Nursing Homes: Medicare vs. Medicaid

There are more than 18,000 nursing homes in the United States.  There are 3 ways to pay for nursing home care: private pay funds, Medicare insurance or Medicaid insurance.  However, the nursing home must accept Medicaid insurance as a payment option and not all of them do.

Medicaid insurance provides medical coverage for low-income seniors and the financial qualifications vary for each state but usually require no more than $2,000 or so in assets and owning a home may or may not be included in that number.

As nursing home care can easily cost up to $80,000 a year, and as Medicare only covers short stays in a nursing home, it is important to ask the right questions about payment when entering a nursing home.  This is necessary even if you are just going into the nursing home for rehabilitation after a major medical procedure. 

Some nursing homes will say they accept Medicaid but it may only be available for current residents who are forced to go onto Medicaid after spending down all of their assets.  The nursing home may not take new admissions who rely on Medicaid for payment.

This is because the government establishes a reimbursement rate for Medicaid and the nursing home may choose to focus on private pay and Medicare clients instead.  Although Medicaid will provide for a permanent long-term stay in a nursing home, this means that the bed will continue to be reimbursed at the Medicaid rate until the senior passes away.  The nursing home is losing out on the ability to charge more for the bed through Medicare or private pay.

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AARP: Available at age 50

The American Association of Retired Persons (AARP) was founded by Dr. Ethel Percy Andrus, a retired high school principal, in 1958.  The association pretty much goes by AARP now - much more hip than their full name.  I receive their mailings since someone, my brother, I think, signed me up when I turned 30.

AARP has expanded beyond their initial task of providing health insurance for retired teachers and others (their founder discovered a retired teacher living in a chicken coop, in poor health and unable to afford health insurance, and set out to find a solution which led her to found AARP).  She successfully created insurance programs for retired teachers and then expanded to offer it to others.  Now the National Association of Retired Teachers is just a division of AARP. 

AARP offers many benefits that all of us should consider tapping into when the need arises, including safe driver tests,  a work training program for low-income persons age 55 and over, free tax preparation and counseling, legal hot lines, training and assistance for aging advocates in elder law and advocacy, support for housing counselors in their work with older homeowners seeking reverse mortgages, and a community of support for all senior issues on their website.

AARP also offers a variety of discounted insurance programs for seniors.

As their membership has grown with the aging populatioin, AARP has become a very strong political lobby.  Their magazine and radio program provide updated information on their initiatives.

Check out their services on their website:  www.aarp.org

 

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Good Senior Living: Paul Harvey

Paul Harvey, known for his radio shows "News and Comment" and "The Rest of the Story"  which air on more than 600 U.S. radio stations, turns 90 today.  Why is this newsworthy?  Because he continues to work - at age 90!  He does have a reduced schedule since his wife passed away earlier this year and to allow for health concerns.

He says he will retire the day he finds something more fun to do, but even after working in radio for 57 years, he still enjoys his job.

Doctors advise healthy aging consists of maintaining social interactions, engaging in physical and mental exercise, and eating nutritious meals. 

While there have been many recent news stories on seniors delaying retirement because of the increased costs in living and the decreased returns on investments, maybe continuing to work a little delivers some benefits. 

And thank you to Paul Harvey for reminding us of this!

 

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Another Caregiver: Michelle Obama

In her speech last night at the Democratic National Convention, Michelle Obama mentioned her father's illness, Multiple Sclerosis.  She talked about how her father, Frasier Robinson, battled the disease from when he was in his 30's, and inspired his family by never letting his physical challenges stop him - he just got up earlier to accommodate the extra time he needed because of them.

Michelle's father died in 1990, but she mentioned that she still felt him watching over her. 

In the daily struggles of caregiving, it is nice to be reminded that how we choose to handle our difficulties can be a form of inspiration to others - and to know that a potential first-lady with a law degree from Harvard has found her inspiration in how her father lived his life after being diagnosed with M.S.

