I know I havent posted anything in a while and ask for your patience. I have been going through some personal struggles and need to spend time concentrating on my family. Please rest assured that I will be back posting articles and information soon.
Regards,
Vernon
Medicare – An Essential Part of Elder Care
By Tom Krahel
One time when we were taking care of my father-in-law I was explaining the costs involved in elder care, a befuddled person asked me, “Well, Medicare covers everything, right?” The short answer is that Medicare does cover a lot but it does not cover everything. In our case, my father-in-law was in the hospital thirteen times and in re-hab 8 times. Medicare and a Medi-Gap insurance policy covered his costs. This is how it works.
Medicare Part A
Medicare has different parts. Part A covers the hospital costs of people over 65. It also covers people under 65 who have kidney failure. It is paid for by contributions from employers, employees, and the self-employed and from premiums deducted from the social security payments of the person receiving the coverage. The premiums are deducted automatically from their Social Security payment. If your loved one (LO) is not receiving Social Security there is a seven month enrollment period, three months before their 65th birthday and four months after. Be sure they don’t miss this enrollment period.
Medicare does not cover long term or custodial care, which is what elder care usually involves. The services that are covered have to be prescribed by a doctor and provided by a Medicare approved facility. Medicare also covers hospice care if a doctor certifies that a person has six months to live. The recipient has to give up his other rights under Medicare.
Medicare Part B
Medicare Part B is paid for by the premiums of people who voluntarily enroll. The federal government pays the rest. Medicare Part B covers physicians’ costs, lab costs, outpatient care and certain home care services. It does not cover routine physical exams or routine eye exams, hearing aides, dentures, or orthopedic shoes. If your parent is covered by another form of insurance, such as a retirement program, he/she may not want to enroll in Part B. If that is the case he/she must let Social Security know about their decision.
Medi-Gap Insurance
Medicare Part B covers 80% of the bill. The remaining 20% has to be covered with a separate insurance policy.. We had the premiums automatically deducted so there would be no gap in the coverage. When buying Medi-Gap insurance make sure that it does not exclude pre-existing conditions. Be sure also that they buy the policy within six months of turning 65. If you enroll during that period, the insurance company can not charge more because of any pre-existing condition. Ask if the company is approved by the state insurance department to sell Medi-Gap policies. As always, fill out the insurance application completely. Don’t give the insurance company a reason to refuse your claim.
Medicare HMO
If you don’t want Medi-gap insurance you can enroll your parent in a Medicare HMO. He/she has to keep Medicare A & B but they use the doctors and hospitals in the HMO. One nice thing about an HMO is that it covers preventative care that is not covered by Medicare. An HMO also covers hearing aides (if you can your LO to wear one), dental care, and eye glasses. You pay monthly premiums to the HMO. Be aware that if your LO wants to get out of the HMO they have to apply for Medi-Gap insurance which could be more difficult if they develop a new health issue. They may not get guaranteed access to a policy.
Doctors and hospitals can go in and out of an HMO which may leave you with fewer options. When you inquire about joining an HMO find out how many doctors have left. Ask about switching doctors if your doctor leaves or if you are dissatisfied with his/her service. Since the elderly use so many prescriptions, be sure they can fill your current medications. Find out how often they update their formulary. How and who determine what is medically necessary and how can you appeal that decision? What happens when your LO needs emergency care while traveling beyond the area covered by the HMO?
Medicare Part D
Medicare Part D pays for part of the cost of prescription drugs. I think Part D was purposefully designed to be complicated. When I tried to figure the cost frameworks, the different tiers of drugs, the enrollment procedures I simply got more confused. I suggest you do what I did, and that is to talk with your pharmacist. He/she will know what medications your LO is on and which plan will offer the best coverage. That kind of advice is very valuable so it pays to patronize a good local pharmacist.
If You Have A Problem With Medicare
If a hospital or clinic wants to release your LO too early or if you have other issues with them ask the hospital for the phone number of the Peer Review Organization, or PRO. The PRO monitors the care given under Medicare.
Two Important Resources
Two of the best resources for more information about Medicare and Medi-Gap insurance is Medicare itself at Medicare.gov or 1-800-633-4227 or your local area agency on aging. That number is in your phone book.
I am certified by the Department of Health in New York State as a Home Health Aide to work with the elderly at home and those in hospice care. I addition, I provided care for an elderly relative both in his home and in our home for seven years. That care involved all the aspects of elder care such as legal, financial, medical, support, psychological, relationships, dietary, safety, physical therapy, and transportation. I have delivered lectures on these issues. For a free DVD on the basics of elder care go to HomeCareSurvival.com or visit my blog, HomeCareSurvival.com/blog, for more information.
