Elder Law Firm of Marshall & Associates - Nursing Home Alternatives

Some Alternatives to Nursing Home Care

Written By: Geriatric Planning Specialist Lisa M. Barner

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.)

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, 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.

Written By: Geriatric Planning Specialist Josephine Balsamo
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.

If you are interested in having an attorney or geriatric planning specialist from

The Elder Law Firm of Marshall & Associates speak to your group, or at an upcoming event, please contact

The 7^th 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.

G etting 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 & 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 & 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.

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!

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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

1-800-401-4552

www.paelderlaw.com

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