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Geriatric Care Management

What does a Geriatric Care Manager do?

This is a question I am often asked.  My best answer is that a Geriatric Care Manager does everything a terrific and caring Adult Child would do if they had the time.  However, unlike most Adult Children of seniors, the Geriatric Care Manager also has the professional expertise to understand the legal, medical, emotional and financial issues which are involved in senior care and as a non-family member, they can effectively keep all the care services on track.  A good Geriatric Care Manager is worth every penny and will often assist in solving family tensions.

Long-distance Caregivers especially can benefit from a Geriatric Care Manager to advocate for the senior and make sure they are receiving all the necessary care services.

How much does Geriatric Care Management cost?  Anywhere from $100.00 to $150.00 per hour and initial assessments are usually around $500.00 and will include a recommended or suggested Plan of Care.

Although there are not nationally standards in place for Geriatric Care Management licensing, it is usually advisable to have a manager with a background in social work and specialized training in working with or counseling seniors.  Registered Nurses are also often trained to work as Geriatric Care Managers.  Just make sure some credentials are in place and that the Geriatric Care Manager has referrals from other professionals in the community, including medical doctors and estate attorneys. , , ,

Moving Mom and Dad

Last week's Newsweek column, "My Turn" features a story shared by Anne Kennedy Rickover of Lincoln, Nebraska, who recently realized it was time to move her parents from Philadelphia to Lincoln to live near her.  Her parents were still living in the same house they lived in when she was a baby and now, 55 years later, it was requiring upkeep and her parents also were requiring "upkeep" with their day-to-day activities.

Rickover compares moving her parents to planning for a new baby's arrival.  However, unlike a pregnancy and newborn, she did not find an easy place to go for all the answers.  She talked to friends, looked for doctors and researched options.  She also is already thinking ahead to how she will feel when she loses her parents, now that they will become part of her daily life.

After working with hundreds of seniors, as a former owner of a Senior Home Care Agency, I can relate to the challenges Rickover is experiencing.  And as I am also babysitting my 3-month old niece this week, I find her comparison to a newborn baby very appropriate. 

Babies and seniors both have daily schedules.  Just as a baby will start crying if their diaper isn't changed or they are hungry, anyone who has assisted a senior with an age-related illness knows how upset they can become if their daily routine is thrown off.  One of the first questions I always asked a new client was:  what is your daily routine?  It is important to know what time they like to eat breakfast, lunch and dinner, when they prefer to take a nap, what television shows they watch and what weekly schedules are in place.  While they may not tell you specifically that it upsets them if their routine is changed, they will definitely communicate this in some form after a change occurs.

When battling all the challenges of aging, a routine is one comfort seniors can count on.  It is important to respect this and to try to not disturb their ways, however different they may be from ours, if we are to be successful in assisting with care.

You can read Rickover's entire story at:  www.myturn.Newsweek.com

 

 

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Alzheimer's Disease Early Detection

Last week, the Alzheimer's Association held the 2008 International Conference on Alzheimer's Disease in Chicago.  In an effort to promote early detection of the disease, advances in discovering biomarkers by recent research were shared.

It was explained that a biomarker is a substance or characteristic that can be objectively measured and evaluated as an indicator of normal body processes, disease processes, or the body's responses to a therapeutic intervention.

There is even more "scientific-speak" (which also can be very similar to "government-speak"), but in a nutshell, the research indicates that some of the brain changes such as amyloid plaques and neruofibrillary tangles begin many years before symptoms are shown.  If we could identify individuals with these brain changes while they are still cognitively "normal", we could test more future disease modifying therapies.

I guess this is similar to knowing that you are more likely to develop diabetes, for instance, due to certain factors being present and if you change your diet and start exercising, you can delay or prevent the on-set. Researchers are hoping to find a similar solution to Alzheimer's Disease by being able to identify the brain changes earlier. They would like to be able to use measurable markers to determine the presence of Alzheimer's pathology through blood or urine samples or perhaps MRI or PET imaging technology.

