Some
Alternatives to Nursing Home Care
Many
options exist between the stages of living alone in a private residence
and moving into a nursing home. Yet
older people and their families often dread nursing home placement as
their only resort without learning about the choices in between.
There
is no place like home. Often foresight and adjustments within the home
make the difference between the ability and inability to remain at home.
Although some solutions seem obvious, some are not so obvious to an
inexperienced caregiver. In
addition, denial on the part of the person in need of care and by the
caregiver can become a factor.
Denial
often makes it difficult for the caregiver to recognize the degree of
decline in someone who has always been so independent. This difficulty
becomes even worse when the incapacitated individual does not realize or
will not accept his or her own limitations.
In this situation, the family
should seek some assistance from outside sources that can be more
objective.
<
Geriatric
Care Managers - Geriatric
Care Managers are a new breed of professionals who can assist in the
management of some or all of the care.
If the family caregiver is far away, busy with other
responsibilities, or just needs some guidance and support, a geriatric
care manager can assess the situation, connect the caregiver with
appropriate services, and then oversee every aspect of care on an
ongoing basis.
Care
Managers, who are usually social workers or nurses with training in
geriatrics, can help with almost any facet of care. They can introduce
you to community services, oversee a particular issue, step in when the
situation gets tricky, or take over the whole kit and caboodle.
Typically,
a care manager will first meet with the person in need of care to
discuss the needs and urgency of the situation.
He or she will assess the daily living needs of the client and
will then draft a detailed plan of care outlining what services will be
provided, when, by whom and at what cost.
Once these services are in place, the care manager will monitor
them on a regular basis. Care
managers can be hired privately or found through your local Area Agency
on Aging. Privately hired
care managers typically charge an hourly fee for their assistance.
<
Elderly
Housing - These
are apartments designed specifically for elderly residents.
This option can often delay a stay in a facility because of the
built in supports provided. The
supports can include:
.
Maintenance Staff
.
Call Systems
.
On site managers
.
Opportunities for socialization
.
Peer monitoring of safety and well being
.
Security and lock systems
Some
offer limited services such as meals, housekeeping, laundry, and
transportation. Often these
are subsidized apartments through the government's Section 202
program, but they can also be privately owned. The rent in elderly
housing can vary from $500 to as much as $1,000 a month.
<
Med Alert
Systems - These
are systems that can be used to summon help in an emergency.
The client in distress presses a button on a necklace or watch
which then signals a central call center.
The center then either calls a list of emergency contacts that the
client has provided or calls 911. These systems can be installed for
approximately $50 - $75 and charge a monthly fee of $25 -$40.
<
Contact
Local Agencies - There
are numerous agencies that can be contacted for information regarding a
certain diagnosis. For
example, if the client is visually impaired, the Blind Association could
be contacted for assistance in making home adaptations.
The Cancer Society, MS Society and Alzheimer's Association are
just a few. They may be able
to make suggestions for home improvements, adaptive equipment, etc. that
could make the task of caregiving easier for all involved. (Typically
these services are provided either at no cost or are dependent on your
gross monthly income.)
<
Medicare
Funded Home Health Services
A
common misconception is that Medicare funded home health services will
meet all the care needs of an older person.
The circumstances which permit someone to qualify for Medicare's
home health coverage are narrowly defined.
Above all, the older person must be home bound.
They must have a medical condition which makes it difficult to
obtain services outside of the home. The older person must be in need of
skilled nursing or rehabilitation services rather than simply requiring
personal care. Finally, the
physician must approve the types of services.
Medicare does not cover a nurse's aide to stay with the older
person all day while a family member goes to work.
Aide services are usually two hours or less at a time for only one
to three days a week and for just a limited period.
Home health aides and social workers may be covered if their
services are an integral part of the skilled care package.
However, once the nurse is no longer needed, the health aide will
no longer be covered, even if the client still needs the care.
In other words, if a nurse comes in twice a week to change bandages
and check catheters, and a health aide comes five days a week to bathe and
dress the client, the aide will not be covered by Medicare once the wounds
have healed and the nurse is no longer visiting. With the proper supports
in place, this intermittent service is often enough to keep the client
safe and independent in his or her home. The original Medicare plan pays
the full approved amount of all covered home health services.
