Our organization attempts to let our website audience drive the site's content. By analyzing the questions we receive and we can determine our content development priorities. We have long produced in-depth content about how to pay for home care supplies and durable medical equipment and the resources which are available as financial assistance. While this information is valuable, we recently recognized that people visiting our website are more task driven. Instead of wanting to understand the options available for home medical equipment, they want to know specifically if (for example) Medicare will pay for bathroom safety modifications or for a motorized wheelchair.
To accommodate this task driven approach, we are trying a new approach to content development. Recently we published three articles which attempt to answer very specific questions about home medical equipment, home modifications for aging in a place and home care supplies. Available now on the website are our guides to paying for bathroom safety modifications, such as walk-in tubs, paying for motorized and manual wheelchairs and paying for adult diapers and other incontinence supplies.
We are hoping this approach will provide families with faster answers to their questions. However, we continue to press that families should consider the larger picture of how to manage caring for a loved one financially even while addressing problems which require immediate solutions. Please don't hesitate to provide feedback both on the helpfulness of the articles we've published as well as the need for articles on subjects we have not yet published.
Our mission is to help the families of individuals with Alzheimer’s and other aging conditions to find the financial and care resources they require to enable their loved ones to age in comfort and with dignity. Find Financial Resources to help pay for assisted living and home care.
Thursday, May 2, 2013
Sunday, April 28, 2013
Adult Day Care: 5 Things Everyone Should Know
1) Adult day care is, by far, the most affordable form of elder care available. In 2013, the average cost of adult day care across the US is $65 / day. In some states, especially in the Southeastern USA, adult day care and adult day health care can be found for as little as $35 / day. In the Northeast, the cost is slightly higher averaging in the $80 - $90 / day. Learn about how to pay for adult day care.
2) Many seniors are resistant to the idea of adult day care, but end up liking it. This is a rather common scenario perhaps due to an outdated idea of what senior care is or a failure to distinguish between nursing homes and day care. Regardless of the reason, when seniors experience the diverse social activities and camaraderie which exists in adult day care, most end up liking it and looking forward to the days on which they will participate.
3) Getting to and from adult day care is not that difficult. Approximately 70% of adult day care centers offer transportation services for program participants. There are also many volunteer services that offer transportation for the elderly and other programs which receive federal money to provide discounted transportation assistance.
4) There is more than one kind of adult day care. There are adult day care centers that provide personal care and there are more sophisticated adult day health care centers which offer nursing home level care. There are also centers which specialize in helping individuals with Alzheimer's or dementia; referred to as Alzheimer's Day Care Centers. Find adult day care that meets your loved one's needs.
5) Adult day care centers are licensed and regulated. Each state has different guidelines but generally speaking, staff members are subject to background checks, there are minimum staff-to-patient ratios as well as minimum staff-on-premise requirements.
The most important thing to know about adult day care is that it can be very flexible. Most families who bring a loved one to adult day care find that not only can they make it work, but that it works very well for their loved ones, their caregivers and themselves. Families can try adult day care for a week without making any commitments and they can choose the hours and days which work for them.
Learn more about paying for adult day care or find a adult day care center near you.
2) Many seniors are resistant to the idea of adult day care, but end up liking it. This is a rather common scenario perhaps due to an outdated idea of what senior care is or a failure to distinguish between nursing homes and day care. Regardless of the reason, when seniors experience the diverse social activities and camaraderie which exists in adult day care, most end up liking it and looking forward to the days on which they will participate.
3) Getting to and from adult day care is not that difficult. Approximately 70% of adult day care centers offer transportation services for program participants. There are also many volunteer services that offer transportation for the elderly and other programs which receive federal money to provide discounted transportation assistance.
4) There is more than one kind of adult day care. There are adult day care centers that provide personal care and there are more sophisticated adult day health care centers which offer nursing home level care. There are also centers which specialize in helping individuals with Alzheimer's or dementia; referred to as Alzheimer's Day Care Centers. Find adult day care that meets your loved one's needs.
5) Adult day care centers are licensed and regulated. Each state has different guidelines but generally speaking, staff members are subject to background checks, there are minimum staff-to-patient ratios as well as minimum staff-on-premise requirements.
