Adult therapy

Geriatric Therapy: Balance, Falls, and Staying Independent

Expert-reviewed guidance on balance and falls, bone health, staying independent at home, and how to find the right therapist for an older adult.

  • Expert Reviewed
  • Evidence Based
  • Patient Focused
A physical therapist supporting an older adult through a resistance band strengthening exercise in a bright therapy room.

Dr. Eva Lassey, PT, DPT reviewed the physical therapy, falls and movement content on this page. Speech, swallowing and Medicare information follows published guidance from the sources listed at the foot of this page. · View full bio → · Last updated November 4, 2026

Geriatric therapy is physical, occupational and speech therapy for older adults: staying steady on your feet, keeping strong, managing at home and recovering after an illness or a hospital stay. Muscle weakness in old age goes with declining physical function, yet strength training improves physical function in later life and balance exercise reduces falls,⁠1,2 with strength gains even in a trial of frail nursing home residents whose average age was 87.⁠3 More than one in four people 65 and older fall each year,⁠4 and many falls can be prevented.⁠5 Original Medicare covers medically necessary outpatient therapy with no yearly limit,⁠6 including therapy to keep function or slow a decline.⁠7

Geriatric therapy guides, by what you need

Falls and balance

Staying steady: fall risk tests, balance exercise, home safety, and what to do after a fall.

Learn more →

Osteoporosis and bone health

Keeping bones strong: exercise that loads bone safely, movements to avoid, and spine fractures.

Learn more →

Staying independent at home

Managing at home: daily tasks, an occupational therapy home visit, and home changes room by room.

Learn more →

Therapy after a hospital stay

Recovering after the hospital: where therapy continues, observation status, and who pays.

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Medicare coverage for therapy

Getting therapy paid for: 2026 Part B costs, referrals, Medicare Advantage, and appeals.

Learn more →

Speech therapy for adults

Speech, swallowing and memory changes: what a speech therapist treats, and what it costs.

Learn more →

What is geriatric therapy, and who does what?

Three kinds of therapist work with older adults, and Medicare describes each one:⁠6,8,9

  • Physical therapy helps restore or improve movement after an injury, illness or surgery, and can also help you keep your current function or slow a decline.⁠6
  • Occupational therapy helps you do activities of daily living, such as dressing and bathing, and can likewise improve or keep what you can do, or slow a decline.⁠8
  • Speech-language pathology evaluates and treats speech and language, including thinking (cognitive) and swallowing skills.⁠9

So the problem points to the therapist: movement to a physical therapist, daily activities to an occupational therapist, and speech, language, thinking or swallowing to a speech-language pathologist.⁠6,8,9 With arthritis, for example, physical therapists work on joint function and occupational therapists teach ways to protect joints, manage daily activities and save energy.⁠10

A physical therapist starts with an evaluation and designs a treatment plan around your own needs and goals, including help getting past what keeps you from being active.⁠11

How can older adults prevent falls?

More than one in four people 65 and older fall each year, fewer than half tell their doctor, and falling once doubles the chance of falling again.⁠4 Falls caused over 43,000 deaths among adults 65 and older in 2024, the leading cause of injury death at that age.⁠12 Yet many falls can be prevented.⁠5

Falls usually have more than one cause: loss of muscle mass, balance and walking problems, changes in eyesight and hearing, foot pain or unsafe shoes, medications that cause dizziness or confusion, and hazards at home.⁠5 Most falls come from a combination of these, and many of them can be changed.⁠4

  • Exercise has high-certainty evidence behind it: in a Cochrane review of trials in people aged 60 and over living in the community, balance and functional exercises reduced the rate of falls by 24% (39 trials, 7,920 people).⁠2 An earlier review of 88 trials found larger effects from programs that challenge balance and add up to more than three hours a week, and no evidence of an effect in residential care or among people recently discharged from the hospital.⁠13
  • A medication review matters: some medications cause dizziness or confusion, and the more medications you take, the more likely you are to fall.⁠5
  • Eyes, ears and shoes are worth checking: even small changes in sight and hearing are linked to a higher risk of falls, and so are backless shoes and high heels.⁠5
  • Home hazards are worth removing for someone at higher risk: in trials, home fall-hazard changes reduced the rate of falls by 38% in people at higher risk, such as those who had fallen in the past year or had recently been in the hospital (high-certainty evidence), and probably by 26% overall (12 trials, moderate-certainty evidence), with no reduction in people not selected for risk.⁠14
  • Tell your doctor about any fall, even one that did not hurt. A fall can point to a new medical problem or to a medication or eyesight issue, and your doctor may suggest physical therapy or a walking aid.⁠5

Is it too late to start strength training?

