Getting to Know the "Continuum of Care
Home and Community Based Services
Senior Living Options
Hospice
Continuing Care Retirement Communities (CCRC's)
Advance Directives
Payment Options

Getting to Know the "Continuum of Care"

• The language of caregiving and healthcare may be all new to you. This section will clarify the types of services available to you; what advance directives are and your payment options. Also, a general "jargon" listing will give you a good working knowledge of the language you'll now be speaking.

 

Home and Community Based Services

• Adult Day Centers. Working caregivers may opt to use these “adult day care centers” to ensure that their loved one receives proper care during their work hours. Programs vary, but usually offer health and medical monitoring, meals, and group recreation. Click here for A Glimpse of an Adult Day Center
  
• pan id="ctl00_ContentPlaceHolder1_rightDynamic_articleBody">Care managers. These specialists in planning care for elders are sometimes called geriatric care managers and are trained as gerontologists, social workers and/or nurses. They assess needs and arrange for services. This is particularly helpful for long-distance caregivers.
• Congregate meals. Senior centers and nutrition sites often provide inexpensive or free, nutritious meals in a group setting. Transportation may be available, as well as recreational and social activities.
  
• Companions or friendly visitors. These may be volunteers or paid companions. They provide companionship, friendship, support, or supervision to older adults for a few hours at a time. Some may even be available to stay overnight. In general, they do not provide housekeeping or personal care services.
  
• Home-delivered meals. Home delivered meals operate in almost all areas of the U.S. This service provides a hot or frozen meal for each day of the week. Services vary from one area to another.
  Home health aides. Aides can be hired to provide help with personal care such as bathing, feeding and toileting. Those provided by a certified home health agency are trained and supervised by a registered nurse.
  
• Home health nurses. These registered nurses provide health assessment and home health care to loved ones who need nursing care at home. Often, additional services such as physical or speech therapy can be arranged. Homemaker services. These services provide in home assistance with light housekeeping, laundry, linen changes, and meal preparation.
  
• Hospice. Hospice is care an individual receives at the end of their life. Hospice focuses on caring, not curing. In many cases, hospice care is provided in the individual’s home. However, hospice care is also provided in freestanding hospice centers as well as special departments within hospitals, nursing homes and other long-term care facilities. Click here for more information.
  
• Medical alert device . In the event that the residential caregiver works during the day, or even has to be away from the home for a short time for errands, the care recipient can wear this electronic device that sends a signal to a central dispatcher, often located at a hospital, if he or she falls or needs help. Emergency assistance is summoned immediately if there is no answer when the dispatcher calls the home.
  
• Senior Centers. Senior centers provide recreational activities and health and wellness services to seniors living in the community. Local communities often offer senior centers through their division of parks and recreation. Other sponsors may include community organizations.
  Service Coordination. Service coordinators often work for senior apartment management and help its residents become informed about services available.

   

Senior Living Options

• Adult Care Facilities and Group Homes provide housing and limited personal services for usually 3 to 16 adults. Each state has its own regulations and definitions.
• Assisted Living Facilities and Residential Care usually offer private suites or apartments with congregate services, personal care and limited skilled care. Licensure rules vary from state to state. Click here for a Glimpse of Assisted Living
• Congregate and retirement housing features apartments in which residents receive some services, such as a daily meal with other tenants. Some may be rent-subsidized (Section 8 housing) or affordable, meaning that they are priced to serve those at or below median income levels.
• Continuing Care Retirement Communities (CCRCs) offer multiple levels of care (independent living, assisted living, skilled nursing care), housed in different areas of the same community. As a result, residents can remain in the same community even if needs change. They charge a monthly fee and sometimes require a considerable entrance fee. Click here for more information on CCRC’s. Click here for a Glimpse of a CCRC.
• Independent living facilities feature private apartments but services are not included as part of the rent, though the resident may be able to get them for an additional fee.
• Nursing Homes are licensed by the state to offer residents personal care and skilled nursing care 24 hours a day. They may also provide room and board, supervision, medication, therapies and rehabilitation. Click here for a Glimpse of a Nursing Home.