Article Source: http://EzineArticles.com/?expert=Tom_Krahel
http://EzineArticles.com/?Medicare—An-Essential-Part-of-Elder-Care&id=3651491
I started as a Healthcare Administrator almost 10 years ago. It has always been a pleasure to get to know the staff, residents and family members that make working in this field such a joy. As an administrator I get to hear a lot of the things that don’t go so well. However, I also get to hear about when my teams have gone above and beyond to help someone. The people who choose to work in long term care are so dedicated to serving the needs of our residents that it humbles me and inspires me to be a better leader and a better person.
Thanks to Care Givers
I am also very humbled and inspired by the tireless efforts of the many family members and care givers of our residents who courageously look after the needs of their loved ones. The husband who visits the wife with dementia daily even though she can’t remember who he is. The daughter who has to balance the needs of her growing family and her career with overseeing the care for her mother or father. The neighbor who comes to visit because she knows no one else will. The many volunteers who give so freely of their time and themselves yet ask for nothing in return. When I see these generous acts of love and dedication it makes me so proud that I am able to be a part of it.
Senior Options
So as we head into the holiday season I am filled with such joy and peace with the knowledge that I have the honor of working in a field where there is love in such abundance. The acts of kindness that most people experience only during the holidays are daily occurrences in assisted living and skilled nursing homes all across the country. There are so many senior options available to family members who are trying to ensure the safety and comfort of their elderly loved ones. I am proud to be able to be a link in that chain and work hard everyday to ensure I do things just a little bit better to improve the quality of life for my residents.
The day a senior moves into a new long term care home can be either a very positive or negative experience. A good quality home will have a sound process in place to ensure that things go smoothly. However as a family member there are a few things that you can do as well to make the move in day as easy as it can be.
• Keep the day as normal as possible for the senior- Of course any moving day is tough even under the best conditions but try and do everything possible to keep the senior in their routine. My grandmother ate the same breakfast every day, and when she wasn’t able to her chances of having a bad day increased dramatically. These types of routines provide peace and comfort and can help to sooth some of the anxiety associated with moving.
• Have someone focus on just the senior- If you are fortunate enough to have help during the move in day assign someone just to stay with and essentially cater to the needs of the senior. Knowing that the senior is well taken care of and that all of their needs are being met frees you up to oversee the move in processes, sign documents, etc. There are also many senior options available that can help with the transition and beyond such as using care managers or private duty care givers.
• Bring favorite furniture and pictures- The senior’s new home in a long term care community should not look foreign to them. Ideally they will collaborate with you in deciding on what to bring. If they are not able to do so try and pick out pieces and items that you think are favorites and have sentimental value.
• Do everything you can to eliminate fear of the unknown- As with most of us fear of the unknown can be anxiety provoking so getting the senior involved in the decision making and keeping them informed can help. Although this may slow things down a bit try and focus on the long term results of getting the senior in to the new home with as little fear and anxiety as possible which will help them to adapt and accept their new surrounding.
These tips are general in nature so please keep in mind that nothing replaces your knowledge of your loved one’s likes and dislikes. Although the transition to a senior care home can be tough at times I know from first hand experience the oversight provided combined with the socialization opportunities helps to provide most seniors with a richer quality of life.
As an administrator in long term care we have to ensure that our frail elderly residents are being care for as directed by their physician, our company directives, and our own vision of how we think care should be provided.
The care givers that provide the daily hands on care are at the same time the most problematic area to manage and the area that brings the most pride in providing care compassion to our residents.
The ability to recruit and retain the type staff that is capable of providing quality care in an assisted living or skilled nursing environment is key to the success of the home. The work that care givers and nurse’s aids provide is challenging on a good day. It takes a very special kind of person to provide quality care to seniors consistenly.
As you evaluate assisted living or skilled nursing homes you should evaluate how the administrator is personally involved in staffing his or her community. One way of doing this is to ask questions. I would ask- “what criteria do you use when hiring staff?” The vast majority of long term care administrators will speak to the regulatory requirements for hiring, and their company policies for hiring employees. However, just as important but very seldom heard is what are the administrators’ personal requirements or expectations for hiring new team members. My personal philosophy goes something like this, I can train for technical skills but I can’t teach anyone how to be caring and compassionate, they have to have those qualities internally. As an administrator in senior care I have developed my own way of not only screening people for being caring and compassionate, but it is important that I teach it and preach it regularly.
There are other ways to probe and monitor how any senior living community ensures a balance between hiring for technical skills and hiring for a good heart. For more information please subscribe to my Blog and you will receive my monthly newsletter filled with more great advice on senior living topics from my perspective as an administrator.
Vernon Roberson, LNHA, MA
When family members see their parents or loved ones staring to need additional help they are faced with having to make the decision to move them to Assisted Living. The assisted living environment offers seniors the freedom to live independently in a supportive setting. They can have as little or as much help as needed. The socialization that seniors get in Assisted Living leads to a much better quality of life. I have had several residents tell me over the years, that they wish they would have moved in sooner.
The problem arises when the senior refuses to move. Here are a couple of effective strategies for helping a senior make the transition to assisted living.