No. A Cochrane review of 121 trials with 6,700 older people found that progressive resistance training had a large effect on muscle strength (73 trials) and called it an effective way to improve physical functioning in older people, while urging caution in using the exercises with people who have medical conditions, because harms were not well reported.⁠1 In a randomized trial of 100 frail nursing home residents aged 72 to 98 (average 87), those who did ten weeks of resistance training gained 113% in muscle strength, against 3% in those who did not exercise.⁠3

The National Institute on Aging suggests strengthening the major muscle groups at least two days a week and balance exercises about three times a week, as part of a weekly mix that includes aerobic activity. Strength work makes everyday tasks such as getting up from a chair, climbing stairs and carrying groceries easier, and helps prevent falls.⁠16

If you are starting after a fall, an illness or a long stretch of doing very little, a physical therapist can set the plan around your own needs and goals.⁠11

How can older adults keep bones and joints strong?

Osteoporosis weakens bones until they can break easily, often with no sign until a bone breaks. It affects about one in five women over 50 and one in 20 men. The National Institute on Aging, citing the US Preventive Services Task Force, says women over 65 should be tested.⁠17

Weight-bearing exercise, such as strength training, walking, climbing stairs and dancing, helps build and strengthen bone. With osteoporosis, movements that twist the spine or bend forward from the waist, like sit-ups and toe touches, can cause a fracture, and a fall is more likely to break a weakened bone, so fall prevention is part of bone health.⁠17

Osteoarthritis is the most common type of arthritis and is more common in older people; it most often affects the hands, knees, hips, neck and lower back.⁠18 Exercise can reduce joint pain and stiffness and build strength, and the care team can include physical therapists for joint function and occupational therapists for protecting joints in daily tasks.⁠10

How can therapy help an older adult stay at home?

The help that lets older adults keep living at home covers everyday activities (bathing, dressing, grooming, using the toilet, eating and moving around) along with chores, meals, money, health care, transportation and safety.⁠19 Occupational therapy is therapy to help you do those activities of daily living.⁠8

The National Institute on Aging suggests going through the home room by room and fixing immediate dangers first, such as loose stair railings and poor lighting.⁠19 Incontinence belongs on the list too: conditions that cause a rush to the bathroom can raise the chance of a fall.⁠5

Medicare's home health benefit covers part-time skilled care, including therapy, for people who are homebound, but not 24-hour care, meal delivery, or help with bathing and dressing when that is the only care you need.⁠20

Therapy after a hospital stay: where, and who pays

Therapy after a hospital stay can continue in several settings, and Original Medicare has different rules for each. Hospital status matters: you are an outpatient, even overnight, until a doctor writes an order to admit you,⁠21 and time under observation does not count toward the three inpatient days a skilled nursing facility stay usually needs.⁠22

Where therapy continues after a hospital stay, under Original Medicare in 2026
SettingWho it is forWhat Medicare requiresWhat you pay
Inpatient rehabilitation facilityRecovery from a serious surgery, illness or injury that needs intensive therapy, doctor supervision and coordinated care.⁠23Your provider certifies that you need that level of care.⁠23Part A: $1,736 deductible per benefit period, not charged again if you paid it for a hospital stay in the same benefit period; then $0 a day for days 1 to 60.⁠23
Skilled nursing facilityShort-term skilled nursing or therapy care.⁠22An inpatient hospital stay of at least 3 days in a row first, unless your doctor takes part in an accountable care organization approved for a waiver; observation and emergency room time do not count.⁠22Part A: $0 a day for days 1 to 20 after you pay the Part A deductible, $217 a day for days 21 to 100, all costs after that.⁠24
Home healthPeople who are homebound and need part-time or intermittent skilled care.⁠20A doctor or other provider sees you in person, confirms the need and orders the care; a Medicare-certified agency provides it.⁠20$0 for covered services; 20% for medical equipment after the Part B deductible.⁠20
Outpatient therapyTherapy in a therapist's or medical office or a hospital outpatient department; some independent therapists and home health agencies also give it at home.⁠25A doctor or other provider certifies that you need the therapy.⁠6Part B: the $283 yearly deductible, then usually 20% of the Medicare-approved amount; no yearly limit.⁠6,24

A Medicare Advantage plan must cover what Original Medicare covers and follow Original Medicare's rules for skilled nursing, home health and inpatient rehabilitation coverage,⁠26,27 and it may waive the three-day hospital stay.⁠22 It can require prior approval and its own network;⁠26 once it approves a course of treatment, the approval must stay valid for as long as it is medically necessary.⁠28

When does an older adult need a speech therapist?