The most important thing to know about adult day care is that it can be very flexible. Most families who bring a loved one to adult day care find that not only can they make it work, but that it works very well for their loved ones, their caregivers and themselves. Families can try adult day care for a week without making any commitments and they can choose the hours and days which work for them.
Learn more about paying for adult day care or find a adult day care center near you.
Friday, April 12, 2013
How Prescription Discount Cards Make Money? (and should you be concerned?)
We had a very interesting conversation recently that gave us a behind-the-scenes look at prescription discount cards and how they make money. We were surprised to learn about the number of players involved and their motivations. We were equally surprised by how much variation there is in the operational practices of the different cards.
To better understand discount drug cards, it helps to first identify all the players and learn some terminology. There are five or sometimes six entities involved in each prescription purchase that involves a discount card. These are:
1. Cardholder - the consumer
2. Pharmacy - the retail outlet in which the purchase is made
3. Pharmaceutical Company - the manufacturer of the medication
4. Adjudicator - the organization that negotiates the discounts with the drug makers
5. Card Marketer - the organization whose brand is on the card
6. Card Marketer Affiliate - an organization that assists the Card Marketer in distribution
Each time a card is used there is a transaction fee applied to the purchase price. That fee is split 3 or 4 ways (though perhaps not evenly) between the Pharmacy, the Adjudicator, the Card Marketer and their Affiliate. This transaction fee comes at the Cardholder's expense. However, usually the negotiated discount cost of the medication far exceeds the transaction fee so the Cardholder still wins. For example, the retail price for a medication is $100. The prescription discount card has negotiated a 40% discount, so the cost would be $60 but there is a $10 transaction fee. So the Cardholder pays $70 instead of $100. Of the $10 transaction fee, the Pharmacy might take $2, the Adjudicator $2 and the Card Marketer $6. The Card Marketer might pay out $1 to their marketing affiliate.
What's more is that transaction fees are not the only way the cards make money. With each purchase there is valuable information gathered that the Card Marketers then sell to other marketing organizations. Two types of information is gathered and sold. Although only one of which should be of concern to the Cardholder, which is when their personal information, their name, address and the medications they've purchased is sold. The other information gathered and sold is anonymous and in aggregate, such as 20% of persons buying a specific medication also purchased over-the-counter Vitamin C. This information is still valuable to marketers but harmless to consumers. It is worth noting that not all cards sell their members' personal information.
Finally, some prescription discount cards also charge annual, monthly or enrollment fees. While these may seem minor, they may add up to as much as $100 / year. As with selling personal information, not all cards engage in this practice.
Obviously, Card Marketers can generate a significant amount of revenue each time one of their cards is issued and even more when it is used. This goes a long way to explaining the aggressive distribution tactics employed by those companies that issue prescription drug cards.
On our website, we've published more detailed information about how consumers can select a drug card that maximizes their saving and protects their personal privacy.
To better understand discount drug cards, it helps to first identify all the players and learn some terminology. There are five or sometimes six entities involved in each prescription purchase that involves a discount card. These are:
1. Cardholder - the consumer
2. Pharmacy - the retail outlet in which the purchase is made
3. Pharmaceutical Company - the manufacturer of the medication
4. Adjudicator - the organization that negotiates the discounts with the drug makers
5. Card Marketer - the organization whose brand is on the card
6. Card Marketer Affiliate - an organization that assists the Card Marketer in distribution
Each time a card is used there is a transaction fee applied to the purchase price. That fee is split 3 or 4 ways (though perhaps not evenly) between the Pharmacy, the Adjudicator, the Card Marketer and their Affiliate. This transaction fee comes at the Cardholder's expense. However, usually the negotiated discount cost of the medication far exceeds the transaction fee so the Cardholder still wins. For example, the retail price for a medication is $100. The prescription discount card has negotiated a 40% discount, so the cost would be $60 but there is a $10 transaction fee. So the Cardholder pays $70 instead of $100. Of the $10 transaction fee, the Pharmacy might take $2, the Adjudicator $2 and the Card Marketer $6. The Card Marketer might pay out $1 to their marketing affiliate.
