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Posts Tagged ‘adult day care’

Hospice services are always available, twenty four hours a day, seven days a week. There is always a nurse on call at night and on weekends. The nurse will visit a patient as long and as often as necessary to ensure quality care. Because of this wonderful service, many people are under the impression that hospice care is expensive, and believe they cannot afford such treatment. However Medicare, Medicaid and private insurance companies cover hospice care and services. This would include, but is not limited to, medications, medical supplies, nursing care, home health aides and social services. In 1983, Congress established the Medicare Hospice Benefit, covered under Medicare Part A, to ensure that all beneficiaries could receive high-quality end-of-life senior care. In order to receive the Medicare Hospice Benefit, the patient must meet three key criteria.

First, the patient’s doctor must certify, within his or her best clinical judegement, that the patient should be terminally ill with a life expectancy of six months or less. If the patient lives longer than six months, he or she can continue to receive hospice care just as long as the doctor re-certifies that the patient is under a terminal case and with declining health. The second key criterion is that the patient is willing to receive comfort care instead of curative treatments for their illness. For example, a patient could not be getting chemotherapy to cure their illness and be getting hospice care simultaneously. Hospice is intended be used once curative treatment is no longer an option. Finally, the patient needs to enroll in a Medicare-approved hospice program. This should be one of the first questions you ask in determining which hospice agency to use. More than 90% of hospices in the United States are certified by Medicare.

Congregate care is similar to independent living. Residents of congregate care live independently, for the most part. This type of housing environment is usually offered at least one communal meal per day, and it;s common for services and activities to be offered to residents. Independent living, on the other hand, typically offers only living quarters and limited services.

On Monday, the New York Times ran a great story about Medicare Advantage Plans. Medicare Advantage Plans are a type of home health care plan sold by private insurance companies. These plans are actually associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. There are some cases when the seniors did not understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the insurance agents had signed them up for the plan. The insurance companies that sell these plans have been accused of several bad practices, including:

Deceptive marketing strategies that don’t make a clear distinction between Medicare and Medicare Advantage  Targeting of uninformed seniors in low-income areas by pushy agents with hard-sell techniques, Outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system, Insurance agencies such as Medicare Advantage Plans undergo greater scrutiny than they have in the past;and it seems to be helping at least a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, “There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods.”

Medicare Advantage programs can help some consumers to finance their senior care, but these plans are not for everyone. There are some factors that need to be considered before you sign up for any type of Medicare Advantage Plan. Here, a few of the most essential issues: Make sure your doctor(s) and local hospital are within the insurance company;s network of providers.  Also remember that Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, cancel it once coverage begins with a Medicare Advantage Plan to avoid paying twice.

Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so pick a plan that will meet your future senior care needs as well as your current ones. Always read the fine print. This is an important decision;don;t rush it!  We live in a society where the buyer must beware. Call your parents tonight! Make sure that they know about the issues concerning Medicare Advantage. That phone call could be the one thing that saves them from making;or worse yet, being pushed into;a decision that isn;t right for them. You don;t even want to think about the alternative!

Long-term care insurance (LTCI) policies are very different from most other kinds of insurance. As a result, even the foundational features of these policies require taking some time to understand before making your final decision. However, what about all the other choices and features which are not built into the policy and requires you to pay extra to get them? In my opinion, LTCI policies are best kept simple. If you have done your homework on setting up the foundational features of the policy, you have already done 90% of the work in most cases. It’s a good idea to explore those other options if you feel that you can afford to spend more on your care, but you should also examine whether they are truly going to be cost-effective in your case. One good way to do this is to narrow down your selection to the two to three carriers that you feel most comfortable with and get quotes on a straightforward policy setup with no extras or options added.

Next thing to do is to add on the choices that you are interested in one at a time and then get a new quote. This will tell you exactly how much extra you can expect to pay for these options. If you have all those figures, then it is much easier to decide if the choices you are considering are really worth pursuing further. Here is a list of some of the most popular options in LTCI or Long Term Care insurance policies:

1. Return of Premium – This will give you the option of allowing you to recieve back some or all of the premiums that you pay into the policy if you either decide to cancel the policy or if you die without using all of your benefits. This is often a very expensive option.

