Missouri Home Care Facts Page

Patient Eligibility ● Choosing a provider 
Diabetic Peripheral Neuropathy ● Peripheral Neuropathy Treatment Program

Patient Eligibility Facts

Choosing a Provider

Choosing the right home care provider can be a difficult and emotional decision.   But, the choice is yours.  How do you decide which company is right for you?  Home care companies differ in the services they provide and the qualifications of their staff.

To assist you in the selection process, we have compiled a list of questions to guide your decision.  Ask these questions either directly to the home care company or to your physician, discharge planner or case manager.

Types of Service:

• What types of services does the company provide?
•  Home nursing, respiratory care, infusion therapy, and medical equipment are just a few of the specialized home care services. 

• Is the company specialized or does it provide more general care?
•  Some providers are specialists in home care, providing a limited menu of services.  Others are generalists and provide a more extensive range of services.

• Does the company provide services to pediatric patients?
•  Not all providers are equipped to provide services to children.

Level of Service:

• Is service available 24 hours a day, 7 days a week?

• How promptly will your calls be returned?

• How quickly will the company respond to changes in your service?

• How quickly can your service begin?

• Will the company bill the insurance company on your behalf?

• Will the company investigate your insurance coverage for home care?

  Qualifications of Staff:

• What are the qualifications of the staff who will be providing your care?  Are they licensed nurses, pharmacists, respiratory therapists?

• What type of training is provided for staff?

• What type of quality programs does the staff participate in?

  Office Locations:

• Where is the office located?  How far is the company from your home?

• What is the company's service area?

Diabetic Peripheral Neuropathy Facts

What is Diabetic Peripheral Neuropathy (DPN)?
Diabetic Peripheral Neuropathy is a serious complication of diabetes and has been considered to be progressive and irreversible.  Between 26% and 50% of people with diabetes are diagnosed with DPN and up to 100% develop some degree of neuropathy 5 years after diagnosis of diabetes.  Over 20 million people have neuropathy of all causes (Source:  www.neuropathy.org).

What are the Symptoms?
The symptoms of DPN are prickling, tingling or burning pain and numbness in the feet, legs and/or hands.  These can be worse at night interrupting sleep and can make exercising, walking and even driving a car extremely difficult.  Many people have problems with balance and falls are common.

How is Diabetic Neuropathy Treated Today?
At best, the current management strategies treat the symptoms of the disease rather than the underlying cause, which is increasingly believed to be poor microcirculation to the nerves and tissues in the extremities.  Controlling blood sugars can help in the early stages, but once the diabetic neuropathy is more advanced, many of the medications used to control pain cause unpleasant side effects and may not be effective.

What are the Complications?
Diabetic Peripheral Neuropathy leads to serious complications including chronic ulcers, falls that result in fractures and other serious injuries and amputations.  Here are a few facts:

• DPN accounts for more hospitalizations than all other diabetic complications combined.1
• Total costs for DPN exceed $37B annually.1
• One in three people over 65 fall each year – at an annual cost of $20B.2
• Patients with DPN are 15 times more likely to report injury during gait-related activities than those without DPN and have an increased incidence of leg and foot fractures.3
• DPN is the leading cause of diabetic foot ulcers and amputations. 87% of non-traumatic amputations are due to DPN.  There are 80,000 amputations in the US each year and 3,000 in VA hospitals.4
• Over 7% of all people with diabetes will develop a diabetic ulcer (DU) per year.5
• Medicare costs for diabetic ulcers exceed $15K per patient per year.4
• 11% of patients with a DU require a lower extremity amputation (LEA) within 3 years. The 3-year survival rate is 50%. 50% of lower extremity amputees require a second LEA within 5 years.

–      What Can a Person with Diabetic Neuropathy Do to Prevent these Complications?

The American Diabetes Association recommends routine foot exams and screening for loss of protective sensation.  On October 17, 2001, CMS (Medicare) issued a Coverage Decision Memorandum stating that all people with loss of protective sensation (LOPS) would be covered for two foot exams per year.  Education on personal foot care and prevention should also be provided to patients.  Wearing well-fitting shoes and examining one’s feet regularly are key to prevention of foot ulcers and amputations.

1. Vinik, Neuropathy: New Concepts in Evaluation & Treatment, South Med J95 (1):21-23, 2002.

2. Tinetti, etal, Risk factors among elderly persons living in the community. N Eng J Med, 1998;319:1701-1707
   Sattin, RW. Falls among older persons: A public health perspective. Annu Rev Public Health, 1993; 13:489-508
   American Academy of Orthopedic Surgeons, Don’t Let a Fall Be Your Last Trip, www.aaos.org

3. Conner-Kerr, T and Templeton, MS, Chronic Fall Risk among Aged Individuals with Type 2 Diabetes, Ostomy Wound  Management, March 2002, Vol 48 (3):28-35

4. Levin, Marvin, MD; Management of the Diabetic Foot: Preventing Amputation, South Med J95(1):10-20,2002.Decision Memorandum CAG-00059, Centers for Medicare & Medicaid Services, October 17, 2001

5. Powell, Mark etal., Reversal of Diabetic Peripheral Neuropathy and New Wound Incidence, 2004, 17(6):295-300

Peripheral Neuropathy Treatment Program Facts 

Who Can Benefit from the Peripheral Neuropathy Treatment Program?
Patients with numbness or pain in their feet or legs combined with difficulty with gait or balance abnormalities may qualify for this program.  People with diabetes and peripheral vascular disease (PVD) are most likely to benefit, although many other types of neuropathy do respond.   

What is the Treatment Program Protocol?
The program typically consists of 3 therapy sessions per week and lasts 4 weeks – although some patients may take more treatments.  The therapy consists of monochromatic infrared photo energy called Anodyne Therapy, along with balance, gait and strengthening physical therapy exercises.  This 12-session protocol has been clinically proven over ten years on thousands of neuropathy patients to provide the best outcomes.  An ongoing home treatment program may be recommended after the twelve sessions are complete. 

Will Insurance Cover This Therapy?
Medicare and most insurance companies cover physical therapy programs when prescribed by your physician.  Patients should ask their insurance carrier if their insurance plan covers physical therapy.

What is Anodyne Therapy?
The Anodyne Therapy System is a safe, FDA-cleared, drug-free, non-invasive device that uses near-infrared light emitting diodes to safely increase local circulation and reduce pain.  Use in thousands of patients since 1994 has demonstrated that the Anodyne Therapy System increases local circulation in patients with DPN, who often have severe vascular impairment.  The results of this improved circulation have been published in numerous medical journals and include improved sensation and nerve function, pain reduction and healing of chronic diabetic ulcers.  New data shows that treatment with this therapy can also improve balance and gait and reduce the risk of falls by 96% in the elderly patient with neuropathy.

Is Anodyne Therapy Safe for Everyone?
Anodyne Therapy may be used in any patient except over the womb during pregnancy and directly over a cancerous tumor.  It can even be used safely over pins, implants, screws, pacemakers and defibrillators.

Are There Any Serious Side Effects or Drug Interactions?
There are no known drug interactions.  However, as circulation improves and the symptoms of diabetic peripheral neuropathy are reduced, sometimes less diabetes medication is required.  It is important to check blood sugars regularly during this program and reduce diabetes medication as needed.  The only known side effect is a slight potential for a topical burn.