Hospice

• • Personal physician
  • Hospice physician
  • Nurses
  • Home health aides
  • Social workers
  • Clergy or other counselors
  • Trained volunteers
  • Speech, physical and/or occupational therapists
  • Family members
  • Hospice care provides for:
  • Pain and symptoms management
  • Assistance with the emotional and spiritual aspects of dying
  • Provision of needed drugs, medical supplies and equipment
  • Coaching of the family on how to care for the patient
  • Delivery of special services like speech, physical or occupational therapy
  • Provision of short-term inpatient care when pain or symptoms become too difficult to manage at home or the caregiver needs respite time
  • Provision of bereavement care and counseling to surviving family and friends

Hospice General Information

Hospice services are available to patients of any age, religion, race or illness. It is covered under Medicare, Medicaid, HMOs, most private insurance plans and other managed care organizations. Long-term care insurance may provide for hospice care as well.

Once hospice care is initiated by the family, the staff is generally on call 24 hours a day, seven days a week. An interdisciplinary team develops a plan to meet the patient’s individual needs for pain management and other needs. The team can be composed of any combination of the following:

 

Advance Directives

Advance directive is a general term that refers to a person's verbal and written instructions about future medical care, in the event that the person becomes unable to speak for him or herself. Each state regulates the use of advance directives differently. Advance directives go into effect in the event of the individual’s incapacitation.

Living wills are a form of advance directives, which provide the patient’s desires and preferences for medical treatment when they are unable to communicate those desires on their own.

Generally a living will provides the opportunity for a person to put into writing his or her wishes about life-sustaining treatments if he or she becomes permanently unconscious or terminally ill and unable to communicate. Laws in different states differ, but the person may need to be declared permanently unconscious or terminally ill and unable to communicate by two physicians before the Living Will becomes effective.

A Health Care (or Medical) Power of Attorney is a type of advance directive that allows a person to appoint someone to make medical decisions for the person in the event that he or she is unable to do so.

A “do not resuscitate” order (DNR) is an advance directive which allows a person the option of not being resuscitated in the event of a cardiac or respiratory arrest. The patient can choose to die without heroic measures, and health care providers are provided with legal means to respect those wishes.  It may be necessary to be enrolled in this program by a medical practitioner and have acceptable forms of DNR identification.

Organ and Tissue Donation is an advance directive for anyone who wishes to donate organs and/or tissues after their death. This is another conversation to have with your loved one, because decisions regarding organs and tissues very often have to be made and carried out immediately in order for the organs and tissues to be useable.

The web sites www.putitinwriting.org and www.nhpco.org have state specific information on advance directives.

It is best to consult your attorney and inform your physician of your advance directives.

Payment Options

• • All costs for up to 20 days of skilled care in a skilled nursing facility after 3 consecutive days in a hospital (within 30 days of discharge) during a benefit period.
  • All costs over the daily coinsurance amount for days 21 through 100 in a skilled nursing facility during a benefit period.
  • Hospice care.
  • Medically necessary home health visits from a Medicare-certified home health agency.
  • Eighty percent of the Medicare approved amount for durable medical equipment (such as a hospital bed or wheelchair).
  • Medicare nursing home coverage doesn’t go into effect until after a hospital stay of at least three days. This coverage also requires substantial insurance co-payments after the first 20 days and can be used for no more than 100 days.
  • Medicare does not cover assisted living costs. However, if you contract short-term services through a home care agency while living in an assisted living center, Medicare may cover this care.
  • Medicare covers home care only if the aging individual is unable to leave their home and needs therapy or skilled nursing care. These needs will likely have to be documented by a medical professional.
  • All care provided in a Medicaid-certified nursing facility.
  • Home health care.
  • Homemakers and chore services.
  • Hospital care.
  • Physician care.
  • Hospice care.
  • Community mental health services.
  • Medical transportation.
  • Prescription drugs.
  • Assistive devices.
  • Some Medicare Part A and B premiums, deductibles and co-payments, if you are financially eligible (through the Qualified Medicare Beneficiary and Special Low-Income Medicare Beneficiary programs).
  • Medigap insurance is a supplement to Medicare designed to fill in “gaps” in Medicare coverage, such as co-payments.
  • Funding from the Older Americans Act is distributed to the Area Agencies on Aging to pay for in home and community based services such as home delivered services, chore services, homemaker services and adult day care.  Contact your Area Agency on Aging for information.
  • Long-term care insurance policies pay for long-term care services that Medicare and Medigap policies do not cover.  Ask your state’s Department of Insurance for information, or contact your insurance agent for more information.
  • Some states have savings programs for senior citizens. Check with your state’s Department of Aging.
  • Many counties sponsor services for older adults through tax revenue.  They may be offered free of charge or on a sliding fee scale basis.  Contact your county department on aging to determine what is available.
  • Veterans’ Affairs offers benefits to veterans, and in some cases, their families. Contact your county veterans services office or your local or state V.A. office.