What's more is that transaction fees are not the only way the cards make money. With each purchase there is valuable information gathered that the Card Marketers then sell to other marketing organizations. Two types of information is gathered and sold. Although only one of which should be of concern to the Cardholder, which is when their personal information, their name, address and the medications they've purchased is sold. The other information gathered and sold is anonymous and in aggregate, such as 20% of persons buying a specific medication also purchased over-the-counter Vitamin C. This information is still valuable to marketers but harmless to consumers. It is worth noting that not all cards sell their members' personal information.
Finally, some prescription discount cards also charge annual, monthly or enrollment fees. While these may seem minor, they may add up to as much as $100 / year. As with selling personal information, not all cards engage in this practice.
Obviously, Card Marketers can generate a significant amount of revenue each time one of their cards is issued and even more when it is used. This goes a long way to explaining the aggressive distribution tactics employed by those companies that issue prescription drug cards.
On our website, we've published more detailed information about how consumers can select a drug card that maximizes their saving and protects their personal privacy.
Wednesday, March 27, 2013
Medicaid vs. Veterans Pensions? Assisted Living vs. Nursing Home? Are these even the right questions?
We often let the volume of email questions we receive guide our content development priorities. There are two questions we receive nearly every day and both of similar themes. The first question is which is the better option financially Medicaid or VA Aid and Attendance? The second question is which is the better option for a loved one assisted living or a nursing home?
These are difficult questions and there is no single answer for either. In publishing our recent articles we have attempted to help families with these decisions in two ways. First by presenting the facts about each option and second by presenting the consideration factors which need to be applied to their specific situation. For example, for practical purposes Medicaid and the Aid and Attendance pension benefit are mutually exclusive options. It is a choice, one option or the other. Persons who could be eligible for both need to decide between them and a major factor that needs to be considered is the type of care they require or desire; assisted living, home care or nursing home care. Another factor is the immediacy of need. Medicaid's approval process is relatively quick while veterans might wait as long as two years to begin receiving their pensions. Fortunately, payments are retro-active once the application has been approved.
Our intent is not to reproduce the articles on this blog, so we will keep this post relatively short. However there is one thing we should add which we don't stress in the articles. Most people are asking "should I apply for Medicaid or a veteran's pension?" We feel the question should be "how do I plan so I can be eligible for either?". The same applies to the assisted living vs. nursing home question. It is very likely that if one type of care is required, the other type will also be necessary at some point. One should plan for both.
These are difficult questions and there is no single answer for either. In publishing our recent articles we have attempted to help families with these decisions in two ways. First by presenting the facts about each option and second by presenting the consideration factors which need to be applied to their specific situation. For example, for practical purposes Medicaid and the Aid and Attendance pension benefit are mutually exclusive options. It is a choice, one option or the other. Persons who could be eligible for both need to decide between them and a major factor that needs to be considered is the type of care they require or desire; assisted living, home care or nursing home care. Another factor is the immediacy of need. Medicaid's approval process is relatively quick while veterans might wait as long as two years to begin receiving their pensions. Fortunately, payments are retro-active once the application has been approved.
Our intent is not to reproduce the articles on this blog, so we will keep this post relatively short. However there is one thing we should add which we don't stress in the articles. Most people are asking "should I apply for Medicaid or a veteran's pension?" We feel the question should be "how do I plan so I can be eligible for either?". The same applies to the assisted living vs. nursing home question. It is very likely that if one type of care is required, the other type will also be necessary at some point. One should plan for both.
Friday, March 15, 2013
Waiting for Veteran's Benefits: 11 Things Every Applicant Should Know and Do
The Veterans Administration offers many different types of assistance to help aging and disabled veterans receive the care they require. Included are programs and benefits such as Aid and Attendance, Disability Compensation, Survivor's Benefits, Housebound and the Improved Pension. The problem with VA benefits is not the lack of assistance but in the bureaucratic backlog of claims processing. As anyone who has filed a claim for assistance with the VA knows, the wait time is excruciating.
By the Department of Veterans Affairs own admission, the average time to process a claim is 241 days. For those whose require assistance, that is over 8 months worth of home care, assisted living or nursing home bills piling up. For many veterans the experience is much worse. Complicated claims, errors made by the VA or by the applicants and the appeals process can add months or even years to the wait. It is not unheard of or even unusual for applicants to wait two years to begin receiving their full benefits.
