People often confuse Medicaid for Medicare, another popular government-sponsored program. However, these programs are very different in what they are designed to do. Medicare is actually the national health care assistance program given by the federal government.
Its function is to make sure that affordable home health care is available to all seniors and disabled people younger than 65. But on the other hand, Medicaid is another program run by the individual states, along with some federal assistance, and it varies considerably from one state to another. One of Medicaid’s main function is to provide assistance to those who have very few possessions and assets. One of those areas that many people need assistance with is health care, and so Medicaid picks up the tab for assisted care costs that many seniors simply cannot pay for on their own. Medicaid is a wonderful provision to make sure that those with few means receive the care they need even when they cannot afford to pay for it themselves.
Only problem is that Medicaid does have its limitations, and one area that is draining Medicaid of its precious resources is long-term care. In fact, based to the Centers for Medicare and Medicaid Services, in 2001, Medicaid paid for almost 40% of the annual long-term care bill in this country.
So what is long-term care according to the definition put forth by Medicaid? It is generally custodial care that is provided when a person needs assistance for activities of daily living, which include eating, bathing, dressing, continence, toileting, and transferring.
Skilled care on the other hand, which is paid for to some extent by Medicare, is for situations in which you are always expected in getting better as a result of the care. It is often referred to as short-term rehab, and includes IVs, administering medications, changing dressings, and physical and speech therapies. Once a patient’s progress stops, the skilled care reverts to any custodial care. Medicare will not pay for long-term care if it is not accompanied by the need for skilled care, and so the burden falls on Medicaid to pay for the ongoing costs of custodial care.
Although Medicaid will pay for long-term care, there are severe restrictions on the qualifications for assistance.
Also, Medicaid is a program designed to help anyone who is impoverished. In order to qualify for long-term care assistance through Medicaid, a person must spend practically all of his own assets before Medicaid will begin to pick up the tab. Medicaid, in general, is not set up to provide care in a home setting.
Usually the care must be provided within a residential facility, meaning that a person has to give up much of his independence in order to qualify. Much of the individual’s ability to control the kind of care received is also lost, because the state will determine where and how the care is administered since it is paying for the care.
The skyrocketing costs of long-term care are placing many state Medicaid programs under extreme pressure, and much needs to be done to help make sure that this vital program for those who have few means will be able to continue to serve those who need it most. As a result, both state and federal governments are encouraging most Americans to take the responsibility for their own future long-term care needs. Getting more information on the important issues surrounding long-term care and how it affects us all is a good place to start.
If you are confined to bed, your hospital team (nurse or discharge planner) will assess your ability to move about and position yourself to prevent skin breakdown and for maximum comfort. They will decide whether you need a trapeze to help raise yourself in bed and will examine your ability to transfer in and out of bed, either to an ordinary chair or a wheelchair.
If you are able to be up, your hospital team will evaluate your ability to “ambulate” (walk) to the bathroom, and to other parts of your house. If you need help to move about, your home health care team will show your family on how to support your own weight while you are walking and getting out of bed, so as to avoid injury to either of you. Maybe you may be able to walk independently with the use of a “walker,” a “three-pointed” or ordinary cane, braces, or other specialized equipment. It is very important that this equipment be the right size and configuration, and that it be adjusted specially for your needs. You also need to be sure to speak up at any time when the equipment is no longer working for you. When using braces, pay particular attention to your skin in the areas where braces fit. Always remember to tell your caregiver for any areas of redness or blisters on your skin. If you find that your shoulders, arms or legs get very tired during walking, it could be that your cane, appliances or crutches are not in proper adjustment, or that you may need some additional strengthening exercises. Toileting Bowel and bladder elimination should be re-evaluated in light of your home set-up.
Are you able to walk to the bathroom independently or with the use of aids? Is the toilet situated so that you can safely and easily use it? Special equipment may be needed to adapt the accessibility or height of your toilet. A raised toilet seat, arm rests or grab bars can be easily added if needed. If you cannot get to the bathroom, a bedside commode can be provided. Arrangements can be made for privacy and cleanliness. Urinary incontinence is sometimes a problem after certain kinds of strokes or surgical procedures. If your situation requires the use of a catheter of any type, your homecare nurse will show you how to care for it and use it. If incontinence products are needed, purchasing those ahead of time is important.