How much do long-term care services cost?

Prices for home-based and institutional services vary depending on where you live and which organization provides them. While government programs such as Medicaid offer free or low-cost services to those with low incomes, many programs and agencies make services available to anybody, on a sliding-fee basis.

Who pays?

Programs that require a fee can often be calculated on a sliding scale, based on ability to pay.

Other services may be cost-free or be attainable with a voluntary donation because they are provided by volunteers, government, or charitable organizations.

Some programs also have age, income, or other eligibility requirements. When calling an agency, state your needs as clearly as possible and remember to ask about eligibility requirements and costs.

One member of your caregiving team can be designated as the contact for agencies, so that information can be gathered and organized by one person.

Your local Area Agency on Aging is a good place to start investigating the programs and services available in your community. It may also be called Senior Service Division, Aging Services, or the Office on Aging.

How can I find out what we’re eligible for?

www.BenefitsCheckUp.org is a convenient, Internet-based tool that helps identify benefits for which you may be eligible and where to get them.

What about Medicare?

Medicare is the federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). If you are eligible for Social Security benefits (including disability benefits), you may apply for Medicare. There are two basic parts to Medicare: hospital insurance (called Part A) and medical insurance (called Part B).

Medicare Part A covers hospitalization, hospice care, some skilled nursing care and some home health care. Specifically, it covers:

 

 

Medicare Part B covers 80% of necessary medical services and equipment, including doctors’ fees; physical, occupational, and speech therapies; durable medical equipment, X-rays and lab tests.

 

If eligible for Medicare, you do not pay a premium for Part A, though you may have to pay yearly deductibles or co-payments for hospital care or skilled nursing care. If you are 65 or older and do not otherwise qualify or if you are under 65, are disabled, and have received Social Security disability benefits for Medicare benefits, you may purchase Part A benefits (certain qualifications apply). Whether or not you are eligible for Part A, you can receive Medicare Part B benefits by paying a monthly premium and any deductibles and co-payments.

 

Important to note:

 

For more information about Medicare Part A, call toll-free 1-877-602-2430. For more information about Part B, call toll-free 1-800-282-0530. For general information about Medicare, contact your local Social Security office or the Social Security Administration. If you have Medicare-related complaints or are concerned about quality of care, contact the Quality Improvement Organization (1-800-589-7337).

What is Medicare+Choice?

Medicare+Choice replaces the traditional “fee-for-service” health care delivery system. Under this system, persons eligible for Medicare can join a health maintenance organization (HMO) for a wider range of services with fewer out-of-pocket costs. In exchange, the beneficiary agrees to follow procedural rules and use a selected group of physicians and other health care providers.

www.medicare.gov and from your state’s Senior Health Insurance Information Program.

What is Medicaid?

Medicaid is federal and state funded medical assistance to low-income individuals of all ages. Services under Medicaid are free, but strict financial eligibility requirements may require you to reduce, or “spend down,” your assets, income and savings to reach the eligibility level. Generally, Medicaid covers:

 

Medicaid generally covers long-term care expenses in a Medicaid-certified nursing facility. Check with your county Department of Job and Family Services for current requirements, rules and restrictions.

It is important to note that Medicaid does not cover assisted living or continuing care retirement communities (except for their skilled nursing units). Medicaid pays only for care at nursing homes and intermediate care facilities for people who have mental retardation.

Are there alternatives or supplements to Medicare and Medicaid?

Several programs and insurance programs help you pay for long-term care, depending on your needs and preferences. Options may include:

Ohio Passport Program

In Ohio, the PASSPORT program covers the cost of home and community based services for very low-income older adults.

The Costs of Care

Many families are unprepared for the costs of long-term care. When your loved one has need of aging services, you will very quickly become aware of why these costs are a major concern to many American families.

AARP found in a recent study that Americans aged 45 or older generally don’t know much about the costs of long-term care, including the costs associated with in-home nursing care. Many believe their insurance covers long-term care, but only about six percent have purchased such insurance.

In this area, it is helpful to gain all the information you can in order to be prepared. Ask for rates and financial plans when you inquire about long-term care services. Take notes. Do research on the Internet. Educate yourself as much as possible.

Talking with a professional financial planner or attorney is an excellent idea.