While it is interesting to know what is causing the problem (23 million aging veterans among other things) and what the administration is doing to fix it (quite a bit, actually), it is of little comfort to the veteran waiting for assistance. The VAs proposed fixes are years away and even with those improvements wait times will still be 6 months. This is not a problem that is going away any time soon. So what should veterans know and do to speed up their claims? How can we make the best of this bad situation?
1) Do it right the first time. We cannot over-emphasize the importance of properly filling out an application. Take the time to answer every question thoroughly and accurately. Don't skip questions or leave blanks because you don't understand the question or think it does not apply to you. Get help when you need it. The rejection and appeal cycle is not something that is going to benefit anyone.
2) Do your research. Know the exact benefit type and amount for which you are applying. Know the eligibility requirements and know why you qualify. Don't ask for benefits for which you think you might be eligible. Know that you are eligible for certain before applying and have the evidence to prove it.
3) Recognize that the VA prioritizes, officially. For example, a terminally ill veteran's first-time claim will be prioritized in front of an appeal for a higher benefit rate. Present your case with the urgency it requires.
4) Recognize that the VA prioritizes, un-officially. VA claims processors are human. When presented with an overwhelming number of claims, they are going to choose the less complicated cases first; they are going to choose the thinner file folders. Don't take the "everything and the kitchen sink" approach to providing evidence to back your claim. Provide the exact evidence which is needed and nothing more.
5) Keep copies of everything. Lost paperwork, unsurprisingly, causes long delays. Keep paper and digital copies of everything and be ready to fax or email anything which is requested immediately. Don't waste time blaming the VA for losing paperwork, simply provide them with another copy.
6) Don't put all your eggs in one basket. For many veterans, Medicaid is a much faster alternative to receiving assistance. Applications are usually processed within 45 - 60 days. Learn more about Medicaid vs. Veterans Pensions or get help determining your Medicaid eligibility.
7) Don't put all your eggs in two baskets. Many elderly veterans are or could be eligible for other, non-Medicaid non-military, federal, state and non-profit assistance programs. Use the Eldercare Resource Locator Tool to find public and private assistance options which are available to you.
8) Know How Long You'll Wait Death, taxes and a long wait for VA benefits are sure things. Expect to wait 9 -18 months to begin receiving assistance and plan for it. The VA does a good job of publishing information on the backlog. You can view the average wait time for each regional VA claims processing office here.
9) Know that financial help is available. One relatively new and very good option for aging veterans are eldercare loans. These are loans designed specifically to assist veterans pay for the cost of home care or assisted living while they are waiting for their VA application to be approved. The lender will even help with the application paperwork. Learn more about eldercare loans for veterans.
10) Who do you know? Though officially denied, all evidence points to the fact that knowing someone within the administration can speed up the veterans claims approval process. Working with a veterans benefits consultant will undoubtedly reduce the time needed to gain approval. If not because of who they know within the Department of Veterans Affairs, then because they help their clients to present an application that is complete, thorough and without errors, inaccuracies or missing data. Read more about or find a veterans benefits advisor.
11) Find affordable care. Veterans who pay for care out of pocket while waiting for a claim approval and reimbursement check should be aware of the vast difference in the cost of home care and assisted living. Even within the same geographic area, the cost for the same care can vary by 50%, even 100%. Veterans and their families should use one of the free services to help them find the most affordable care in their area.
By the Department of Veterans Affairs own admission, the average time to process a claim is 241 days. For those whose require assistance, that is over 8 months worth of home care, assisted living or nursing home bills piling up. For many veterans the experience is much worse. Complicated claims, errors made by the VA or by the applicants and the appeals process can add months or even years to the wait. It is not unheard of or even unusual for applicants to wait two years to begin receiving their full benefits.
While it is interesting to know what is causing the problem (23 million aging veterans among other things) and what the administration is doing to fix it (quite a bit, actually), it is of little comfort to the veteran waiting for assistance. The VAs proposed fixes are years away and even with those improvements wait times will still be 6 months. This is not a problem that is going away any time soon. So what should veterans know and do to speed up their claims? How can we make the best of this bad situation?
1) Do it right the first time. We cannot over-emphasize the importance of properly filling out an application. Take the time to answer every question thoroughly and accurately. Don't skip questions or leave blanks because you don't understand the question or think it does not apply to you. Get help when you need it. The rejection and appeal cycle is not something that is going to benefit anyone.
