do not believe that the use of CGMs will change that. However, it will save on test strips.
I don’t have anything to add, but I’m at the ripe old age of 32 and I think about this a lot already. My husband could take care of me but not as well as I do, and I don’t want him to have that burden. We don’t have any kids, and even if we did, how unfair would that be to ask them to take care of me?!
I have friends who have worked in nursing homes and it’s terrifying to think about how poor the quality of care can be, even in the nice places. So, I don’t have any suggestions, but I’m glad you brought this up because it’s nice to know other people are also concerned about this.
I’m thinking a type 1 retirement village could be a gold mine. We can have workshops on how to loop.
How to replace batteries in our dex transmitters.
All kinds of carb manipulation and cooking classes.
Hiking with diabetics is like a traveling candy store.
I mean I am 54 so not looking for a retirement or nursing home but someday I might have to.
I’m hoping technology gets better in the next 20 years.
But really an investor who starts a retirement home with nursing care too. The people will be busting down the doors.
LOL Oh my! So true!!
I love it all … thanks so much for the suggestion @Timothy
As an under-40, this stuff isn’t quite on my radar yet. What an interesting read. I see just enough about Medicare on this forum to be overwhelmed by the options. I don’t know how you all choose your plans or muddle through that mess.
I wonder what things will be like for me in 25-30 years? Heck, we might not even have anything like Medicare. As fast as technology is evolving, though, even sub-standard facility care that far in the future will probably have at least the semi-closed loop systems available now.
Thanks for more clarification, Terry. So maybe the issue is that my normal supplier will not be able to provide my supplies if I’m in a facility, but the facility can.
My husband would never just pick up my receiver and look at my numbers unless I asked him to. He will occasionally ask what my reading is if I say we need to wait to eat, or if I am low. It isn’t that I mind sharing that information at all, but to just pick up my receiver would seem intrusive to both of us. Showing each other a great deal of respect is one of the reasons we have remained together for so long.
My wife has gotten used to hearing my CGM alerts for high and low BG but only gets excited by the alert if I get excited. (I use the alerts for a pretty tight range when at home). If I calmly go about my business with treating a low or correcting a rise she pays it no mind. She rarely picks up my phone or receiver to review the CGM data. That’s all fine with me, it is the way we’ve gotten used to it. She is very in tune with carb counts, meal planning etc.
I have walked her through the bolus calculator on my pump so she understands the basics of a meal bolus. I don’t believe any caregiver would be able to figure out or adjust how I handle basal rates, temp basals, etc. I think if I land in a spot where I need a caregiver, I would go back to Tresiba daily basal and stay with the pump for bolus insulin.
Much like you, I have asked the same questions. 80+ yrs. Insulin pump for 23 year. Good control with no major complications. We are looking at CCRC’s(continuing care retirement centers) and with each one we’ve visited or contacted I ask how their assisted living or nursing facility would be able to manage my pump and cgm and much to my surprise many have faced this issue and have educated a specialist care person to manage these technically challenging patients. Some centers offered to have us interview one of their care individuals. I’m certain that that many retirement/assisted care facilities would bend over to provide the type of care that you and I need when we are no longer able to do it ourselves. Will it be as good as we provide for ourselves…it will sadly depends on our care givers enthusiasm for managing diabetes to the fullest.
Thanks for your thoughtful concern.
A T1D retirement village! What a great idea! It wouldn’t have to be totally T1D, of course, but any such facility that provides special care for us sweet folks would be attractive to many of us. I’ll ask my favorite nurse practitioner/CDE whether she’s heard of such a thing. Thanks for the idea, Timothy!
Thank you for your report and encouraging news. While this may be something that only the very best facilities offer initially, there is also a level of competition between facilities to attract “customers” that will likely cause this type of offering to expand.
Of course, @Timothy’s idea for “year-round summer camp for aging T1Ds” may be the ultimate in this approach.
Also, I appreciate that some of the “youngsters” like @Allison1 are following this discussion. Like it or not, we all end up here …
Difficult dillemna. You have done very well after a lifetime of successfully living with diabetes. You have already exceeded the capably of most caregivers, who ate poorly trained for even type 2 diabetics who are on oral agents. As more type 1 diabetics live into “ old age” because of both improved technology and knowledge about diabetes, your dilemna will become even more common. Tandem has the capability of sharing data with a patient’s endocrinologist and diabetes team. They may be able to provide daily monitering with contact with a caregiver to give Specific instructions. Fortunately, the tandem pump will lessen dangerous lows, especially at night. As s 72 year old who has had type 1 for about 38 years, I share your concern.