JustCare

Tag: Home care

  • Medicaid coverage of home and community-based care

    Medicaid coverage of home and community-based care

    If you would like to remain in your home as long as possible–sometimes called “aging in place“–Medicare will be of only limited help. Medicare pays for only a small amount of home care in situations where it would be difficult for you to leave home on your own and you require skilled nursing or therapy services. That said, Medicaid can be of enormous help if you qualify.

    No matter where you live, if you qualify, Medicaid covers home and community-based services (HCBS). These services include coverage to fill gaps in Medicare and to allow you to remain in your home or a community-based setting, such as an assisted living facility. Medicaid provides services that Medicare will not cover. (Medicare always pays first if it covers the service.) How much care you get and the types of care you get depend upon the state you live in.

    Medicaid services that Medicare does not cover include:

    • Personal care, such as cooking or grocery-shopping
    • Homemaker services, such as cleaning
    • Home modifications
    • Help with chores
    • Case management
    • Adult day care

    Medicaid services that Medicare also covers, include:

    How can you qualify for Medicaid HCBS? You should plan ahead and understand the rules in your state. You may be able to move some of your assets into a trust to help you qualify or spend down your income and assets if they are above the Medicaid eligibility threshold, depending upon where you live. You also may be able to set aside some money for your spouse, if you are married, to bring down your assets. If you own your home, you need to understand how the value of your home will affect your Medicaid eligibility.

    Of course, you will need to meet your state’s eligibility requirements for Medicaid home and community-based services, which generally means that you need nursing home level care. Also, keep in mind that your state may have a limit on the number of people for whom it provides home and community-based services. If so, you may be put on a waiting list.

    Contact your local Medicaid office or Area Agency on Aging to learn more.

    Here’s more from Just Care:

  • VA program offers older veterans care in private homes

    VA program offers older veterans care in private homes

    Patricia Kime reports for Kaiser Health News on foster homes for older veterans. At these private homes, licensed caregivers attend to their needs and often treat them like family. These private homes are part of an effort of the Veteran’s Administration to move vets out of long-term nursing home care.

    The Medical Foster Home program is a VA initiative designed to improve the quality of life for vets with physical or mental disabilities. It moves these vets out of nursing homes and into private homes. It offers them the opportunity to live in the community. It provides a private or semi-private room and board, 24-hour one-on-one attention and personal care. It also gives vets some flexibility in their daily activities.

    Vets in the program must use the VA’s Home-Based Primary Care Program. One Brookings study showed that the care Vets receive in these homes is not only less expensive than nursing home care but far better. They have significantly fewer hospital admissions and shorter hospital stays when they are admitted.

    Today, 1,000 veterans in 42 states avail themselves of this program. They must be diagnosed with a serious chronic disabling condition that requires a high level of care, including care coordination and access to VA services. Given the amount of care these vets need, the average $2,300 monthly cost to veterans is low relative to most home care environments. Costs range from $1,500 to $3,000 a month for room and board, depending on location. The government subsidizes the cost of care and still saves about $10,000 a month on what it would have spent on nursing home care.

    The VA would like to increase the size of the program. But, a licensed caregiver can care for no more than three veterans. And, the VA has strict requirements for homes and caregivers, which slows its growth. For example, each foster home must be licensed by the state as an assisted living facility and must agree to VA and state inspections, as well as inspections by nutritionists, pharmacists and nurses.

    Licensed caregivers must pass a background check and complete 80 hours of training. They must take another 20 hours of training annually. They must also permit the VA to make unscheduled home visits. They must be certified in first aid, CPR and administration of medications.

    Today there are some 120 Veterans Administration facilities and 700 licensed caregivers participating in the program.

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    Now available: The Ten Should-Do’s for Your Health, Purse and Peace of Mind, Chapter One of Aging, Schmaging, by Diane Archer. For a $5 contribution, you can help yourself and the people you love; you can also help support Just Care.

    Here’s more from Just Care:

  • Long-term care insurance likely won’t deliver what you need

    Long-term care insurance likely won’t deliver what you need

    You may already know that seven in ten of us will eventually need some type of long-term care services and supports. But, you may not know that most people today receive that care at home and not in a nursing home. The inevitable question is how to pay for it when it is needed, and is it worth getting long-term care insurance as a way to afford this care?