2) Do your research. Know the exact benefit type and amount for which you are applying. Know the eligibility requirements and know why you qualify. Don't ask for benefits for which you think you might be eligible. Know that you are eligible for certain before applying and have the evidence to prove it.
3) Recognize that the VA prioritizes, officially. For example, a terminally ill veteran's first-time claim will be prioritized in front of an appeal for a higher benefit rate. Present your case with the urgency it requires.
4) Recognize that the VA prioritizes, un-officially. VA claims processors are human. When presented with an overwhelming number of claims, they are going to choose the less complicated cases first; they are going to choose the thinner file folders. Don't take the "everything and the kitchen sink" approach to providing evidence to back your claim. Provide the exact evidence which is needed and nothing more.
5) Keep copies of everything. Lost paperwork, unsurprisingly, causes long delays. Keep paper and digital copies of everything and be ready to fax or email anything which is requested immediately. Don't waste time blaming the VA for losing paperwork, simply provide them with another copy.
6) Don't put all your eggs in one basket. For many veterans, Medicaid is a much faster alternative to receiving assistance. Applications are usually processed within 45 - 60 days. Learn more about Medicaid vs. Veterans Pensions or get help determining your Medicaid eligibility.
7) Don't put all your eggs in two baskets. Many elderly veterans are or could be eligible for other, non-Medicaid non-military, federal, state and non-profit assistance programs. Use the Eldercare Resource Locator Tool to find public and private assistance options which are available to you.
8) Know How Long You'll Wait Death, taxes and a long wait for VA benefits are sure things. Expect to wait 9 -18 months to begin receiving assistance and plan for it. The VA does a good job of publishing information on the backlog. You can view the average wait time for each regional VA claims processing office here.
9) Know that financial help is available. One relatively new and very good option for aging veterans are eldercare loans. These are loans designed specifically to assist veterans pay for the cost of home care or assisted living while they are waiting for their VA application to be approved. The lender will even help with the application paperwork. Learn more about eldercare loans for veterans.
10) Who do you know? Though officially denied, all evidence points to the fact that knowing someone within the administration can speed up the veterans claims approval process. Working with a veterans benefits consultant will undoubtedly reduce the time needed to gain approval. If not because of who they know within the Department of Veterans Affairs, then because they help their clients to present an application that is complete, thorough and without errors, inaccuracies or missing data. Read more about or find a veterans benefits advisor.
11) Find affordable care. Veterans who pay for care out of pocket while waiting for a claim approval and reimbursement check should be aware of the vast difference in the cost of home care and assisted living. Even within the same geographic area, the cost for the same care can vary by 50%, even 100%. Veterans and their families should use one of the free services to help them find the most affordable care in their area.
Monday, February 4, 2013
Proving Negligence Against a Nursing Home
Editor's Note:
Recently we published an article regarding helping the
elderly to receive compensation for care costs accrued after a fall or
injury. This article resulted in a flood
of questions; many of which were focused on injuries sustained by the elderly
in nursing homes. We've asked Jonathan Rosenfeld,
an attorney specializing in nursing home injury cases, to shed some light on
what is required to build a case against a nursing home. Follows is his response.
Families Must Establish Negligence in Order to Receive Compensation for Nursing Home Injuries
Unfortunately there are many loved ones that are injured or
die due to negligence or improper care while in a nursing home. It is a cold,
hard truth but one that is not easily proven. When a resident is harmed while
in the care of a nursing home, it becomes the responsibility of the family of
the resident to prove that the nursing home is to blame, even when the evidence
seems obvious.
