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One of our clients, Mrs. Brown, who has been living alone with Multiple Sclerosis and various related health problems since 1986. She is declining. Currently, she is essentially bed bound and has to rely on assistance from at least one other person in order to transfer out of bed. She has little use of her upper extremities, has chronic pain and swelling and numbness in her feet, and requires a supra-pubic catheter for urination. She requires a host of home health services for her chronic condition.

Mrs. Brown's physician has prescribed a variety of home health services, including skilled nursing, physical therapy, patient education services, and personal care services. These services have been covered by Medicare for many months but, following an information session about fraud and abuse, Mrs. Brown's home care agency informed her that they had decided that her condition was "stable" and issued a Medicare denial. Without Medicare coverage, Mrs. Brown will lose her home care services; without the services she will have to enter a nursing home.

Another one of our clients, Rabbi Byron T. Rubenstein, wrote of his fear as illness and infirmity took over his life:

It is not the fear of what lies ahead
That shudders me as the cold water rushes in
And the sails rend and the lines snap and break
But doubting all my youth.

The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, has long recognized that home health care for chronic conditions is an increasingly needed, fiscally sound, and humane method of providing care. It is imperative that these truths are not lost in the zeal for cost containment. Sound public policy must take into consideration the very real home care needs of our most vulnerable citizens. To do less diminishes us all.

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