An assessment of your ability to shower or bathe and what safety equipment you may need is important. If sponge baths are preferred, decide whether the bed or bathroom would be more energy saving and practical. Have the nurse show your family how to bathe you most efficiently, simply, and with the least discomfort. Bed and sponge baths should be comfortable and relaxing.
Transportation may be a concern, particularly if you will have therapy or doctor appointments. If you have long term care insurance, check to see whether it covers ambulance or alternative transportation. Ask your hospital discharge planner if there are local transportation resources available. Some free transportation is available through the American Cancer Society and other organizations. Home Health Licensed home health agencies are available in most communities and will provide skilled services on an intermittent basis. The services of professionals who make up your home health team (e.g., registered nurses, social workers, and physical, occupational, and speech therapists) are prescribed by your physician. Your hospital discharge planner will help arrange for home health services if needed. You can also search for one on our own.
This article, which was written by Jill Gilbert, originally appeared as ” Five Star is Progress” in McKnight’s Long Term Care News February 2009 edition. The Centers for Medicare & Medicaid Services recently released a new rating system to grade the 16,000 nursing homes in the United States that have participated in Medicaid or Medicare. With the goal of streamlining data which is already available in public, the new system assigns nursing homes one-to-five-star ratings based on health inspection surveys, staffing information and quality of care data. The rating system falls short of its primary objective: helping families understand the qualitative data on facilities. The new rating system doesn’t add any new information, and it doesn’t account for patient or family satisfaction. The point is to help consumers compare nursing homes more easily. CMS advises consumers to use the star ratings to narrow their options, then review the deficiencies and citations in detail.
But the problem with this is that the ratings are sometimes unfair or misleading, essentially excluding some facilities from the consumer search to begin with. It is actually an oversimplification of a complex system that will give consumers only a small part of the picture. Looking ahead. Since its implementation, the rating system has been under fire from the nursing home industry, which is concerned about inaccurate representation of facilities, as well as consumer groups, who want reliable, understandable information which they don’t find in the current inspection data. But Rome wasn’t built in a day. The rating system might not be perfect yet but it is in progress. We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.
We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.
The father of a dear friend of mine, Carol, died a few month ago. Last Friday night at our synagogue, she stood up to say Kaddish, the communal prayer for the dead, and I was taken aback by my visceral reaction at seeing my friend stand and speak those ancient words. The reality of her vulnerability and her loss, as well as my own, struck me really hard. In that moment, I realized anew that what had happened to her will happen to me and to those I love. Loss is an intrinsic part of our lives. Each change of our loved ones along the way, illness, a change in one’s mental capacity, a lessened ability to take care of oneself, is a loss to be acknowledged. When senior care managers are called in, the immediate work is to assess any immediate needs and set the necessary services into place. A sensitive care manager also assists the older person and their families and friends in acknowledging and also examine what the changes in their lives means to each one of them, and how they can best manage those changes. Senior care caregiving can raise some difficult questions.
Being aware of the following concerns can help you when the time comes:
Physical: am I physically able to care for my loved one? What sort of help can I give? When is it time to hire outside help?
Emotional: what emotions does this bring up for me? Do I need help in acknowledging the difficult (negative) emotions? Where should I turn to? S
Spiritual: what is the meaning of life? Does it mean something different to me now that my loved one is at the end of life? What will happen to me as I age?
Caregivers will always benefit by addressing the emotional, physical, spiritual concerns of their own lives when helping their loved ones as well as practical considerations such as the significant time commitment that homecare caregiving requires. A care manager can be available to discuss these concerns. She can also sensitively demonstrate that working through loss and grieving is a lifelong task, not one that is simply relegated to after a physical death. Awareness of the small and not-so-small losses during our lives, and grieving those losses as they occur, makes for a fuller and richer life. If we open ourselves to the difficult and painful moments in our lives, we are then free to truly experience moments of pure joy and happiness as well.