A speech-language pathologist evaluates and treats speech and language, including thinking and swallowing skills, and Medicare Part B covers that therapy when it is medically necessary, including therapy to keep current function or slow a decline.⁠9

Signs of a swallowing problem include coughing or throat clearing during or after eating or drinking, a wet or gurgly voice during or after eating or drinking, food that feels stuck, needing extra time to chew or swallow, and weight loss. The evidence on how well each sign predicts a problem is mixed, and some people have no obvious signs at all.⁠29

Therapy for Parkinson's, stroke and other conditions

These guides cover conditions that physical, occupational and speech therapy treat in adults, and what therapy involves for each.

Can therapy help you keep driving or working?

Driving helps older adults stay mobile and independent, but changes in vision, physical function, reasoning and memory, as well as illnesses and medications, might affect some older drivers. The CDC's steps include a regular activity program for strength and flexibility, a medication review with your doctor or pharmacist, and an eye exam at least once a year.⁠30

A driver rehabilitation specialist is typically an occupational therapist trained to evaluate driving risk, especially in people with conditions such as arthritis, stroke, dementia or Parkinson's. A comprehensive driving evaluation has two parts: physical, vision and thinking tests in a clinic, then a test behind the wheel in a car with an instructor's brake.⁠31 The result can be equipment such as larger mirrors, hand controls or pedal extenders, training, safer routes, or a plan for other ways to get around. Some programs need a prescription, and insurance may not cover the cost, so ask first.⁠31

If a health condition makes parts of your job harder, the Job Accommodation Network gives free, expert and confidential guidance on workplace accommodations.⁠32

Do you need a referral for therapy on Medicare?

Original Medicare itself does not require an order or referral for outpatient physical, occupational or speech therapy.⁠33 It pays only when a doctor or other provider (a nurse practitioner, physician assistant or clinical nurse specialist) certifies that you need the therapy.⁠6 If the therapist has a written order or referral in your record and sends your plan of care to that provider within 30 days of the first evaluation, that counts as the certification.⁠33

Medicare Advantage plans can work differently: you may need a referral to see a specialist, approval before some services, and providers in the plan's network for care that is not an emergency. Check your plan's rules before the first visit.⁠26

State law decides whether you can see a physical therapist without a referral. As of July 1, 2025, every state, the District of Columbia and the US Virgin Islands allowed direct access to physical therapists for evaluation and treatment, though some states still attach conditions to treatment without a referral.⁠34 Your insurance can still have its own rules, such as a Medicare Advantage plan's referral requirement.⁠26

How is therapy paid for? Medicare and other options

Under Original Medicare, Part B pays for medically necessary outpatient physical, occupational and speech therapy. In 2026 you pay the $283 yearly deductible, then usually 20% of the Medicare-approved amount, and there is no yearly limit on what Medicare pays.⁠6,24

There is a threshold instead of a cap: once 2026 costs pass $2,480 for physical and speech therapy combined, or $2,480 for occupational therapy, the clinic must mark the claim to confirm the therapy is medically necessary, and some claims above $3,000 can be picked for review.⁠35 You do not have to keep improving to stay covered: Medicare covers skilled therapy to keep function or to prevent or slow a decline when you need a therapist's skills to do it safely.⁠7

If a clinic expects Medicare not to pay because the therapy is not medically necessary, it must give you a written Advance Beneficiary Notice before charging you, and it cannot give you one only because your costs reached a certain amount.⁠25 Medigap can help pay the 20% coinsurance under Original Medicare; a Medicare Advantage plan has its own costs and a yearly out-of-pocket limit.⁠26

PACE (Program of All-inclusive Care for the Elderly) is for people 55 and older who need nursing home-level care but can live safely in the community with its help. It can cover physical, occupational and speech therapy with no deductible or copayment for care the PACE team approves, and it is offered only in some states and service areas.⁠36