    Long term care insurance may not deliver what you need. Fewer than one in ten people now buy this insurance and there are many good reasons why they do not. Judith Graham explains for Kaiser Health News that this insurance is often very expensive, and it primarily covers nursing home care and not the home care people want.

    Indeed, long-term care insurance may never meet people’s needs, both in terms of cost and coverage. Some people believe that long-term care insurance would be less expensive if it only covered home care. Nationally, home care is less costly on average than nursing home care, $46,000 (daily for about six hours a day) v. $82,000 a year. But, home care can be extremely costly if it is needed round the clock, and costs vary by community.

    Moreover, the cost of care has risen rapidly, far faster than inflation. Even a five percent inflation adjustment in a long-term care policy is likely not to keep up with rising costs. You could not count on a policy with a one-percent inflation adjuster, which some plans now offer, to meet your needs. And, unless you can foresee being able to pay an ever increasing premium over ten to twenty or more years—“level premiums” can and too often do rise significantly—you will likely be throwing away your money.

    Similarly, if you do not buy as much home care coverage as you will need, you will likely be wasting your money. More than a quarter of people needing long-term care services will need these services for as long as two years. Around one in eight of them will need services for between two and four years. And, one in seven of them will need these services for more than five years.

    Unless you have family you can count on for round-the clock care, you take a gamble with partial coverage from a long-term care policy. People wealthy enough to afford round-the-clock home care may be better off simply setting aside the money than buying long-term care insurance. And, millions of older adults qualify for Medicaid coverage of long-term care.

    If you have limited income and assets, depending upon where you live, Medicaid will often cover your long-term care needs. In many states, even if your income and assets are too high to qualify for Medicaid, you can spend down to the Medicaid eligibility level once you need a lot of care.

    So, before spending the time and resources to consider a long-term care policy, speak to an independent expert, such as a State Health Insurance Program (SHIP) counselor. Do not rely on the advice of an insurance agent or long-term care insurance salesperson.

    It’s important to plan ahead. The U.S. Department of Health and Human Services estimates that more than six million people over 65 have a “high need” for home care or nursing home care. They need help with two of five activities of daily living such as eating, bathing, toiletting, dressing or moving from their beds to a chair for 90 days or more. Or, they need a lot of help because they have dementia.

    Here’s more from Just Care:

  • How can we rely on paid caregivers?

    How can we rely on paid caregivers?

    Many older adults who want to age in their communities must rely on paid caregivers to provide long-term care services. But, the two million home care workers in the U.S. have little financial security and therefore too often cannot be relied upon. Moreover, there is little data on how well these paid caregivers deliver home care.

    Part of the issue is that traditionally home care workers have been paid precious little. They tend to work for wages that put them below the poverty level and without any benefits. Their hourly wage is about $10 an hour and can be as little as $8. Recently, with support from the SEIU, they have been organizing for fair wages and benefits in the Fight for $15.

    According to Kaiser Health News, as a result of strong organizing efforts and with support from President Barack Obama, several hundred thousand home care workers in a dozen states will finally see a significant pay raise over the next few years, along with benefits. The 500,000 of them who have joined the SEIU and other unions will be able to get sick time, health and retirement benefits.

    These increases  are coming none too soon. With 10,000 people turning 65 every day, the United States is experiencing a huge demand for paid caregivers. So, it’s important that people see home care as a desirable job.

    However, the problem remains that we have no sense of how well individual home care workers meet the needs of older adults. These caregivers bathe, feed, dress and otherwise help older adults with activities of daily living. But, no one is overseeing or tracking them at the state or federal levels.

    Moreover, home care workers often have no experience. And, with low wages, they tend to move in and out of the profession. The industry has extremely low retention, with an annual turnover rate of about 50 percent. High turnover can jeopardize the health of older adults who cannot rely on the same paid caregivers over time. Background checks for home care workers may not be required. And, they are generally not trained on how to work with patients with dementia or depression. Many home care agencies do not supervise or support their workers.

    To make matters worse, there is very little government regulation of the home care industry. Home care agencies often operate with little oversight and may not be serving the interests of their workers or their clients. Recently, six Medicaid agencies in DC were shut down after they were found to be committing Medicaid fraud. The agency shut-downs left their home care workers on the job without pay.