2. Survivorship – For this option, the benefits differ from one carrier to another, but typically it says that if the policy premiums have been paid for a specified period of time, often ten years, and one spouse dies, the surviving spouse’s policy is considered as paid up with no other premiums required.

3. Restoration of Benefits – This provision restores all of the benefits paid out for care if a policyholder fully recovers and does not suffer a relapse for a specified period of time (usually six months).

4. Waiver of Home Health Care Elimination Period – This option reduces the elimination period (the amount of days that you pay for your own care before the insurance company starts to pay) to zero. This only means that it starts to pay from the very first day of services made if the care is recieved at home. There are other options that can be considered when shopping for LTCI too, but in my experience the most common danger is getting bogged down in these extra features that do not really impact the quality of your future care nearly as much as the foundational features.

This is one reason why getting an experienced and knowledgable agent help you with the process can often reduce much of the confusion surrounding these options so that you can select the policy and features that suit you best.

In a long-term care insurance (LTCI) policy, the elimination period is always referred to as the policy deductible. In many ways it is similar to the deductible used in major medical insurance policies. One major difference is this: rather than a certain dollar amount that you will initially pay for your own care expenses, there is always a specified number of days for which you will be responsible for your own homecare.

What are My Options?

These days very few carriers offer a zero-day elimination period. The most common choices are 30, 60, 90, 180 and 365 days, however, these periods can differ from one carrier to another carrier. The choice of 180 or 365 days is most often made by those who have significant assets of their own. Selecting a much longer period can help them keep the expenses of LTCI very low. Even if one chooses a 90-day elimination period, the amount of funds put at risk is miniscule when compared to the asset protection afforded by the policy;s total pool of benefits.

What is a Reasonable Choice for an Elimination Period?

Some popular financial authors recommend setting it as low as possible, perhaps even at zero. It’s true that the shorter the elimination period, the less likely it is that you will have to pay out when the time comes for you to begin receiving care.   On the other hand, low elimination periods can have a dramatic effect on the premiums that you pay throughout the life of the policy. Usually, some form of negotiation is necessary for the very sake of affordability. In making a decision about the elimination period, a lot of policy holders remember that insurance is always used as a way to avoid suffering catastrophic financial losses rather than insuring against every possible expense. Accepting a small portion of the risk involved can be an economical and reasonable choice for most people.

The Smartest Thing You Can Do

What’s right for most people, however, may not be right for you. In deciding on the best elimination period for your particular situation, it is important to check what the cost would be for the most expensive assisted care that you may have to receive, which is most often facility care. Once you have a good idea of the daily costs for facility care in your area, multiply the costs by the various elimination period choices and determine the amount that you feel is affordable. When you decide on the elimination period that best fits your situation, earmark those funds for your care, and allow them to grow so that they keeps pace with inflation, at the very least.   Using a little financial common sense goes a long way toward making a wise decision about the LTCI elimination period.

Some private insurance companies sell LTCI policies to offset the costs of long term care. LTCI, like all insurance policies, requires premiums to help recipients avoid paying large sums later on in the event of an illness or a catastrophic event. Premiums are based on the individual’s age at the time of purchase and are usually locked in for the life of the policy. LTCI covers the following, depending on the policy you choose:

Care in a skilled nursing facility

Care in an assisted living facility

Home health care

Adult day care

Buying a LTCI policy allows the policyholder to choose from many options, such as the amount of the daily benefit, the number of years the policy will pay benefits, and, once the applicant qualifies for a policy, the number of days or months before the policy will begin paying benefits.  It’s very important to evaluate policies carefully to see which one offers the benefits you require with a premium that fits your budget. Policies differ in their benefits, contract conditions, deductibles and premiums.