For free, one-on-one help with Medicare choices, call your State Health Insurance Assistance Program (SHIP).⁠25,37

Warning signs that need prompt medical care

How to find a therapist experienced with older adults

Ask whether the clinic has experience with older adults and whether they can see you at home if getting out is part of the problem. Under Medicare, some independent therapists and home health agencies can give outpatient therapy at home,⁠25 and the home health benefit covers therapy at home for people who are homebound; a doctor who orders home health should give you a list of agencies that serve your area.⁠20

Physical therapists can become board-certified geriatric clinical specialists, a specialty in the prevention, evaluation and management of age-related conditions that affect mobility, physical capacity and quality of life; as of July 2026 the specialty board had certified 4,665 of them.⁠41

For services beyond therapy, such as home-delivered meals and homemaker help, contact your Area Agency on Aging through the Eldercare Locator, a public service of the Administration for Community Living, at 1-800-677-1116.⁠42,43

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Frequently Asked Questions

What is the difference between geriatric physical and occupational therapy?

Physical therapy helps restore or improve movement after an injury, illness or surgery, or keep function and slow a decline. Occupational therapy helps with activities of daily living, such as dressing and bathing.⁠6,8

Does Medicare cover physical therapy for older adults?

Under Original Medicare, yes. Part B covers medically necessary outpatient physical, occupational and speech therapy with no yearly limit. In 2026 you pay the $283 deductible, then usually 20% of the Medicare-approved amount. A doctor or other provider must certify that you need it.⁠6,24

Do I need a referral to see a physical therapist on Medicare?

Original Medicare does not require one, but a doctor, nurse practitioner, physician assistant or clinical nurse specialist must certify your therapy plan for Medicare to pay. A Medicare Advantage plan may require a referral or prior approval.⁠26,33

Does Medicare pay for therapy at home?

Under Original Medicare, yes, in two ways. If you are homebound and need part-time skilled care, home health covers therapy at no cost to you once a doctor or other provider has seen you and ordered it. Outside a home health plan of care, some independent therapists and home health agencies can give outpatient therapy at home under Part B.⁠20,25

Does Medicare stop paying for therapy if I stop improving?

No. Coverage turns on whether you need a therapist's skilled care, not on whether you can still improve, so therapy to keep function or slow a decline can be covered when the other coverage rules are met.⁠7

Is it too late to start strength training in my 80s?

No. In a randomized trial of frail nursing home residents aged 72 to 98, those who did ten weeks of resistance training gained 113% in strength, against 3% in those who did not exercise. A review of 121 trials found strength training improves physical functioning in older people, with a caution about people with medical conditions because harms were not well reported.⁠1,3

What should an older adult do after a fall?

Tell your doctor, even if you were not hurt, because a fall can point to a new medical problem or a medication or eyesight issue. An older person who falls and hits their head should see a doctor right away, especially one who takes a blood thinner.⁠4,5

Can an occupational therapist check whether I can still drive?

A driver rehabilitation specialist, typically an occupational therapist with extra training, can do a comprehensive driving evaluation: clinic tests of movement, vision and thinking, then a test behind the wheel. Some programs need a prescription, and insurance may not cover it.⁠31