This article, written by Jill Gilbert, originally appeared as “Assembling a Cast of Stars” in McKnight’s Long Term Care News October 2007 edition. There is actually no magic formula in making or creating your own dream team. But after talking with Jim Lee, administrator of Nineteenth Avenue Healthcare Facility in San Francisco, we learned some tried and true tactics that every facility can employ and you don’t need to break the bank to do them, either. It starts with hiring. We all know that due diligence pays off when recruiting and doing background checks on potential employees, but Lee also values nontraditional assessments. One innovative example: He forms a panel of residents and nursing homes staff to meet with job candidates so both sides can check and determine whether the candidate would fit with the culture and nature of the facility. Lee describes hiring as “very much a two-way process.” Support also a two-way street as Lee takes a humble approach to management. One way he does this is by turning the organization chart upside down. The top tier is the CNAs, dietary staff and homecare keepers, who Lee says have “the most opportunity to make a difference in the quality of (the residents’) lives.”
{In turn, it is management’s duty to ensure employees~In turn, it is the management’s obligation to make sure that the employees} have the best training and support to do their jobs optimally. This happy symbiosis fosters loyalty. Nineteenth Avenue boasts one CNA who has been on the job for 37 years, and many more employees whose tenure ranges from 17 to 30 years. Social events are an excellent way to pay thanks to your staff. Not only does Nineteenth Avenue celebrate birthdays, company anniversaries and cultural holidays, but each monthly meeting concludes with a drawing for small cash prizes. Staffers who haven’t called in sick that month are eligible to win. In addition to the drawing, he spends less than $100 each month to buy small gifts for all attendees. The bottom line: Even small thank-you’s can be powerful.
My latest article was all about coping strategies for caregivers, a topic I believe can never be exhausted. So this post will continue the theme. This month I’m presenting several important strategies with a philosophical bent. For you to be able to make the most out of these strategies, take the time to think about what’s really important to you.
1. Open Your Hearts – It is important to be “tuned in to” our loved ones when we are with them. This should also include telephone conversations. During those times, the greatest gift we can give is ourselves. We cannot turn back the clock and we cannot affect miracle cures. We can be emotionally available for the people we love who are ailing or frightened. Nurturing an open, honest and caring relationship is a tremendous gift to your loved one under senior care.
2. Take Care of Yourself – Alyce Rudden is a wonderful and caring nursing home social worker who told me, ” When we do this work, there must be other things in our lives.” I have thought of her wise words often. When your visit with a loved one comes to a close or you hang up the telephone, immediately do something for yourself. Have that cappuccino, take a walk in the park, or just take a moment to quietly breathe. Pursue activities that bring joy and pleasure. You need them now more then ever. Time spent on yourself will reap dividends in the capacity to “recharge” you for your loved one under assisted care.
3. Live Life Fully – Now there’s a tall order! But it is, I believe, the most important order. Following the tragedy of September 11th, I spent a year speaking with groups of seniors in NYC. When I asked one group if they did anything differently following that day, one woman said, ” I hug my family before I leave the house every morning. We can’t know how long any one of us has to live. ” I’ll never forget that wise response. Don’t sweat the small stuff. Keep your priorities in order. Don’t procrastinate. And when there is a choice of now or later, strongly consider now.
4. Finish Unfinished Business – Families can sometimes be messy and complicated. In some families, the adult ” children, ” who may be 50 or 60 years old, reunite when a parent becomes ill and then soon behave like five or ten year old children. Squabbles may ensue and statements like, ” Dad always liked you best, ” or ” You’re only interested in the money ” are common. The best gift a family can give themselves, and future generations, is to discuss and resolve longstanding resentments and disappointments, and come together in the anticipated loss of the loved one.
Families should come to terms with what was good as well as with what was not. Some families may wish to avail themselves of professional help to do this work. This is something that needs to think about. So ruminate away, and please feel free to be in touch with any comments or questions.
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