It is also important to take into account the rising cost of home care. Be sure the LTCI policy gives inflation protection for benefits to increase as health care costs continue to rise. Policies are generally labeled according to the place in which benefits are paid.    Remember that homecare only policies only pay for care at home and in an adult day care or adult day health care facilities. Make sure the policy includes both types of day care.  Meanwhile, facility only policies pay for care in a skilled nursing facility and in an assisted living facility.  Comprehensive policies pay for care in a skilled nursing facility, assisted living facility, adult day care or adult day health care facility, and at home.  Since LTCI claims are often paid many years after the purchase of the policy, it is imperative to check the following:  Financial strength of the company. The industry’s major rating services are A.M. Best , Duff and Phelps, Moody’s, Standard and Poor’s and Weiss Ratings .   Reputation and claims-paying history of the company.

Contact your State Insurance Department for information on specific private insurance companies. Check here for more listings information for each of the state’s insurance information. Applicant must be healthy at the time of application   Each insurance company has individual requirements and/or limitations   Not sure when is the right time to buy an LTCI policy? Or how to assess what you will need from a policy? Visit our Expert Column on Financing Long Term Care to find out more.

The Centers for Medicare & Medicaid Services (CMS) is part of the federal government’s Department of Health and Human Services. Because many Medicare and Medicaid recipients are elderly, much of the funding goes to nursing homes or eldercare services. Home health agencies that receive certifications from Medicare undergo an assessment every three years. CMS always checks these home health care agencies via quality measures and publishes each agency’s results.

CMS & Home Health

CMS also provides scoring for all Medicare certified home health services via the Home Health Compare. The quality measures take into account: (1) the patient’s improvement in performing a variety of activities of daily living (ADLs), and (2) whether the patient’s health condition improves or stabilizes within time.   It is important to note that the quality measures should only be used as a general guide. Always remember that the recipients in the home health care are elderly and each of them have different needs. Some patients are recovering from surgery or a medical emergency. Others have chronic and worsening medical conditions. Therefore, it is understandable that the lack of improvement in some home health care recipients is not due to poor standards or substandard care, but rather due to declining health. In addition, Medicare’s quality measures for home care are fairly recent and are still being refined. Currently, the quality measures provide a baseline to help consumers see how a local agency compares to both state and national averages.

CMS Quality Measures

The CMS quality measures are used in Medicare certified home health care agencies in order to come up with the final scoring. Medicare details the following quality measures:  Three measures related to improvement in getting around:   The percentage of patients who get better at moving or walking around   Percentage of patients who get better at getting in and out of bed   Percentage of patients who have less pain when moving around    Four measures related to meeting the patient’s activities of daily living:   The percentage of patients whose bladder control improves   Percentage of patients who get better at bathing   Percentage of patients who get better at taking their medicines correctly (by mouth)   Percentage of patients who are short of breath less often  Two measures about how home health care ends:   Percentage of patients who stay at home after an episode of home health care ends   Percentage of patients whose wounds improved or healed after an operation    Three measures related to patient medical emergencies:    Percentage of patients who had to be admitted to the hospital   Percentage of patients who need urgent, unplanned medical care   Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected

If you happen to be under homecare and if you have to lie immobile for long periods of time, you should pay special attention to the health of your skin, to prevent skin breakdown. Proper skin care helps in preventing pressure sores (bedsores) and will help you feel generally refreshed. Weight loss and the side effects of radiation or chemotherapy can lower your resistance to infections; and since infections are very difficult to treat, the only way is to prevent them. Skin is your body’s first line of defense against infection, and a rupture of the skin exposes you to infections. Germs can enter the body through a cut, an open bedsore, or raw, chafed skin.  Bedsores are caused when an area of skin loses its blood supply for an extended period of time, e.g., when a bony area of the body lies against a surface like a mattress, and nutrients and oxygen are unable to reach the skin cells. The area then begins to break down and the skin cells slowly and eventually die. Parts of your body which are particularly susceptible are the coccyx or tailbone, the hip bones, the spine, elbows, heels and ankles, and the shoulder blades.  If redness doesn’t go away from these bony areas a short time after the pressure is removed, the skin is probably not receiving adequate bloodflow. You may have to tell your senior care caregiver, if you happen to have one

You can always prevent bedsores by changing your bed position frequently, at least every two hours. In addition, placing a cushion on the bony parts of your body is a good way to reduce pressure on the skin. An “egg crate” mattress, or a foam or sheepskin pad will cushion you, as well as providing better air circulation for the skin. You can also use pillows or any other props that can help reducing the pressure on those areas.