Sources

  1. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews. 2009;(3):CD002759. doi:10.1002/14651858.CD002759.pub2 (PMID 19588334).
    Show the passageHide the passage
    A review of 121 randomized trials with 6,700 older people. Progressive resistance training had a large positive effect on muscle strength (73 trials, 3,059 people) and a small but significant effect on physical ability (33 trials, 2,172 people). The authors conclude that it “is an effective intervention for improving physical functioning in older people”, and that “some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported”.
  2. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;(1):CD012424. doi:10.1002/14651858.CD012424.pub2 (PMID 30703272).
    Show the noteHide the note
    108 randomized trials with 23,407 people aged 60 and over living in the community. Exercise of all types reduced the rate of falls by 23% (59 trials, high-certainty evidence), with no evidence of a difference in effect between trials that selected people at increased risk of falling and trials that did not. Balance and functional exercises reduced the rate of falls by 24% (39 trials, 7,920 people; high-certainty evidence).
  3. Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine. 1994;330(25):1769–1775. doi:10.1056/NEJM199406233302501 (PMID 8190152).
    Show the noteHide the note
    A randomized, placebo-controlled trial in 100 frail nursing home residents aged 72 to 98 (average 87): over ten weeks, muscle strength rose by 113% in those who did resistance training, against 3% in those who did not exercise.
  4. Centers for Disease Control and Prevention. Facts About Older Adult Falls (reviewed September 8, 2026). Checked November 4, 2026.
    Show the passageHide the passage
    “More than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.” “Most falls are caused by a combination of risk factors.” Many risk factors “can be changed or modified to help prevent falls”. “An older person who falls and hits their head should see their doctor right away to make sure they don't have a brain injury.” Head injuries “can be very serious, especially if the person is taking certain medicines (like blood thinners)”. “When a person is less active, they become weaker and this increases their chances of falling.”
  5. National Institute on Aging. Falls and Fractures in Older Adults: Causes and Prevention (content reviewed September 12, 2022). Checked November 4, 2026.
    Show the passageHide the passage
    Causes of falls include eyesight, hearing and reflexes, age-related loss of muscle mass, problems with balance and gait, foot problems and “unsafe footwear such as backless shoes or high heels”, and medications that cause dizziness or confusion: “The more medications you take, the more likely you are to fall.” “Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.” “Even small changes in sight and hearing are linked to an increased risk for falls.” “However, many falls can be prevented.” Fear of falling “may lead them to avoid activities such as walking, shopping, or taking part in social activities”. “Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell.”
  6. Centers for Medicare & Medicaid Services. Physical therapy services. Checked November 4, 2026.
    Show the passageHide the passage
    “Physical therapy helps to restore or improve physical movement in your body after an injury, illness, or surgery. You can also get this therapy to help improve or maintain your current function, or slow your rate of decline.” Your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) “must certify that you need it”. After the Part B deductible, you pay 20% of the Medicare-approved amount; “There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”
  7. Centers for Medicare & Medicaid Services. Jimmo Settlement Agreement. Checked November 4, 2026.
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    Medicare covers skilled therapy in skilled nursing facilities, home health and outpatient therapy “when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met)”; coverage “does not turn on the presence or absence of a beneficiary's potential for improvement, but rather on the beneficiary's need for skilled care”.
  8. Centers for Medicare & Medicaid Services. Occupational therapy services. Checked November 4, 2026.
    Show the passageHide the passage
    “Therapy to help you perform activities of daily living (like dressing or bathing). You can get this therapy to help improve or maintain your current capabilities, or slow your rate of decline.” Part B covers it when your doctor or other health care provider certifies you need it.
  9. Centers for Medicare & Medicaid Services. Speech-language pathology services. Part B “covers medically necessary outpatient speech-language pathology services”. “Speech-language pathology services provide evaluation and treatment to regain and strengthen speech and language skills. This includes cognitive and swallowing skills, or therapy to improve or maintain current function or slow decline.” Checked November 4, 2026.
  10. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis: Diagnosis, Treatment, and Steps to Take. Exercise “can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance”; “Physical therapists, who help improve joint function”; “Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy”. Checked November 4, 2026.
  11. American Physical Therapy Association. About Physical Therapists and Physical Therapist Assistants. Physical therapists “evaluate, diagnose, and manage health conditions and movement problems in people of all ages and abilities” and “design treatment plans specific to each person's needs and goals”; they “help people overcome barriers to regular physical activity”. Checked November 4, 2026.