<
Hospice
Services
Hospice,
the philosophy and practice of caring for the dying, is based on the
belief that death is a natural and inevitable part of life and that at
some point all efforts should be focused on enhancing whatever life
remains. Hospices can assist
the patient in his or her home in an attempt to keep the patient
comfortable and free from pain in the last days of his or her life.
There
are more than 2100 hospice organizations across the country.
Hospices provide doctors, nurses, social workers, therapists,
dieticians, clergy, volunteers, and home health aides. Staff members are
usually available 24 hours a day to meet the families' needs, answer
questions, and make visits as needed.
Hospice services can be provided both at home and in health care
facilities.
As
important as the physical care is the psychological care.
Nurses, aides, social workers, and clergy discuss the dying process
and other emotional issues with family members and the patient and offer
bereavement counseling.
Almost
all Hospice services are covered by Medicare.
Medicare pays for nearly all of the costs for the following
services: doctor services, nursing care, medical equipment and supplies,
drugs for symptom control and pain relief, short term care in the hospital
and respite care, home health aide and homemaker services, therapy, social
worker services, dietary counseling, and grief counseling.
To qualify the patient must be enrolled in Medicare Part A and a
doctor must determine (to the extent possible) that the patient has less
than six months to live. Patients
eligible for Hospice care must elect to enroll in the Medicare Hospice
benefit. After 90 days, the patient must be re-certified as being
terminally ill. If an
individual is diagnosed as no longer being terminally ill, he or she is no
longer eligible for services.
Individuals
eligible for hospital care must file an election statement that Hospice
will be providing the care. If
at any point the patient decides to return to the original Medicare
benefit, he or she can do so simply by signing a dated statement of
revocation.
Lisa
can be reached at lbarner@paelderlaw.com
or at 1-800-401-4552.
Who's
Who in the Nursing Home?
Written
By: Planning Specialist Josephine
Reviello
Nursing
homes, also referred to as long term care facilities, are generally
designed for people who are chronically ill or in need of 24 hour medical
care. They also provide skilled care to those who need it for a short time
following an acute illness - also known as rehabilitative care services.
Therefore, a nursing home must be staffed with a variety of skilled
professionals, including medical and non-medical. Nursing homes
sometimes refer to the array of disciplines as the Inter-disciplinary
team. The varied staff in nursing homes will be able to work
together as a team to provide quality care to their residents and
families.
The
following is a list of the primary service providers that you will find in
a nursing home and a brief general description of each department's role
(Please keep in mind that department roles and titles may differ with each
nursing home):
1. Administrative Staff is responsible for the daily planning and
operation of the facility. This category may include the
Administrator or Executive Director of the nursing home, Administrative
Assistant or Receptionist, Admissions Department, Marketing Department,
Registered (or Reimbursement) Nurse Assessment Coordinator, and the
Business or Financial Department.
2. Medical Staff work together to formulate, carry-out, and update
residents' care plans. This includes the Medical Director who is a
physician involved in ensuring the appropriateness of services provided by
the nursing staff and the independent physicians responsible for
prescribing medical care to the residents. Other personnel includes
the Director of Nursing, Registered Nurses (RNs), Licensed Practical
Nurses (LPNs), and Certified Nurse Assistants/Aides (CNAs). The CNAs
are often the principal caregivers in nursing homes. CNA duties
include providing direct resident care and assisting the RNs and LPNs.
3. Rehabilitative Staff provide services sometimes known as
Restorative Services. This department provides medically prescribed
rehabilitative treatments for restoring function to residents. The
team includes Physical Therapists, Occupational Therapists, and Speech
Therapists, as well as trained and/or certified therapy assistants/aides.
4. Social Service Staff identify, assess, and treat the emotional and
social needs of each resident. They may also help the resident
and/or family member(s) with the admission process as well as the
discharge process. This
oftentimes includes filling out forms and other paperwork and making
referrals for needed services. Social Service Staff consists of
Social Workers, and perhaps Psychologists, and/or Counselors.
5. Activity Staff helps residents pursue their former lifestyle
activities as much as possible. The activities are sometimes
referred to as Therapeutic Recreation or Recreation Therapy. The
Activity staff helps create programs that provide recreation,
entertainment, and therapy for the residents.
6. Dietary Staff provides the residents with a daily meal program to
meet each residents individual dietary needs. This department
usually consists of a Dietician Consultant who will consult with residents
that have a special dietary requirement or restriction. The staff
may also consist of dietary aides who prepare and serve the meals and
snacks.
