Posts Tagged ‘Medicaid’

Choosing a Nursing Home

Tuesday, November 24th, 2009

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If you are thinking about a nursing home for yourself or for a loved one, you might realize that this choice is both difficult and painful. Giving up a home to move in with others represents a loss of liberty to some individuals. But, to others, it may represent the beginning of a whole new life.

We’ve listed a few tips on how to choose a nursing home, along with more tips on what to ask when you visit.

  • Plan in advance. Do your investigation long before you may think you need a home, as it may take some time to visit these homes and to make a decision.
  • Get recommendations. You also may need help in filling out the various forms that nursing homes require.
  • Do not visit a nursing home alone. It may prove too difficult, and a friend or relative may help by asking questions that you may forget to ask.
  • Be open-minded. Accept that no nursing home is perfect, and that other people may provide care differently than you do. If you have a negative visit on one day, return on a different day to see if matters are different. Revisit those nursing homes you initially rejected for nonessential reasons.
  • Pick a convenient location first. A nursing home that is convenient and close at hand will be easier for you to visit.
  • Observe the buildings and staff. Is the building clean and relatively odor-free, well lit and attractive? Are safety features such as fire extinguishers and smoke detectors obvious and in good order?
  • Observe the patients or clients: Do they seem satisfied, if not happy? Are they well dressed, or sloppy in appearance (hair not combed, etc.). Does it appear that these clients are tended with care?

Questions and Observations:

  • Look at size. Larger nursing homes may be surprisingly less expensive yet offer more activities and services.
  • Check about medical services. Are the costs included? Are visits from personal physicians allowed? Is a registered nurse on the premises at all times, and is a doctor in-house or on call? Is the nursing home close to a hospital if needed?
  • Ask about residential services. Is there a special unit for patients who suffer from Alzheimer’s disease? Is patient variety important, or would you or your loved one prefer to live with residents from similar ethnic or religious backgrounds?
  • Ask about admission. Is there a waiting list? Can you fill out forms in advance? Is a physical examination required for admission, and who should conduct that exam?
  • Ask about financing. This is especially important if a nursing home is an immediate need. Is that home eligible for Medicare and/or Medicaid? What services are included in the cost, and what services cost extra?
  • Ask about food. Is a dietitian on staff and are the portions big enough? Is the food good and good for you? Is there help for individuals who may have trouble eating?
  • Ask about activities. Does the home provide activities for clients who can participate?
  • Ask about the living facilities. Can the client bring personal furniture, pictures, plants or other objects? Is there a closet and chest of drawers and privacy for dressing? Is there an available phone? How many people reside in one room?

You can visit the Medicare site, where they offer ideas about how to choose a nursing home. If the home you choose has a Web site, look the site over before you visit. The Web site may answer some questions above, so all you need to do on your visit is to confirm that the Web site was correct.

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Government Web Sites on Aging

Wednesday, September 16th, 2009
The U.S. Government can offer many resources for eldercare.

The U.S. Government can offer many resources for eldercare.

Are you afraid of getting older? Are you unsure about what opportunities might be available to your or your loved ones who also are aging? While many people seem to be distrustful of government entities, the U.S. government has produced some insightful Web sites that deal with aging. These sites are listed below, along with information about what they offer to the aging discussion nationwide.

The list is in alphabetical order for your convenience, and it includes a handful of the most important government agencies on aging, health and welfare.

  • Administration on Aging: The mission of the Administration on Aging (AoA) is to help elderly individuals maintain their dignity and independence in their homes and communities through comprehensive, coordinated, and cost effective systems of long-term care and livable communities across the U.S.
  • Aging: The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. This page at HHS offers a variety of information about senior living, from care givers to resources such as assisted living information and much more.
  • Aging Initiative: This Environmental Protection Agency (EPA) website provides a wealth of information about the Agency’s efforts to protect the environmental health of older persons.
  • Aging Stats: The Federal Interagency Forum on Aging-Related Statistics (Forum) was initially established in 1986, with the goal of bringing together Federal agencies that share a common interest in improving aging-related data.
  • Eldercare Locator: Find a local or long-distance eldercare facility with this public service of the U.S. Administration on Aging (see above). The Eldercare Locator is your first step for finding local agencies, in every U.S. community, that can help older persons and their families access home and community-based services like transportation, meals, home care, and caregiver support services.
  • Healthy Aging for Older Adults: The Center for Disease Control (CDC), a division of the U.S. Department of Health and Human Services, offers a site that focuses on health, aging and chronic disease. The Healthy Aging Program (HAP) serves as the focal point for older adult health at CDC, and establishes programs, develops innovative tools, and provides a comprehensive approach to helping older adults live longer, high-quality, productive, and independent lives. HAP collaborates with other CDC programs, such as those focusing on injury prevention, disability prevention, and adult immunizations, as well as key external partners.
  • Medicare: This is the official U.S. site for people with Medicare. Medicaid information is located as the Health and Human Services site.
  • National Institute on Aging: NIA, one of the 27 Institutes and Centers of NIH (National Institutes of Health), leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to this legislation designated the NIA as the primary Federal agency on Alzheimer’s disease research.
  • Senior Citizens’ Resources: This page, part of the U.S. Gov Web site, offers information ranging from caregivers’ resources to resources on travel and recreation for seniors. You can provide an email to be notified when any given page is updated with new information.
  • U.S. Senate Special Committee on Aging: The Senate Special Committee on Aging was first established in 1961 as a temporary committee. It was granted permanent status on February 1, 1977. While special committees have no legislative authority, they can study issues, conduct oversight of programs, and investigate reports of fraud and waste. The Committee has a long and influential history. It has called the Congress’ and the nation’s attention to many problems affecting older Americans. The Committee was exploring health insurance coverage of older Americans prior to the enactment of Medicare in 1965.