A case against a nursing home for negligence or wrongful
death is usually considered a medical malpractice claim. It is not a simple
case to prove; the attorney representing the patient or patient’s family must
be able to prove that the injury or death was due to negligence on the part of
the nursing home. This means the case must be substantiated by evidence that
the nursing home did not provide what is considered standard care to the point
that it caused injury or death. These types of cases are extremely complicated
to prove due to the fact that most patients in nursing homes are already in
poor health. The family must be able to prove, with the help of an experienced
nursing home injury attorney, that the main cause of the injury was due to
negligent care. Though certainly possible, it can be a long, difficult battle
that families and the patient must endure, although worth the effort to stop
the nursing home from harming others in their care. Some aspects that will need
to be proven are:
- The nursing home deviated from standard care of a patient to the point that there was injury or death
- That the negligence was the primary reason for the injury or death
- The patient did not receive treatment that would be normally expected and this lack of care lead to the injury or wrongful death
For any family member that has had a loved one who was
injured while in the care of a nursing home, the first step after making sure
the loved one is safe and in the hands of caring medical personnel should be to
consult a nursing home injury attorney. There is certain documentation and
testimony that may be needed to start a case and the sooner the evidence can be
obtained, the better chance the attorney will have to be able to make a good
case. No one wants to think that those who have been trusted to care for their
loved one have harmed them. However, it does happen and when it is done in a
nursing home setting, there is legal recourse. Although both the state and
Federal governments regulate these institutions, it generally comes down to the
families of the patients to ensure that justice is served on the behalf of
their loved ones. It is a painstakingly complex process, but with the help of
an experienced nursing
home attorney, families and their loved ones can make sure the negligent
facility is held responsible.
Monday, November 12, 2012
Financial and Other Assistance to Help Care for Aging Veterans
We have been meaning to review veterans' option for assisted living, home care and nursing homes for some time now. Just in time for Veterans' Day, we have published our Veterans Guide to Paying for Long Term Care. In this guide, we look at all the financial assistance options available specifically for veterans in all areas of aging care regardless of the source of funding.
The majority of assistance comes from the Veterans Administration but surprisingly not all of it from VA Health Care or VA Medical Benefits. Veterans Home and Community Based Services, Veterans Pensions, supplemental insurance benefits for military retirees and other grant programs can help to offset the out-of-pocket costs of caring for an aging loved one who served this country. In addition to these programs, there are several forms of assistance specifically for veterans from non-governmental organizations. Non-profits also have programs whose benefits are intended to help US Veterans.
The organization of our Guide is intended to direct individuals by need. If a veteran is seeking residential care, the types of assistance are organized according to the type of residential care they require. If the individual is seeking home care, assistance is structured for the different types of home care. There is also a section on areas of assistance not provided by health care professionals or family caregivers. This includes the available options that help pay for durable or home medical equipment and assistive technologies that can reduce the veteran's dependence on others. Lastly, is the area of home modifications to account for service-related disabilities and other disabilities or physical challenges associated with aging.
Visit our Veterans Guide to Paying for Long Term Care
The majority of assistance comes from the Veterans Administration but surprisingly not all of it from VA Health Care or VA Medical Benefits. Veterans Home and Community Based Services, Veterans Pensions, supplemental insurance benefits for military retirees and other grant programs can help to offset the out-of-pocket costs of caring for an aging loved one who served this country. In addition to these programs, there are several forms of assistance specifically for veterans from non-governmental organizations. Non-profits also have programs whose benefits are intended to help US Veterans.
The organization of our Guide is intended to direct individuals by need. If a veteran is seeking residential care, the types of assistance are organized according to the type of residential care they require. If the individual is seeking home care, assistance is structured for the different types of home care. There is also a section on areas of assistance not provided by health care professionals or family caregivers. This includes the available options that help pay for durable or home medical equipment and assistive technologies that can reduce the veteran's dependence on others. Lastly, is the area of home modifications to account for service-related disabilities and other disabilities or physical challenges associated with aging.
Visit our Veterans Guide to Paying for Long Term Care
Thursday, October 25, 2012
Medicaid's Benefits for Home Care
We've just published the results from a major effort in which we researched Medicaid's home care benefits in all 50 states. The good news from our research is that Medicaid, in every state, has at least one program that will help families and aging individuals to care for their loved ones at home.
Additional good news is that Medicaid's care at home is not limited to personal assistance with the activities of daily living. In fact, Medicaid will cover a broad range of different support services that help the individual remain living in their home. Furthermore, Medicaid's assistance is not just limited to the individual who requires care. Many states provide assistance to family members and caregivers as well. Assistance such as respite care and caregiver training can be included. Lastly, we found Medicaid's home care assistance programs were provided both in the form of Medicaid waivers (which are not entitlements) and Medicaid State Plans (which are entitlements).
Now our enthusiasm must be tempered somewhat with our other findings. The majority (though not an overwhelming majority) of assistance programs were in the form of Medicaid waivers. Medicaid waivers limit enrollment. Individuals may be qualified but if the enrollment cap has been met, they are put on a waiting list. Waiting list times can last from a few months to many months.