Other departments that play an important role in the functioning of a
nursing home are the Housekeeping Staff who provide laundry and
housekeeping services on a daily basis; Maintenance Staff who identify,
assess, and make any needed repairs to the facility in order to keep it
safe and functioning properly; beautician/hair stylist who helps residents
maintain dignity in their appearance and volunteers who may help with
group programs or activities, religious meetings, or one-on-one visits
with residents.
Each department plays an important role in providing the nursing home
residents with medical, rehabilitative, recreational, and social services
so they can maintain the highest possible level of functioning and
personal well being.
Josephine
can be reached at jbalsamo@paelderlaw.com
or at 1-800-401-4552.
Does
Your Club Or Organization Need A Speaker?
If
you are interested in having an attorney or geriatric planning specialist
from
The
Elder Law Firm of Marshall,
Parker & Associates speak to your group, or at an
upcoming event, please contact
our
Public
Education
Coordinator, Melissa Bottorf
at
mbottorf@paelderlaw.com
or 1-800-401-4552
Elder
Law Institute to be held in
Harrisburg
July
15 and 16
The 7th
annual Elder Law Institute will take place at the Hilton Harrisburg and
Towers on Thursday July 15 and Friday July 16. The Institute is
nationally recognized as a premier event for elder law and estate planning
attorneys, paralegals, nursing home administrators, social workers,
financial planners and anyone who counsels the elderly.
The Institute
provides an in-depth review of the many legal issues that affect the
elderly. Sponsored by the Pennsylvania Bar Institute (the continuing
education arm of the Pennsylvania Bar Association), it provides continuing
education credits for lawyers, insurance agents, nursing home
administrators, and CPAs. Last year over 300 professionals attended the
Institute.
Our Managing
Attorney, Jeff Marshall, is again on the faculty for the Institute.
He has been asked to present three of the sessions: the opening plenary
session - "The Year in Review;" a session on "Powers of Attorney:
Traps and Tips for Elder Lawyers;" and "Gray Areas of Medicaid."
Jeff's co-presenter for these sessions will be Attorney Robert Clofine
of
York
(www.estateattorney.com). Attorney Clofine is the current chair of the Elder Law Section of the
Pennsylvania Bar Association. Co-presenters for the "Gray Areas of
Medicaid session" will also include Drew Coates, legal counsel for the
Department of Public Welfare, and attorney Marielle Hazen of
Harrisburg
.
Further
Information on the Institute including registration details can be found
on the Pennsylvania Bar Institute website at the following link: http://www.pbi.org/
or by calling 800-445-8667.
"Paying
for Long Term Care" Presentations Set in Lock Haven
Getting good information about options for long term care is critically
important for seniors. Four out of every ten people reaching age 65 will
spend some time in a nursing home and many more will require home care and
assistance with daily living.
The
Elder Law Firm of Marshall, Parker & Associates is known throughout
Pennsylvania
for the expert help we provide
seniors who are faced with long term care needs. We help families
struggling to care for their loved one at home find the programs and
financial help they need.
If
nursing home placement becomes necessary, we work with the facility to
help make the transition go as smoothly as possible. We make certain that
the nursing facility gets paid in a timely manner while helping the family
qualify for government programs that help pay the costs.
Marshall,
Parker & Associates occasionally holds free educational forums to help
educate families about the options that are available to pay for long term
care in the home or a nursing home. Join
us for one of these free presentations and learn what you need to know
about how to get the help you need and protect your family's financial
security when your spouse or parent is faced with a long term illness.
Each
presentation is FREE and open to seniors, their families, elder care
professionals, and anyone else who needs to learn more about this complex
subject. Each presentation
lasts about 1 ½ hours, including a "Question & Answer" Session.
-
Thursday,
July 29th, 2004
at
6:00
PM
Ross
Library Community Room, Third Floor
232
West Main Street
Lock
Haven
,
PA
17745
Reservations
are suggested, but not required. SIGN
UP ONLINE
or call 1-800-401-4552 for more information or to reserve your spot for
one of these free seminars!
Back
issues of The
Elder Care Law Alerts
are available on our website.
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can even search our site by a keyword
or phrase!
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you have a friend or colleague who would enjoy reading the
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*Attorney
Marshall
is
certified as an Elder Law Attorney by the National Elder Law Foundation
under authorization from the Pennsylvania Supreme Court
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