    Here’s more from Just Care:

  • Student housing in a Dutch retirement home

    Student housing in a Dutch retirement home

    Here’s an innovation. With few resources to keep residents active in a Dutch retirement home, the CEO decided to open up rooms to six students. In exchange for free student housing, the young adults spend at least 30 hours a month with the older residents. The students take the nursing home residents around town in a specialized tandem bicycle, play beer pong with them and build friendships and provide comfort to dementia patients.

    Many Dutch students in their 20s are hard-pressed to find housing. It’s so expensive. So, this marriage of students and older adults is a win-win.  They are “good neighbors,” part health care provider, social worker, friend, grandchild, and more. Check out this video:

    Here’s more from Just Care:

  • Help a loved one age in place through hospital-church partnerships

    Help a loved one age in place through hospital-church partnerships

    Hospital-church partnerships are helping to ensure that older adults can remain in their homes and age in place. Through these partnerships, hospital staff work with church volunteers to create a social circle for older adults to ensure their personal, medical and social needs are met in hospital and when they transition back home. You may be able to help a loved one age in place with extra social supports through a hospital-church partnership.

    Hospital-church partnerships are springing up all over the country. Earlier this year, the Maryland Faith Community Health Network was launched, linking the Maryland Citizen’s Health Initiative with Lifebridge Health, a consortium of hospitals, and scores of houses of faith to improve community health. Volunteers in the community partner with local hospitals to help provide support to patients both in hospital and when they return to the community. It is modeled on Methodist Hospital’s Congregational Health Network.

    According to Kaiser Health News, Methodist Hospital in Tennessee partners with hundreds of churches to help ensure their members are safe and healthy and reduce health care costs. In this Congregrational Health Network model, whenever a church member is admitted to hospital, a hospital staff person notifies a church volunteer. The church volunteer then plans a visit to the patient in hospital, if the patient desires it. The volunteer also plans for a smooth transition back home upon discharge from hospital, arranging for community services such as meals on wheels and transportation, as appropriate.

    The Methodist hospital-church network was shown to reduce the mortality rate for patients by 50 percent and the hospital readmission rate by 20 percent as compared with patients who are not in the network. The network also conducts health education programs promoting healthy living and disease prevention.

    Lorna Linda University Medical Center in Southern California has a similar network model with churches. And, the Inova Health System in Northern Virginia also works in partnership with religious communities. It’s a win-win. The hospitals save money and the churches promote the health of their members.

    Health partnerships of all sorts seem to be springing up across the country. The Centers for Disease Control is piloting community health partnerships that address the biggest risk factors for disease and death in 33 cities large and small across the country as well as with six American Indian tribes/tribal organizations.

    Here’s more from Just Care about programs to help older adults be safe and healthy and age in place:

  • Need for more home care workers to care for older adults at home

    Need for more home care workers to care for older adults at home

    An increasing number of older adults are choosing to age in their homes rather than in nursing homes or other institutionalized settings. With the population aging, there are too few home care aides and nursing assistants to care for older adults in their communities. But, in August the D.C. Circuit upheld a new Obama Administration Labor Department regulation providing home care workers minimum wage and overtime protections, which should encourage more people to enter these professions.

    Nursing assistants and home care aides help older adults bathe, dress, transfer from their beds to a wheelchair or walker, use the toilet and eat. They also talk to patients about their health care needs and may report concerns to nurses. They sometimes take people’s blood pressure and temperature as well. Some are trained to give patients their medicines. Many of the people they care for are chronically ill, disabled or cognitively impaired.

    According to the Bureau of Labor Statistics, in 2012 the median pay for nursing assistants was $11.73 an hour or $24,400 a year. And, there were 1,534,400 jobs. Home care aides had even lower hourly wages of $10.25 and average yearly earnings of $20,820. There were 875,000 of these jobs. Training for these jobs is limited at best.

    The new Obama Administration Labor Department rule designed to provide 2 million home care workers better pay was set to go into effect in 29 states in January 2015 but then was challenged. Those states did not have a minimum wage law that applied to these workers because they did not consider Medicaid payments to be wages. These workers are now eligible for the $7.25 hourly minimum wage, as they already were in 21 other states, as well as overtime pay.