For individuals who may not qualify for Medicaid or who are spending down assets to gain eligibility. Our state by state guide also provides links to each state's non-Medicaid programs that provide assistance for home care. Unfortunately, only about 50% of the states offer specific, non-Medicaid assistance to help elderly individuals remain living at home.
Visit our State by State Guide to Medicaid Home Care.
Additional good news is that Medicaid's care at home is not limited to personal assistance with the activities of daily living. In fact, Medicaid will cover a broad range of different support services that help the individual remain living in their home. Furthermore, Medicaid's assistance is not just limited to the individual who requires care. Many states provide assistance to family members and caregivers as well. Assistance such as respite care and caregiver training can be included. Lastly, we found Medicaid's home care assistance programs were provided both in the form of Medicaid waivers (which are not entitlements) and Medicaid State Plans (which are entitlements).
Now our enthusiasm must be tempered somewhat with our other findings. The majority (though not an overwhelming majority) of assistance programs were in the form of Medicaid waivers. Medicaid waivers limit enrollment. Individuals may be qualified but if the enrollment cap has been met, they are put on a waiting list. Waiting list times can last from a few months to many months.
For individuals who may not qualify for Medicaid or who are spending down assets to gain eligibility. Our state by state guide also provides links to each state's non-Medicaid programs that provide assistance for home care. Unfortunately, only about 50% of the states offer specific, non-Medicaid assistance to help elderly individuals remain living at home.
Visit our State by State Guide to Medicaid Home Care.
Friday, October 5, 2012
Understanding State Laws Applicable To Nursing Homes
Of even greater importance than how to pay for long term care is the issue of quality care. Jonathan Rosenfeld is an Illinois attorney whose firm specializes in the protection of nursing home residents. He has generously provided us with an excellent review of nursing home residents' rights and the various agencies and resources available to protect them.
-Editor
Nursing homes are under strict laws that govern resident’s rights to receive not only proper medical care and treatment, but to ensure privacy, independence and respect for the resident. Although there are Federal laws that are applicable to long-term care as well, each state also has its own laws and regulations. It is important for patients and their families to understand and know these laws and the rights to which they are entitled.
Resources:
http://www.medicare.gov/nursing/residentrights.asp http://www.nursinghomeinjurylaws.com/
Nursing homes are under strict laws that govern resident’s rights to receive not only proper medical care and treatment, but to ensure privacy, independence and respect for the resident. Although there are Federal laws that are applicable to long-term care as well, each state also has its own laws and regulations. It is important for patients and their families to understand and know these laws and the rights to which they are entitled.
State Agencies
Although each state may be different, many have specific agencies that handle overlooking the elderly and disabled within their state. Many will be part of the states Department of Health. Each state also has an Ombudsman program, which is mandated by the Federal government.- Ombudsman programs. The Federal Older Americans Act mandates that each state have an Ombudsman program dedicated to protecting persons in long-term care facilities. These regional offices work with residents and their families to support them by providing them with patient rights, resolving complaints and advocating for improved care.
- Elder care. Within the state system, there are departments that handle elder care, often called “Department on Aging” or something similar. These agencies handle all of types of elder services, such as community programs and home care assistance.
- Department Of Health. Most nursing homes will be regulated by their states health department and will have regular inspections. Each state will have specific regulations and laws that these facilities must meet or receive fines, penalties and even closure.
Know Your Legal Rights
When a person is in need of a nursing home, it usually is due to their need for daily care. Although this does mean giving up some independence so that the person can be cared for, it does not mean they give up their rights as an independent person. If a loved one needs to be in a nursing home, families should know what laws their state has and what is expected as a level of care. Some basic rights that are usually covered:- Financial freedom. The patient has the right to handle their own finances or choose someone to handle them for them.
- Medical decisions. Patients have a right to be informed about their medical care and to decline treatments and medications.
- Proper care. Each patient deserves proper care and to be protected from abuse or neglect.