Heat and massage are additional means of increasing the blood supply to the skin. Whirlpool baths are ideal for this purpose. Although you can use heat lamps or heating pads, you must take care not to burn your skin, which is already tender. First check with your doctor or nurse to make sure a lamp or heating pad would be helpful to you; and if you do use a pad, keep it turned on “low,” and keep a protective pad or towel between it and your body to avoid skin burns. A warm pair of socks, an extra blanket at the foot of the bed, or fleece-lined booties are often more helpful than heating appliances. (See: Massage Therapy Techniques that will also increase bloodflow to your skin.)

Chafed or irritated skin is caused by a combination of moisture, heat and friction. It occurs most often where skin folds over itself as in the groin area, under the breasts, or in the abdominal area of heavier people. For chafed skin, you want to keep the area clean and dry. Cornstarch applied after bathing or a small amount of talcum powder will help keep the area dry and free of bacteria. Exposing chafed skin to the air for a few minutes twice a day will also help keep it dry.

Good hygiene is the foundation of skin care. If you can, take a daily bath or shower. Even if you are not confined to bed, bathing may be a chore because of the difficulty of climbing in and out of tubs and showers. Try sponging your body at the sink while sitting in a chair. Aids such as bath seats, grab bars, and long-nozzled showerheads make tub or shower bathing much easier. If you are confined to your bed, take a daily sponge bath. Ask your family or you home health care nurses to assist you with the areas which you cannot reach by yourself. There is no one “right” way to give a bedbath. Common sense will dictate the most comfortable and thorough method for you. Don’t forget bath oils if your skin tends to dryness. Massaging body areas with a little lotion after a bath stimulates circulation and prevents skin breakdown.

In my first article, I have talked about what a geriatric care manager like me does and when exactly to consider getting a care manager.  My following missives will be guided by your feedback, so please be in touch! Caring for an elderly loved one can be confusing, frustrating and overwhelming. There are many emotional pulls and no single easy solution to any situation you may be facing. Even if one feels that he or she is moving in the right direction, other family members and/or friends may disagree on a route or decision even as a situation moves into a crisis mode.  Ask Yourself: How do you choose the best form of long-term care, the right living situation?  How would you find the time to make phone calls, contact government agencies and visit alternative living facilities?  How do you know which local facilities have a good reputation and whether they might be a good match for your loved one?

We have all been newbies in learning a new skill or a new job, or in moving into a new phase of our lives. Just like those skills, the many aspects of caring for an elderly relative can always be learned. You may be thinking, ” Well, I am learning how and feel fine making decisions, and I am coping. ” Should that be the case, great and congratulate yourself then. Others of you read the above questions and think, ;Yikes! Help me, and fast!;  Or, ” I could figure this all out, but I would rather not. Let someone else give me a hand. “  If all these responses sound just like you, consider calling in a geriatric care manager to work with and guide you.  Those who belong to the first group might want to consider a consultation to help determine if there are other angles or aspects of the situation you are involved in that could be considered.

A helpful care manager will act as a consultant, advocate and problem-solver. She will meet with you and your loved one and sensitively and thoroughly assess his or her overall situation. She will look at the whole person, addressing quality-of-life concerns as well as practical considerations. She will then develop a plan that will enable you to choose the optimal form of senior care, and make the necessary contacts for you. She can usually arrange for care at homes or accompany you as you visit nursing homes and assisted living facilities and arrange for placement. An excellent care manager will talk and coordinate your loved one’s care and act as a liaison with family, friends and health care providers, now and in the future. She also provides counseling and support for you and the family, as well as for your loved one, as you deal with these difficult and stressful transitions. A good geriatric care manager will be there for you and your loved one every step of the way, helping to make your lives as stress-free as possible, while ensuring the best and highest quality of life possible at all times. It is my pleasure to meet each and every one of you. I look forward to getting to know each other through our struggles and triumphs.