  12. Centers for Disease Control and Prevention. About Older Adult Fall Prevention (reviewed September 8, 2026). “Falls among adults 65 and older caused over 43,000 deaths in 2024, making it the leading cause of injury death for that group.” Checked November 4, 2026.
  13. Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(24):1750–1758. doi:10.1136/bjsports-2016-096547 (PMID 27707740).
    Show the noteHide the note
    99 comparisons from 88 trials with 19,478 people: exercise reduced the rate of falls in older people living in the community by 21%, with larger effects from programs that challenged balance and involved more than three hours of exercise a week. The review found no evidence of a fall prevention effect in residential care, among stroke survivors or among people recently discharged from the hospital.
  14. Clemson L, Stark S, Pighills AC, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2023;(3):CD013258. doi:10.1002/14651858.CD013258.pub2 (PMID 36893804).
    Show the noteHide the note
    22 trials with 8,463 people aged 60 and over. Home fall-hazard assessment and changes probably reduced the overall rate of falls by 26% (12 trials, moderate-certainty evidence), and by 38% in people selected for a higher risk of falling (9 trials, high-certainty evidence), such as those who had fallen in the past year or had recently been in the hospital; there was no reduction in people not selected for fall risk.
  15. Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing. 2008;37(1):19–24. doi:10.1093/ageing/afm169 (PMID 18194967).
    Show the passageHide the passage
    A systematic review of 28 studies of older people living at home: the main consequences of fear of falling were “a decline in physical and mental performance, an increased risk of falling and progressive loss of health-related quality of life”.
  16. National Institute on Aging. Three Types of Exercise Can Improve Your Health and Physical Ability. Checked November 4, 2026.
    Show the passageHide the passage
    “Try doing muscle-strengthening activities at least two days per week to work the major muscle groups of the body”; they “can help you stay independent and make it easier to perform everyday activities, such as getting up from a chair, climbing stairs, and carrying groceries” and help prevent falls. Balance exercises: “Aim for about three sessions of balance exercises a week.” “Older adults need a mix of physical activities to stay healthy.”
  17. National Institute on Aging. Osteoporosis. Checked November 4, 2026.
    Show the passageHide the passage
    “Osteoporosis weakens bones to the point that they can break easily.” People “may not notice any changes until a bone breaks”. “Osteoporosis affects about one in five women over age 50, but only one in 20 men.” “If you are a woman over age 65, the U.S. Preventive Services Task Force recommends that you get tested for osteoporosis.” Weight-bearing exercise, “such as strength training, walking, hiking, jogging, climbing stairs, tennis, and dancing”, “can help build and strengthen your bones”; activities that may cause a fracture include “movements that involve twisting your spine, like swinging a golf club, or bending forward from the waist, like sit ups and toe touches”. “For individuals with weakened bones, falling is more likely to cause a fracture.”
  18. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. “It is the most common type of arthritis and is more common in older people.” The most commonly affected joints are the hands, knees, hips, neck and lower back. Checked November 4, 2026.
  19. National Institute on Aging. Aging in Place: Growing Older at Home (content reviewed October 12, 2023). Checked November 4, 2026.
    Show the passageHide the passage
    Help at home includes personal care with “activities of daily living”, “including bathing, dressing, grooming, using the toilet, eating, and moving around”, household chores, meals, money management, health care, transportation and safety. “Go through your home room by room to identify potential problems and safety issues. First, correct any immediate dangers, such as loose stair railings and poor lighting”.
  20. Centers for Medicare & Medicaid Services. Home health services. Checked November 4, 2026.
    Show the passageHide the passage
    Covers part-time or intermittent skilled care, including physical therapy, occupational therapy and speech-language pathology, for people who are homebound; “a doctor or health care provider (like a nurse practitioner) must see you in person and confirm you need home health care. They must also order your care, and a Medicare-certified home health agency must provide it.” Medicare does not pay for 24-hour care at home, home meal delivery, or personal care “when this is the only care you need”. “You pay nothing for covered home health services.” After the Part B deductible you pay 20% for covered medical equipment. “If your provider decides you need home health care, they should give you a list of agencies that serve your area.”
  21. Centers for Medicare & Medicaid Services. Inpatient or outpatient hospital status. You are an outpatient if you get observation or other hospital services “and the doctor hasn't written an order to admit you to a hospital as an inpatient. In these cases, you're an outpatient even if you spend the night in the hospital.” Checked November 4, 2026.
  22. Centers for Medicare & Medicaid Services. Skilled nursing facility care. Checked November 4, 2026.
    Show the passageHide the passage