Resources:
http://www.medicare.gov/nursing/residentrights.asp http://www.nursinghomeinjurylaws.com/
Tuesday, August 21, 2012
Medicaid's Assisted Living Benefits: A Good Option for the Lucky Few
Questions about Medicaid's assisted living benefits are probably the second most common questions we receive. The first being the more rhetorical "what do you mean Medicare doesn't pay for assisted living?". The latter has a simple answer, but the former is much more complicated as Medicaid benefits vary from state to state. Our organization recently undertook a major research project to determine just what Medicaid will pay for with regards to assisted living in the year 2012.
The first and most important point to make is that institutional or long term care Medicaid does not pay for assisted living. It is intended to help improvised individuals who require nursing home care. However, Medicaid Waivers in many states do provide assistance to individuals in assisted living residences. To avoid future confusion, we should mention that Medicaid Waivers are often referred to HCBS, Home and Community Based Services,1915 Waivers and sometimes Demonstration Projects.
The second, and also critically important point to make, is that unlike institutional Medicaid, Waivers are not entitlements. An entitlement program means that if one meets the eligibility requirements, they receive the benefits. Waivers, on the other hand, have enrollment caps (or slots in Medicaid parlance). Each Waiver is approved to assist a limited number of persons and once the limit has been reached, a waiting list is started. Another finding from our study was that the types of assisted living benefits varied by state and can be loosely grouped into one of three categories.
1) Personal Care Only - these states will pay for their waiver participants personal care costs regardless of the location in which they reside. Therefore, assisted living residents could expect the personal care portion of their assisted living bills to be covered, at least up to Medicaid's allowable reimbursement rates.
2) Nursing Home Level Care - similar to above, these states pay for personal care but also cover other nursing home level types of care for waiver participants. Again, independent of residence.
3) Complete Assisted Living - in these states, their Medicaid Waivers will pay for both personal care, nursing home level care and the room and board costs for the participants. Individuals must reside in assisted living communities which accept Medicaid reimbursements.
While the number of individuals receiving Medicaid help in assisted living is limited as is the amount of assistance they receive; the situation is not all doom and gloom. In fact, the long term view (current political environment aside) can almost be considered rosy. Ten years ago, approximately half the number of states provided assistance and we fully expect this positive trend will continue. Ten years from now, Medicaid Waivers in all 50 states will likely be covering assisted living for the elderly in some capacity.
We've consolidated the results from our study into a State by State Guide to Medicaid's Assisted Living Benefits in which we explore each state's coverage, its limitations and other state based alternatives.
The first and most important point to make is that institutional or long term care Medicaid does not pay for assisted living. It is intended to help improvised individuals who require nursing home care. However, Medicaid Waivers in many states do provide assistance to individuals in assisted living residences. To avoid future confusion, we should mention that Medicaid Waivers are often referred to HCBS, Home and Community Based Services,1915 Waivers and sometimes Demonstration Projects.
The second, and also critically important point to make, is that unlike institutional Medicaid, Waivers are not entitlements. An entitlement program means that if one meets the eligibility requirements, they receive the benefits. Waivers, on the other hand, have enrollment caps (or slots in Medicaid parlance). Each Waiver is approved to assist a limited number of persons and once the limit has been reached, a waiting list is started. Another finding from our study was that the types of assisted living benefits varied by state and can be loosely grouped into one of three categories.
1) Personal Care Only - these states will pay for their waiver participants personal care costs regardless of the location in which they reside. Therefore, assisted living residents could expect the personal care portion of their assisted living bills to be covered, at least up to Medicaid's allowable reimbursement rates.
2) Nursing Home Level Care - similar to above, these states pay for personal care but also cover other nursing home level types of care for waiver participants. Again, independent of residence.
3) Complete Assisted Living - in these states, their Medicaid Waivers will pay for both personal care, nursing home level care and the room and board costs for the participants. Individuals must reside in assisted living communities which accept Medicaid reimbursements.
While the number of individuals receiving Medicaid help in assisted living is limited as is the amount of assistance they receive; the situation is not all doom and gloom. In fact, the long term view (current political environment aside) can almost be considered rosy. Ten years ago, approximately half the number of states provided assistance and we fully expect this positive trend will continue. Ten years from now, Medicaid Waivers in all 50 states will likely be covering assisted living for the elderly in some capacity.
We've consolidated the results from our study into a State by State Guide to Medicaid's Assisted Living Benefits in which we explore each state's coverage, its limitations and other state based alternatives.
Subscribe to:
Posts (Atom)