It’s no surprise that with age, seniors often experience increased limitations, the loss of certain abilities and require more assistance with the activities of daily living. It is equally unsurprising that one;s finances  largely influence the types of services and long-term care available to that individual. An experienced financial planner for the elderly can provide the seniors and their families with invaluable advice on money issues and more,  to help seniors find the appropriate solution to their particular situation. Some of the questions a financial  planner can address include:  What type of long-term care can I afford? Will I outlive my assets? How much are all my assets worth? Can I make my assets create more income to meet growing expenses? What do I sell first? What are all my options? What is the cost of selling different assets? Do I have to sell my own house? Are there other financing alternatives? What impact will this have on my spouse and dependents? Is it too late to do any estate planning? What about inheritance issues?

Listening to Your Needs – Financial planners can assist you in understanding and evaluating your decisions,  which will help you avoid confusion, frustration, major errors and family dissension. Financial decisions are more  than about just money, I know from experience how difficult it is for everyone involved. Making major financial  decisions can be even more daunting when you don;t have the detailed knowledge, time, experience or ability. What are the potential impacts and benefits of making one decision over another? So what are the requirements to execute such decisions? Financial planning for senior care begins with acknowledging and considering all present and  possible future situations you might encounter. This can be very difficult as it requires both forward thinking as  well as transitional realism. By ” transitional realism, ” I mean about being realistic about your changing needs, and the impact of those needs on your life as well as the lives of  your loved ones. When evaluating your needs, a financial planner should consider:

Personal care, do you need assistance with activities of daily living? Services, what types of long-term care services do you require? Are there any specific concerns with regards to safety? Transportation;are there physical or financial considerations? Priorities, what are your desires and limitations? Interpersonal relationships;how will financial decisions affect your loved ones? Following is a list that comprises the elements you should consider in identifying  and evaluating your needs. You may want to think about these things before talking to a financial planner to ensure  the time you spend in conversation is well spent. If you happen to have questions about any of these elements, a financial planner  who works with the elderly will be well versed in all of these issues and should be able to address any concerns.  Financial needs Insurance coverage and limitations Income sourcesExpenses (present and future) Assets availabilityReal estate needs Human resources: home health care, personal and quality-of-life issues After you have indentified all of your needs, think about the resources that you will need, and  the ones that you already have at your disposal.

This can help you in developing a plan of action.  Make a list of the following  resources that you might need: Public resources like prepared food services, community activities, religious and charitable assistance/support, etc.Private resources, including family members and/or homecare caregivers. Planning can make a huge difference in finding the best solutions. Knowing all of your needs and resources is paramount before making any major financial changes. Financial decisions should be holistic in nature, therefore recognizing that everyone, seniors and caregivers, all have   different needs and resources, unique to their particular situation. Making financial decisions based only   on your present situation, without full consideration of everything, can have disastrous results.

A major fear people have of dying is that they’ll be in pain. Hospice eases that fear by providing palliative care with an emphasis on pain control. The main objective is to relieve symptoms that interfere with one’s quality of life.. Hospice manages emotional and spiritual pain in addition to physical pain. By using a combination of counseling, medication and therapy, hospice care has a very high success rate of easing a patient’s pain. Some families are worried about the thought of their loved ones being so drugged that they are unable to communicate or are unaware of what’s happening. Although this can happen, it’s rare. Fortunately, hospice nurses are capable of providing strong medications and high dosages that will provide comfort without impairing the patient;s alertness.

Hospice supports the Pain Care Bill of Rights, which states that as a person with pain, you have a right to:

Have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists, and other health care professionals.

Have your pain thoroughly assessed and promptly treated.

Remember to be kept informed by your health provider about what may be causing your pain, possible treatments, and the benefits, risks, and cost of each.

Participate actively in decisions about how to manage your pain.

Have your pain reassessed regularly and your treatment adjusted if your pain hasn;t been eased.

Be referred to a pain specialist if your pain persists.

Get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose. CCRCs are living communities for seniors. Most have three levels of residence: independent living, assisted living and skilled nursing. Each level of residence is tied to the level of care that the resident requires. The primary concept behind a CCRC is that it offers a wider spectrum of assisted care, so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change.