A blood test may be possible as healthy brain cells do not go through the process of division and replication (known as the "cell cycle") that is common in other cells in the body. However, in Alzheimer's Disease, brain cells have a tendency to prepare to re-enter this cell cycle, which may increase their likelihood of dying or directly cause their death.

This cell cycle defect can be found in white blood cells (lymphocytes) of people with Alzheimer's and this means a simple blood cell collection could be used for testing.  More trials are being conducted this summer and if all goes well, physicians will be able to use this method as another early test for Alzheimer's Disease.

Definitely a senior will benefit from early detection of Alzheimer's Disease as both medications and proper care can assist the senior and loved ones to more easily adjust to the needs of the disease.

If you are interested in reading the scientific explanations, visit the Alzheimer's Association website at:

www.alz.org

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Estate Planning: Don't be James Brown

Singer James Brown attempted to have an Estate Plan in place but it seems there were a few glitches which are now resulting in his heirs receiving nothing and a lot of lawyers (21 showed up at the last court hearing) earning a paycheck from the resulting legal battle over his estate.

In August, 2000, Brown signed a will leaving his "personal and household effects" to his six children and created the "I Feel Good" trust to educate low-income kids in South Carolina and Georgia.  And then he married his fourth wife and did not update his will to include her and the son their son. And, to complicate matters, the lawyer he hired to create his will is serving 30 years in a South Carolina prison (another reason to be sure you are using a lawyer who specializes in estate planning and maintains a positive track record).

And then to make his estate situation even more interesting, James mortgaged the royalties to most of his songs to TIAA-CREF, the financial services company which was originally created for teacher's pensions (they opened their doors to all investors several years ago).  James Brown received $26 million in this deal and TIAA-CREF now receives the revenue for his song royalties until his loan balance is paid off.  Because of this, it could be as long as 10 years before the loan is paid off.

James Brown passed away on Christmas Day, 2006, and with his beneficiaries still fighting over his assets, the only real heirs are the lawyers.

What lesson can we all learn from this:  plan ahead, use quality lawyers, update your will when children are born or you marriage status changes and, most importantly, pull the family together in a meeting with everyone present to communicate the estate information to them.  This way you have witnesses for your wishes, to provide added credibility to your written plans, to assist when an heir decides to dispute.  Of course, it probably helps to not have as many wives and mistresses as James Brown had, but such is the life of a rock star!

 

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Planning for Long-term Care

Have you discussed your wishes for long-term care, if the need should arise, with your loved ones?

We are encouraged to save for retirement through a retirement plan such as a 401K or IRA and financial planners and advisors have an arsenal of charts and graphs to help you determine just how much money you will need to enjoy the same lifestyle you do now upon retirement, in an effort to encourage you to save.

This is because Medicare does not pay for long-term care.  You must provide for this need yourself.

But what we often miss, is mapping out what kind of care would be preferred and where you would want the senior care to be.  Many times senior care can be an emergency need and when families are not sure of the preferred care options, it only adds more stress to a difficult situation.  And with just a little planning, the process can be so much easier.

Separate from costs, think about where you would prefer to have care services.  In your own home with a professional care service provider?  Or, would you prefer to move into a senior community with Assisted Living services in order to enjoy an active senior lifestyle and know that care services are easily available, if needed?  And if your care needs are acute, do you want to receive the nursing care at home or in a nursing center?

Once you know how you would prefer to receive senior caregiving services, it is easy to connect with professionals in your area to find quality care providers and senior care communities.

The main types of care options are:

-In-home Caregiving services

-Assisted Living Community

-Nursing Home

-Continuing Care Community

-Independent or Supportive Living

-Outpatient Adult Day Care

Caregiverlist does offer Experts who answer your questions in these areas for free, to assist you to plan ahead for your senior care needs.

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