    Covered “For a limited time (on a short-term basis)”, including physical therapy, occupational therapy and speech-language pathology, after “a prior medically necessary inpatient hospital stay of at least 3 days in a row”. “Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight.” “You may not need a 3-day minimum inpatient hospital stay if your doctor participates in an Accountable Care Organization (ACO) that's approved for a ‘Skilled Nursing Facility 3-Day Rule Waiver.’” “Medicare Advantage Plans may also waive the 3-day minimum inpatient hospital stay.”
  23. Centers for Medicare & Medicaid Services. Inpatient rehabilitation care. Checked November 4, 2026.
    Show the passageHide the passage
    For people recovering from a serious surgery, illness or injury who need “an intensive rehabilitation therapy program, physician supervision, and coordinated care”; your provider must certify that need. In 2026, “Days 1-60: After you pay the $1,736 deductible you pay $0 each day.” No deductible is charged if you already paid it for a hospital stay in the same benefit period.
  24. Centers for Medicare & Medicaid Services. Medicare costs. In 2026: the Part B deductible is $283 a year, then usually 20% of the Medicare-approved amount; the Part A deductible is $1,736 per benefit period; in a skilled nursing facility, $0 a day for days 1 to 20 after the Part A deductible, $217 a day for days 21 to 100, and all costs from day 101. Checked November 4, 2026.
  25. Centers for Medicare & Medicaid Services. Medicare Coverage of Outpatient Occupational Therapy, Physical Therapy, and Speech-language Pathology Services (fact sheet, October 2026). Checked November 4, 2026.
    Show the passageHide the passage
    Outpatient therapy can be given “At home, from certain therapy providers, like privately practicing therapists and certain home health agencies”; a provider can charge you for services that are not medically necessary only after giving you an Advance Beneficiary Notice, and “They can't give you an ABN only because your therapy expenses have reached a certain amount.” “Call your State Health Insurance Assistance Program (SHIP) to get free, personalized health insurance counseling.”
  26. Centers for Medicare & Medicaid Services. Compare Original Medicare & Medicare Advantage. Checked November 4, 2026.
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    Original Medicare: “In most cases you don't need a referral to see a specialist” and “In most cases, you don't need approval (prior authorization)”; you can buy Medigap to help pay costs like the 20% coinsurance. Medicare Advantage: “You may need to use doctors and other providers who are in the plan's network and service area (for non-emergency care)”; “You may need to get a referral to see a specialist”; “You may need to get approval (prior authorization) from your plan before it covers certain services or supplies”; “Plans must cover all medically necessary services that Original Medicare covers”; and plans have a yearly limit on what you pay for covered services.
  27. Code of Federal Regulations. 42 CFR 422.101, requirements relating to basic benefits. Medicare Advantage plans must cover all services covered by Part A and Part B and comply with Traditional Medicare's coverage criteria, including “requirements for payment of Skilled Nursing Facility (SNF) Care, Home Health Services under 42 CFR part 409, and Inpatient Rehabilitation Facilities (IRF)”. Checked November 4, 2026.
  28. Code of Federal Regulations. 42 CFR 422.112, access to services. “Approval of a prior authorization request for a course of treatment must be valid for as long as medically necessary to avoid disruptions in care”, and new plan members get “A minimum 90-day transition period for any active course(s) of treatment”. Checked November 4, 2026.
  29. American Speech-Language-Hearing Association. Adult Dysphagia (Practice Portal). Checked November 4, 2026.
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    Signs include “coughing or throat clearing during or after eating or drinking”, “changes in vocal quality (e.g., wet or gurgly sounding voice) during or after eating or drinking”, complaints of food “sticking”, “extra time needed to chew or swallow”, and weight loss; “the evidence supporting the predictive value of these signs and symptoms is mixed”, and “Silent aspiration may be present, meaning the patient presents without overt signs or symptoms of dysphagia.”
  30. Centers for Disease Control and Prevention. Older Adult Drivers (January 28, 2026). Checked November 4, 2026.
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    “Driving helps older adults stay mobile and independent.” “Age-related changes in vision, physical functioning, and the ability to reason and remember, as well as diseases and medications, might affect some older adults' driving abilities.” Steps include “Follow a regular activity program to increase strength and flexibility”, a medicine review with your doctor or pharmacist, and “Have your eyes checked by an eye doctor at least once a year”.
  31. Clearinghouse for Older Road User Safety (CHORUS). What to Expect When You Are Referred to a Driving Rehabilitation Specialist? Checked November 4, 2026.
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    “A DRS is typically an occupational therapist specially trained to evaluate an individual's driving risk, especially individuals with medical conditions that may impact driving abilities. These conditions include arthritis, stroke, dementia, Parkinson's, and advanced age.” Comprehensive driving evaluations “consist of two parts: a) physical, visual and cognitive tests in an office or clinic, as well as b) a test behind the wheel of a car”, in a vehicle with an instructor's brake. Specialists can help with “assistive devices, such as larger mirrors, hand controls, or foot pedal extenders” and safer routes, and with planning other transportation; a clinician can advise on “the typical costs, if not covered by insurance”, and “Some programs may require a prescription”.