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Posted in Caregivers, Death & Dying, Insurance Plans and Hospice Care, Other Legal Matters | No Comments »

In-Home Care vs. Nursing Home

Tuesday, July 14th, 2009
In-House Care can Save Money

In-House Care can Save Money

If you’re planning your retirement, you might note that not every older American ends up in a nursing home or a retirement residence. Many elders continue to live at home with the assistance of in-home care. This type of elder retirement meets the needs of the retiree and – often – the needs of that retiree’s family. This type of care helps to maintain independence and can helpfully delay the need to enter an assisted-living facility.

In-home care is a broad term, and it covers the gamut from nursing to cleaning service and personal assistants. For instance, if you have a medical condition that requires daily monitoring or therapy, you may need to hire a nurse or an aide to help take care of you at home. Look for these services through nursing registries or home health agencies (HHAs). HHAs can match you specifically with a nurse or nurse’s aid who is supervised and trained. HHAs usually are state licensed and may be accredited by a national association such as the National Association for Home Care and Hospice. Most have Medicare certification as well, meaning that they have met minimum federal standards and accept Medicare.

Even if you’re not retiring, you may want to hire household help. Someone who can take care of the cleaning, laundry, shopping or cooking is valuable to any family. Help wanted sections of local classified ads can help in your search for this person, but you may want to run references or ask your friends for their opinions. Some state and local governments may have free or low-cost programs set up to assist the elderly. They may include providing personal assistance services as well as companionship services. To find out what programs are available in your area, check for Department of Social Services, Department of Human Services, Health Department, or the Council (or Office) on Aging in your Yellow Pages.

Personal care may be required if you experience trouble with bathing, dressing, walking or eating. Sometimes, the person who provides household care also may provide personal care. Check with the HHA in your area to learn if they keep references on personal care assistants. While some personal aids work on a consulting or freelance basis, others require that you hire them as employees. This means that you may become responsible for their Social Security taxes and you will need to withhold income tax from his or her salary.

While you might save money with in-home care, you may be surprised at the cost, depending upon where you live and the type of services you may need and how frequently you need them. You may be able to pay for in-home care from your savings or income, but check into care programs offered by your community first. You should also determine if you are entitled to any Medicare or Medicaid benefits that may help defray costs.

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Community Resources for Your Elderly Loved Ones

Thursday, February 26th, 2009

What happens when you end up caring for a elderly loved one at home? You might be surrounded by community programs that could help you and you may not be aware they exist. Some programs are funded by state or federal government, and others might be privately funded or provided by charitable organizations.

While you need to spend time searching for some programs, that time and energy might be worth the effort. The help provided by programs listed below might help you retain a semblance of normal life and sanity. Use the list below, the Internet, your phone book, a doctor’s advice or advice from a local hospital to discover help that is within reach. Additionally, if your elderly loved one is sick or dying, take advantage of any hospice care in your region.

