Home Health & Hospice

Putting Maintenance Therapy into Perspective

Homecare Insider, May 23, 2011

Many homecare professionals may not understand exactly what maintenance therapy is and when it can be used. Maintenance therapy differs from restorative therapy in that it should help the patient maintain function or to prevent decline in function. It should also involve the specialized skill of a qualified therapist versus an assistant. There truly are two types of maintenance therapy. The first is usually short term, during which the therapist evaluates the patient’s needs, designs and establishes a home program, and teaches the patient/caregiver how to perform the program. The second type involves the therapist carrying out the program that could not be performed by the caregiver/family without putting the patient at risk.

The Medicare coverage criteria for maintenance therapy requires that the patient’s clinical condition require the specialized skill, knowledge, and judgment of a qualified therapist to design or establish a maintenance program, related to the patient’s illness or injury, in order to ensure the safety of the patient and the effectiveness of the program. Whenever a maintenance program is established for a patient who has either completed a rehabilitative therapy program or there was no rehabilitative therapy program, there must exist an identified danger to the patient.

When designing or establishing maintenance program, the qualified therapist must teach the patient/caregiver necessary techniques, exercises, or precautions. But, when this is impossible due to the clinical condition and safety risk to the patient, a qualified therapist may perform the maintenance therapy. Documentation in the clinical record is important to justify maintenance therapy and it should identify the particular function at risk and show that the program requires the skills of a therapist. The clinical record should also identify the program design, necessary instruction, and necessary periodic reevaluations and focus on safety and effectiveness. As with other Medicare-covered services, the amount, frequency, and duration of the services must be reasonable.