    In the 10-year period between 2012 and 2022, the Bureau of Labor Statistics projects a 21 percent average growth rate for nursing assistants and a 48 percent growth for home care aides, as compared to 11 percent average growth rate for all jobs.

    An increasing percentage of people will be over 65 in the coming years, and about 70 percent of them will require long-term care services and supports. Eleven million people needed paid long-term care services in 2013.

    Here are three tips for planning for long-term care services and supports, including questions to consider regarding long-term care insurance. Keep in mind that Medicare only covers limited home care and skilled nursing care under certain conditions.

    Until now, home care aides, like babysitters, were not eligible under federal law for overtime pay and not covered under labor rules.

  • Seven questions to ask before scheduling a house call with a doctor you don’t know

    Seven questions to ask before scheduling a house call with a doctor you don’t know

    Without a doubt, many of us would prefer a house call from a friendly primary care doctor than a trip to the doctor’s office or, if necessary, the emergency room. And, people with chronic and disabling conditions in particular may find it hard to leave home to visit the doctor. With no doctor available to make a house call, many older adults skip needed care and end up in hospital or, worse still, having an ambulance take them to the emergency room.

    With the right medical team, house calls can be a good alternative to an emergency room visit. Indeed, house calls are on the rise for people with Medicare, up 40 percent between 1998 and 2004. And, in 2013, Medicare paid for more than 2.6 million house call visits. Medicare pays for home health care services from Medicare-certified home health agencies in some cases when a patient is homebound and for hospice care at home in some cases when a patient is terminally ill.

    Medicare is now in the midst of a small demonstration project to determine whether house calls for patients with chronic conditions can improve care and save money. If you or someone you love is not participating in that demonstration project or cannot find a doctor you know to make a house call, one emerging health care business makes it easy to summon a doctor for a house call via a smartphone app.

    Before scheduling a house call with a doctor you do not know, check in with your primary care doctor. You want to make sure that the doctor who makes the house call will meet your needs. Here are seven questions to ask:

    1. Will the doctor provide quality care? Find out whether the doctor is board certified in internal medicine or family practice medicine. Also, check out the doctor with your local hospital, health system, Area Agency on Aging or other community resource. If they are not familiar with the doctor, they might have a doctor who makes house calls to recommend.
    2. Will the doctor take the time to understand your medical conditions, including current medications, allergies and chronic conditions?
    3. Is the doctor part of a medical team that includes nurses, therapists, social workers and pharmacists who can provide additional support?
    4. Is the doctor bringing portable diagnostic equipment and medical supplies to properly diagnose your condition?
    5. Will the doctor assess the home environment for safety and health risks?
    6. Will the doctor develop a plan of care and be in touch with your primary care doctor to coordinate your care?
    7. Will you need to pay out of pocket or will Medicare reimburse for this service? Ask whether the doctor accepts Medicare. If the doctor accepts Medicare, traditional Medicare should pay and your charges should be capped. If you’re enrolled in a Medicare Advantage plan, call the plan to see whether there are in-network providers who make house calls.

    For more information about the advantages of house calls and what you need to think about, read this publication by Leading Age.

  • What if you could get hospital care at home?

    What if you could get hospital care at home?

    The Johns Hopkins Schools of Medicine and Public Health have developed an innovative care model that allows qualified patients with particular conditions to check into their own bed for their hospital care. Called Hospital at Home, this new way of delivering care is available in some communities to patients with certain types of pneumonia, congestive heart failure, chronic obstructive pulmonary disease and cellulitis, who would otherwise have to be hospitalized for treatment. Doctors and nurses provide both diagnostic tests and treatment therapies to patients at home.

    Hospital at Home is designed to work for any hospital or care facility that meets certain criteria. And, it is intended to address the risks of treating acutely ill older adults in hospital, where they all too often experience adverse events, such as hospital-acquired infections, as a result of compromised immune systems.

    More studies need to be undertaken to understand the full benefits of the Hospital at Home model. But, in an initial study, researchers found that patients getting hospital care at home spent fewer days “in hospital,” and were less costly to treat. Care met quality standards similar to those in hospital. And, some evidence also showed that people experienced fewer complications.