  • Associations: Visit the National Association of Area Agencies on Aging (n4a) to find an information and referral service, or you can check your local yellow pages under the community services section. Many national organizations such as the American Association of Retired Persons (AARP), the American Red Cross, or the Eldercare Locator can also provide good referral information.
  • Care management: Instead of trying to figure out the services you need and then finding them, use a case manager or a geriatric care manager to handle this task. You can find geriatric care managers through private companies and licensed agencies. Case managers also are found through licensed agencies, as well as through government and nonprofit agencies.
  • Health information services: National associations such as the Alzheimer’s Association provide excellent information on various health problems. Home health care agencies and associations such as the Visiting Nurse Association can help you locate in-home medical care or household help. Social Service agencies can provide you with mental health services or referrals and information on Medicaid. Hospitals can provide physician referrals, and doctors can provide referrals for geriatric assessment. Each state is required to have a health insurance counseling program, and you can receive advice about health insurance from an insurance agent or financial planner.
  • Legal services: Your local bar association may operate a referral service that you can use to find a lawyer if you need one. They may not recommend a particular attorney, but may provide you with a list of attorneys that specialize in elder law and help you set up a consultation with one or more of them. You can also receive information from your AARP chapter or from certain federal agencies. National organizations such as Legal Counsel for the Elderly can also answer your questions and provide referrals.
  • Meal services: Meals-on-wheels is a well-known program that provides one hot meal and a light supper once a day, at least five days a week. Volunteers deliver the meals. If subsidized, the meals may be free, but sometimes you must pay a small charge for each meal that is delivered to you. Your community may also have a delivery service available that will pick up meals from a restaurant and deliver them to your home for a few dollars more than the actual cost of the meal. Check your local yellow pages for these services.
  • Ombudsman service: An ombudsman is a trained volunteer who monitors nursing home care or other long-term care facilities. Each state also has at least one ombudsman, and many cities and counties have local ombudsmen as well. If you have a complaint about the quality of long-term care, you can contact an ombudsman through the nursing home or care facility, through the area agency on aging, or through your state department of aging.
  • Recreation services: Community centers, senior centers, churches, temples, and YMCAs (or YWCAs) usually offer recreation (including activities and exercise) programs geared towards older individuals. Many of these programs also provide meals, educational prorams, health screening, counseling and trips. Some programs may ask for fees, but in many cases these fees merely cover expenses. Check your yellow pages or call your local area agency on aging to find these programs.
  • Senior advocates: You may need an advocate when you have a legal problem or a problem involving a government agency. You can find out about advocates from the National Association of Professional Geriatric Care Managers, the AARP, and through your local social service agency or bar association.

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Your Hospice Rights

Monday, February 9th, 2009

Your Hospice RightsIf you are considering hospice care for yourself or a loved one, you might want to know about Hospice Patients Alliance (HPA). This group was formed in August 1998 as a non-profit means to serve the U.S. public with health care rights in a hospice situation. HPA was founded by nurse Ron Panzer, and the group was formed by hospice staff and health care professionals who felt that some patients were not receiving adequate death care during the end-of-life cycle.

HPA promotes quality care whether a patient is enrolled in a licensed hospice or not, whether residing at home or in a facility. HPA is rare in that it is one of the very few true “watchdog” advocacy groups that truly serves hospice patients, families and caregivers. They are dedicated to promoting the welfare of the hospice patients, their families and/or caregivers. No member of their Board of Directors can be an employee or administrator in any hospice Agency or hospice lobbying groups.

HPA can help you learn about many hospice issues. For instance, did you realize that there are four levels of required services that hospices must provide? The hospice must inform you about all these levels of care when you consider admission to hospice services. If the hospice’s “informed consent” form does not list the following four levels of care, think carefully about whether you want to use their services.

A hospice that provides the following levels of care and lists them clearly in their “informed consent” form is more likely to provide the required services, especially if your request them and remind the hospice that you have this service ‘in writing.’

  1. Routine Home Care: Routine home care includes case manager visits, social worker visits, access to a chaplain, counselors, dietitian, therapy and more. Additionally, you have access to 24-hour hospice-registered nurses who can answer your questions. These services are part of the “hospice benefit” reimbursed by Medicare, Medicaid or private insurance.
  2. Continuous Nursing Care at Home: If you choose to stay at home for death care, continuous around-the-clock nursing care in your own home is your right if the you (as the patient) or the your loved one is having symptoms which are “out of control.” According to HPA, “This standard of care applies whether you reside in your own home in the community, a foster care home, assisted living facility, apartment or even a nursing home…all of these locations are considered ‘your own home.’” However, the patient cannot be forced into a facility if the patient wants to remain at home.
  3. Inpatient Care Level of Services: If your loved one is already residing at home or in a hospice facility and the symptoms become uncontrolled, you can inquire about placing the patient on “In Patient Level of Services” so that he or she can get the special attention required. In some instances, the patient may be temporarily placed in an acute care hospital (transferred from home) if there is no hospice facility.
  4. Respite Level of Care: If the family needs a break with taking care of an in-home patient, respite care is there to save the day. The patient, if willing, is temporarily placed in a facility up to five days so that the family can get rest from the seemingly never-ending list of things to do which are part of the patient care routine. After that time, the patient is transferred back home.

If you want to learn more about your hospice rights and even more about deathcare management, be sure to visit the HPA site. Their resources are numerous and helpful to anyone who is considering the ability to die at home.

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