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Posts Tagged ‘long term care insurance’

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.

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.

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.