The problem nobody looks at
She is walking less. She goes to the dining room less often, holds onto furniture, shuffles. Somebody calls it decline, somebody else calls it fear of falling.
Before accepting that, do something almost no family member does: look at her feet. Not through a slipper — take the socks off and look. A surprising share of the time you will find toenails months overgrown and thickened, an ingrown corner, a callus that hurts at every step, and slippers two sizes wrong.
This is not cosmetic. Foot pain changes how a person walks, an altered gait costs balance, and the fall is what changes everything else. Feet are one of the very few serious problems in an older adult that can be fixed in half an hour.
Two different things that get muddled
Get this distinction straight, because it settles most arguments with a facility.
Ordinary foot hygiene — washing, drying between the toes, moisturizing, and trimming a normal healthy toenail — is basic personal care. It is what the facility is there to do, and it is part of the daily rate, not an extra. If you are told nails are not their job, ask to see that in the policy.
Podiatric care is different: thickened or ingrown nails, fungal nails, corns and hard skin, deformity, and anything at all on a diabetic foot. That is medical care, and facilities are right that aides should not be doing it.
So ask two questions: who trims her ordinary nails and how often — and who do you call when the nails are no longer ordinary?
The Medicare rule, and the exception that matters
Here is the part that decides everything. Medicare generally excludes routine foot care — cutting nails, removing corns and calluses, hygienic maintenance — when that is all there is to it.
But the exception is broad, and it is the reason to read this section twice. Medicare does cover foot care when there is a qualifying systemic condition that puts the feet at risk — most commonly diabetes with peripheral neuropathy, and also peripheral vascular disease and certain other conditions. In that situation, what looks like routine nail trimming becomes covered treatment, typically at defined intervals, when performed by a qualified provider.
Two more things worth claiming:
- Diabetic foot exams. For a resident with diabetic peripheral neuropathy, a periodic foot examination is a covered service. Ask when hers was last done and what it found.
- Therapeutic shoes and inserts. Medicare covers a pair of therapeutic shoes with inserts each year for people with diabetes who meet the criteria, when prescribed and supplied properly. This is one of the most under-claimed benefits in this whole area, and it lands squarely on the falls problem.
If she is on a Medicare Advantage plan, check the plan's routine foot care benefit separately — several include one that Original Medicare does not.
Diabetes changes the whole article
In a diabetic foot, sensation is reduced: a small injury does not hurt, is not noticed, becomes infected, and the chain from there is one everyone knows. Three things to insist on:
- Daily foot checks as part of her care, documented, not on request.
- No improvised nail cutting and no over-the-counter corn removers. On a diabetic foot, a clumsy trim is how it starts.
- A named podiatrist and a same-day escalation route for redness, a blister or any break in the skin. On a diabetic foot, the difference between today and next week is the whole prognosis.
The slippers, which nobody checks
The most neglected part of all. Many residents spend the day in slippers bought years ago, stretched out, with no fastening — or walk in socks on a smooth floor. Footwear is a documented falls factor: a fastened, well-fitting shoe with a non-slip sole and a low heel is safer than a soft slipper.
Feet change with age and with swelling: her size from ten years ago is not her size. If she has inserts or custom shoes, ask when they were last reviewed — worn or outgrown inserts are worse than none.
The link to falls
If she has fallen and nobody examined her feet and footwear afterward, that review is incomplete. Falls risk assessment and care planning are standard requirements, and this belongs in them. Raise it at the care plan meeting so it lands in the record rather than in a hallway.
Six questions to ask
- Who trims her toenails, how often, and is it included in the daily rate?
- Which podiatrist sees residents here, and how quickly do they come?
- Does she have a qualifying condition that makes foot care covered — and has anyone checked?
- Has she had a diabetic foot exam, and has anyone applied for therapeutic shoes?
- Do her shoes fit and fasten, and when were they last replaced?
- After her last fall, were her feet and footwear assessed?
If nothing moves
Put it in writing to the director of nursing, with the distinction between personal care and podiatric care set out plainly — that distinction unlocks most cases, because on the first point the facility has no argument. Then put it on the care plan meeting agenda.
If that fails, the long-term care ombudsman is independent and takes calls from families, and the state survey agency investigates complaints — a diabetic resident whose feet are not being checked is a clinical safety issue, not a comfort preference.
Where to start
On your next visit, do one thing: take her socks off and look. If the nails are pressing on the end of the slipper, or there is a reddened callus under the ball of the foot, you have found the reason she is walking less — and it is not inevitable decline.
If you are still choosing a facility, ask how foot care is arranged and how often a podiatrist visits. Few families ask, and the answer says a lot about the general level of attention.
If you would rather not run it alone, we can. For $89 we take down your mother's situation, look for the facilities near you that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical advice on your own situation. If she has diabetes, do not cut nails or treat corns yourself and do not use over-the-counter corn removers — ask her physician or a podiatrist. Coverage rules and plan benefits change: check the current position with her plan. Curalune does not allocate beds and does not guarantee availability.