In other words, millions of Americans are so eager to have the government pick up the tab for their own or their parents' long-term care that they are willing to bend the rules. But the rules are complex, poorly defined, and difficult to enforce. There is no clear definition of what constitutes being homebound, though some cases are clearly over the line. Vigilant investigators in Louisiana, for example, found one patient receiving regular home care benefits who also was vigorous enough to drive more than 600 miles to Mexico for his honeymoon. But many more cases fall into a gray area where a patient who is not exactly bedridden has a genuine need, such as for a nurse to help with a daily injection.
Doctors thus face a dilemma.
Very few people facing chronic, long-term conditions wouldn't benefit by having a skilled nurse attend to them from time to time. In some cases, the patient may only need a maid or a cook, but since Medicare won't pay for that but will pay for medical care, doctors might prescribe visits from a nurse. The doctor thereby enables the patient to receive fully subsidized care at home rather than in a nursing home. Since there is not even a co-payment for home care services, people regard it as free and aren't incensed if their nurse or doctor also gets a nice check from the government. Besides, voters figure they have earned the help.