  32. Job Accommodation Network. JAN. “JAN is the leading source of free, expert, and confidential guidance on workplace accommodations.” Checked November 4, 2026.
  33. Code of Federal Regulations. 42 CFR 424.24(c), outpatient physical therapy, occupational therapy, and speech-language pathology services. Checked November 4, 2026.
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    When a therapist establishes the plan and “there is a written order or referral from the individual's physician, nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) in the patient's record and the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation”, the certification does not need a signature; without one, the therapist must get the plan signed. “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”
  34. American Physical Therapy Association. Direct Access Advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment.” “some provisions tied to treatment absent a referral still persist in a number of states”. Checked November 4, 2026.
  35. Centers for Medicare & Medicaid Services. Therapy Services (last revised February 2026). Checked November 4, 2026.
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    For calendar year 2026 the KX modifier threshold is “$2,480 for PT and SLP services combined” and “$2,480 for OT services”; “Claims for services over the KX modifier threshold amounts without the KX modifier are denied.” The targeted medical review threshold is $3,000, and “not all claims exceeding the MR threshold amount are subject to review”.
  36. Centers for Medicare & Medicaid Services. PACE. Checked November 4, 2026.
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    PACE “helps eligible older adults who need nursing home-level care meet their health care needs in the community”; services it may cover include occupational therapy, physical therapy and speech therapy. To join you must be at least 55, live in the service area of a PACE organization, need nursing home-level care (as certified by your state) and be able to live safely in the community with help from PACE; “The PACE program is only available in some states that offer PACE under Medicaid.” “Regardless of your financial situation, you won't have a deductible, copayment, or co-insurance for any drug, service, or care your PACE team approves.”
  37. State Health Insurance Assistance Program National Technical Assistance Center. SHIP: Medicare Help. Local Experts. Real Answers.. “Local, one-on-one Medicare counseling from your local SHIP at no cost to you.” Checked November 4, 2026.
  38. Centers for Disease Control and Prevention. Signs and Symptoms of Stroke (May 19, 2026). Checked November 4, 2026.
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    Signs: “Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.” “Sudden confusion, trouble speaking, or difficulty understanding speech.” “Sudden trouble seeing.” “Sudden trouble walking, dizziness, loss of balance, or lack of coordination.” “Sudden severe headache with no known cause.” “Call 9-1-1 right away if you or someone else has any of these symptoms.” “Note the time when any symptoms first appear.”
  39. Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion (September 15, 2025). Checked November 4, 2026.
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    Danger signs in adults: call 9-1-1 or go to an emergency department right away for a person who has “a headache that gets worse and does not go away”, weakness, numbness, decreased coordination or seizures, repeated vomiting, “slurred speech or unusual behavior”, one pupil larger than the other, confusion, restlessness or agitation, or who “Lose consciousness, look very drowsy or cannot be woken up”.
  40. MedlinePlus, National Library of Medicine. Septic arthritis (reviewed May 12, 2025). Checked November 4, 2026.
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    “Symptoms usually come on quickly. There is a fever and joint swelling that is usually in just one joint. There is also intense joint pain, which gets worse with movement.” Risk factors include “Artificial joint implants”. “Contact your provider if you develop symptoms of septic arthritis.”
  41. American Board of Physical Therapy Specialties. Become a Board-Certified Geriatric Clinical Specialist. The specialty “focuses on the prevention, evaluation, and management of age-related conditions that affect the functional mobility, physical capacity, and quality of life of older adults”. “As of July 2026, ABPTS has certified 4,665 geriatric specialists.” Checked November 4, 2026.
  42. Administration for Community Living. Area Agencies on Aging. Checked November 4, 2026.
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    “AAAs coordinate and offer services that help older adults remain in their homes, if that is their preference, aided by services such as home-delivered meals, homemaker assistance, and whatever else it may take to make independent living a viable option.” “Find your local AAA by visiting the Eldercare Locator website or calling 1-800-677-1116.”
  43. Administration for Community Living. Eldercare Locator. “a public service of the Administration for Community Living connecting you to services for older adults and their families. You can also reach us at 1-800-677-1116.” Checked November 4, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation.