Making the Nursing Home Choice

While placing a loved one in a nursing home is a difficult decision, there may come a time when it is the right one. It will help if you do your homework and trust your instincts.

According to the Department of Health and Human Services, the nation’s nursing homes provide care to over 1.5 million people. Over 90% of these residents are over age 65. Most of the residents are frail and require round-the-clock supervision due to dementia.

Things You Need to Know

A nursing home is a residence that provides room, meals, nursing and rehabilitative care, medical services and protective supervision to its residents. While someone coming from the hospital may require the services of many long-term care professionals such as nurses, therapists and social workers, a nursing home is not a hospital (acute care) setting. The goal at a nursing home is to help people maintain as much of their independent functioning as possible in a supportive environment.

Choosing a Facility

One of the first things to consider when making a nursing home choice is the needs of the individual for whom you’re providing care, suggest experts at the MetLife Mature Market Institute®. Make a list of the special care they need, such as dementia care or various types of therapy.

If the person is hospitalized, the discharge planner and/or social workers can assist you in assessing the needs of the individual and locating the appropriate facility.

If you are choosing a nursing facility for someone who is presently at home, ask for referrals from your physician, Area Agency on Aging, friends, and family.

Other factors such as location, cost, the quality of care, services, size, religious and cultural preferences, and accommodations for special care need to be considered.

When you’ve located a few facilities that you’d like to consider more thoroughly, plan on visiting each one, both with scheduled and unscheduled visits, and at different times and on different days of the week.

As you are walking around, take note of what you hear and don’t hear. Is it silent? Is there activity? How clean does it look? Are the residents dressed appropriately for the season? Most importantly, find out the ratio of nurses to residents is and what is the staff turnover rate?

Helpful Hints

When you’ve finally decided on a facility, you should know your rights and those of your family member. Before you or the resident sign the admissions agreement, understand what you’re signing, and do not sign any paperwork unless everything has been fully explained.

The admissions contract should, at a minimum, contain the daily room rate, reasons for discharge and transfer from the nursing home, and the policy regarding payment of the daily room rate if the resident goes to the hospital or the family brings the resident home for a short period of time.

You may question if you’re really making the right decision to place your loved one in a facility at all. Remember, you can do no more than your best, and if you’ve done that, neither you nor your family member can ask any more of you.



Image: renjith krishnan / FreeDigitalPhotos.net Evan H. Farr on Google +

Considering Home Care? Read this First!

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person.

In one example, Karen, would stop by her parents' home on her way to work every morning and again on her way home from work in the evening. She checked in the morning to see that they were up and ready for the day and Karen would take a shopping list for things they needed. In the evening she delivered the needed items she had purchased during her lunch break and sometimes she fixed a meal when one was not prepared by her mother. This worked well until Karen began to notice her father did not shave or dress during the day and both parents were forgetting their medications. Karen felt more time and supervision was needed in their care but with her own family and job, she could not do it. Non-medical or personal home care services would be a good option for Karen to consider.

Before starting your search for a non-medical or personal home care company, determine what the care needs are and how much time each week will be required for assistance from the company. You may want to consult with the family physician and other family members as well as experienced social workers or care managers to determine needs. Most home care companies, as well, will help you do an assessment at no charge. With your care needs in hand, you are ready to begin your search.

The National Association for Home Care & Hospice (http://www.nahc.org/home.html) gives the following guidelines and checklist in searching for a home care company.

• How long has this provider been serving the community?
• Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish their home care clients with a detailed "Patient Bill of Rights" that outlines the rights and responsibilities of the providers, clients, and family caregivers alike.
• How does this provider select and train its employees? Does it protect its workers with written personnel policies and malpractice insurance? Does it protect clients from theft or abuse by bonding its employees?
• Does this provider assign supervisors to oversee the quality of care clients are receiving in their homes? If so, how often do these individuals make visits? Who can the client and his or her family members call with questions or complaints? How does the company follow up on and resolve problems?
• What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
• What procedures does this provider have in place to handle emergencies? Are its caregivers available on notice?
• How does this provider ensure client confidentiality?

If a home care company has not previously been recommended to you, ask for a list of previous clients and call for their experience with this provider.

Following up on these guidelines can help you determine the quality of personal care that is given. Many states license non-medical home care companies and require both legal and health standards to be maintained.
Read about individual home care companies in your area on the National Care Planning Council's website www.longtermcarelink.net. Photographer: photostock Evan H. Farr on Google +

New Medicare out-of-pocket home health care expenses for Seniors on the horizon?

The Medicare Payment Advisory Commission suggested Thursday one strategy to cut health care spending; the strategy would force Medicare recipients who receive home health care to pay an out-of-pocket cost.  The proposed cost is not yet certain, though sources suggest the amount may be around $150 for a series of visits.  Medicare home health care costs have steadily increased and have reached a point of about $20 billion per year, according to BusinessWeek.  Home health care can encompass home visits from care workers, nurses, therapists, and other health professionals. 

The strategy may come as unwelcome news for Medicare recipients who receive home health care.  Home health care has been free for patients, but amidst the pressures to control the federal deficit, the advisory panel is re-evaluating aspects of Medicare. 

If this suggestion becomes law, more than 3 million seniors will be affected. 

The rationale for paying for the home health care costs in the past has been based on the fact that it is cheaper to care for a person in their own home as opposed to in a hospital. 

For a description of various types of in-home care providers, AARP.org describes the similarities and differences between medical professionals, home health aides, and home care aides in this useful article.  The AARP Seniors lobby is one group opposing the proposed strategy outlined above.

Evan H. Farr on Google +

Three Keys To Planning For Long-Term Care

Baby-Boomers and Seniors 2011 Legal Report

I want to dispel two huge myths that routinely produce false security for senior citizens and their adult children: First, a revocable living trust does not protect your assets from nursing home costs or other long-term care expenses. Second, Medicaid is not just for the “poor.”

“Is it time to start thinking about my parent’s long-term care options?”

This question alone may be the most difficult decisions that baby-boomer’s are faced with in 2011. Baby-boomers have been referred to as “the Sandwich Generation” because they often must take on health-related responsibilities for both their own children and their aging parents. Planning for the future should be the #1 New Year’s resolution for baby-boomers and senior citizens.

Key #1: Plan in Advance

The sooner that you or your parents explore and understand the benefits of senior-focused asset protection planning, the better equipped everyone involved will be towards reaching the goal of maintaining your parents’ highest quality of life.

Proper planning can ease anxieties for baby-boomers by removing stressful decision-making and feelings of guilt. Likewise, a senior-focused asset protection plan can ensure that a senior citizen doesn’t feel as if he or she is a “burden” on thefamily.

Key #2: Get on the Same Page

Bringing up the need for long-term planning to an aging parent can be difficult.  But if you understand that the primary goal of this type of planning is maintaining your parents’ highest quality of life for as long as possible, you should be able to effectively communicate that proper advanced planning is in your parents’ best interests.

Just as good parents want what is best for their children, adult children should likewise seek what is best for their parents. The protection, peace of mind, and elimination of uncertainty brought about by proper planning at an early stage is always in the best interests of senior citizens.

Key #3: Select the Right Attorney

Medicaid eligibility rules and veterans’ benefits rules are the most complex areas of law in existence, and it is essential that the attorney your parents work with for their long-term planning has a comprehensive understanding of these laws. The easy way to ensure that an elder law attorney has the requisite knowledge of these laws is to look for the Certified Elder Law Attorney (CELA) designation, which is approved by the American Bar Association.  There are over 5,000 attorneys in the US who practice elder law, but less than 500 of these have passed the full-day exam required to become a CELA.

Evan H. Farr on Google +

How expensive will nursing homes be in 2020?

The cost of growing old is a concept Baby Boomers are beginning to wrestle with as they contemplate long term care options for both themselves and their aging parents. But in today’s age of economic uncertainty and rising care costs, more dependent adults are relying on family members for care. The Wall Street Journal recently reported on a growing trend - compensating a relative to save money. In citing a report by the National Alliance for Caregiving and AARP, the WSJ pointed out that  more than 43 million Americans cared for a friend or relative age 50 or older in 2009. This number has increased by more than 27% since 2004! But this strategy can have drastic consequences that must not be ignored.

Genworth Financial has posted a tool to view median care costs by state, plus future projected costs. Below are some key figures for the Commonwealth of Virginia:

Type of Care - 2010 Median Cost/Year in Virginia - 2020 Projected Cost

Nursing Home Private Room - $73,000  - $118,909

Assisted Living Private Room - $43,182 - $70,339

Adult Day Health Care - $13,780 - $22,446

Home Health Aide - $41,184 - $67,084

If a family opts for relative-care, they must ensure that the relative can provide the assistance that is actually needed. Other important considerations include: Whether to pay the family member, how much to pay, and whether those facts should be disclosed to other family members. And of course, the person receiving the care should always be comfortable with their caretaker. The WSJ article referenced above suggests complete disclosure to the entire family, as a way to ease potential tension. Another important point – if Medicaid eligibility is a goal, there is no substitute to consulting an Elder Law Attorney. Medicaid laws may require a caregiver to be compensated in a specific way.  One common misconception is that Medicaid is only available for the poor. To the contrary, Medicaid is available to anyone who can legally qualify. An Elder Law Attorney should be consulted for Medicaid asset protection planning, because as this article alluded to above, there are nuanced and complicated qualification rules.



Image: renjith krishnan / FreeDigitalPhotos.net