1. Try before you buy- The best thing to do for a reluctant senior is to get them used to the idea slowly. There are several options for getting seniors slowly acclimated to the idea of moving into assisted living. You can try a Respite stay which is a short term stay, in a community that does not require a long term contract. Respite stays are generally from 2 days to 2 weeks. Having your loved one stay for the weekend will give them a good feel for what the community has to offer and often, is enough to dispel some of the dated misconceptions that seniors hold. Most communities charge a fee for a respite stay, but many will allow a perspective resident to enjoy a complimentary meal or two. This experience allows the senior to meet some of the residents and sample the food and services of the community. The senior may also want to attend a special event or a particular activity that interest them. All of these things should be done without putting pressure on the senior to make a decision. If the senior feels forced they will be more hesitant to move.
2. Listen to what is being said- Is the senior afraid of loosing their freedom or independence, are they afraid of giving up their personal belongings, or are they holding on to an outdated concept of senior housing? You have to listen closely and help the senior work through their concerns.
I have more tips that have been proven to work over the years that I will share in future Blog postings. Please subscribe to this post to get my free monthly newsletter filled with great information to help families navigate the worlds of Assisted Living and Skilled Nursing.
Vernon Roberson, LNHA, MA
As we head in to fall the risk to seniors health living in assisted living or skilled nursing centers rises because of the flu virus. Because of the congregate living conditions in senior care an outbreak can spread quickly. Every year thousands of seniors across the country die related to the annual flu. This year we also have to be concerned with the H1N1 Virus as well. The H1N1 virus is not impacting seniors as much as first anticipated and this may be related to many of them already having anti-bodies built up due to a previous swine flu outbreak in 1973.
Whether it is the H1N1 virus or the annual flu virus the protective measures are the same. If you have a loved one in a long term care setting you should be seeing some movement toward managing the risk of a flu outbreak. Some of the things that I am doing in my community are:
1. Ensuring my staff has received both the annual flu and the H1N1 vaccines. It is critical that everything possible be done to stop the virus from ever entering the facility.
2. Ensuring my residents have received their vaccines.
3. Establishing hand sanitation stations throughout the facility for staff, residents, and guests to use.
4. Communication to families and guests asking them not to visit the community if they are experiencing flu like symptoms.
5. To help ease concerns we are also conducting presentations for families and residents so there is a deep level of understanding of how the flu affects seniors in assisted living and skilled nursing.
The management and prevention of a flu outbreak in a senior care community has to be a concerted effort between administration nursing and the housekeeping team. If you are not seeing similar steps in the senior care community your loved one lives in as described above you should ask what steps are being taken. Hopefully this will give you a good baseline understanding.
Please feel free to subscribe to this Blog to receive my monthly news letter.
Vernon Roberson, LNHA, MA
Tips for choosing an assisted living or skilled nursing community
There are many really good senior options available when seniors need more care. However, making the decision to place your loved one in the hands of a long term care community is a tough one. I have seen many families struggle with fear, guilt, and regret in trying to make this very important decision. To that end, I would like to offer 3 quick tips to help in your decision making process.
I hope these tips help. And please feel free to leave a comment or ask a question. For more tips please subscribe to the infoseniorliving blog.
Vernon Roberson MA, LNHA
As a long term care administrator I have experienced many family members over the years that have been great advocates for their loved ones in my assisted living and skilled nursing communities. I have also seen many who have worked hard at being an advocated but who have been less than effective. It is important for families to be champions for their loved ones care and quality of life. So I would like to offer 3 quick tips to help increase your effectiveness.
1. Write vs. Talk- When an issue arises that requires your attention you can get really good results by putting your concerns in writing. A written letter hand delivered to the administrator requesting resolution and or a meeting is a powerful communication tool.
A letter generally requires a written response as a minimum which means the resolution will be well thought out and thorough.
2. E-mail Exchanges- By developing an e-mail relationship with the administrator you get a deeper level of access and increased frequency of communication. My only caution is to use with restraint.
3. Company Policy vs Licensing Regulation- At times family members will request things the facility refuses to do. Pay attention to the reasons given. If they say it’s against “company policy” you may have some flexibility. However if your request is a violation of “licensing regulations” there may not be much that can be done.
I hope these quick tips help. Please feel free to leave a comment or question as I am here to be a resource for family members.
Vernon Roberson, MA, LNHA
ASK THE ADMINISTRATOR
Welcome to my first Blog posting. I have created this Blog to serve as a tool for helping families whose loved ones are in a long term care facility. I have assisted families in working through the many challenges they face as they make the transition with their loved ones to an assisted living or skilled nursing setting. I have 10 years of experience as an Administrator in both Skilled Nursing and Assisted Living. I have worked in both small and large facilities, as well as in communities for low income seniors and in very upscale communities. I hold a graduate level degree, and currently work in the field as an Administrator. In short I have a broad breadth of experience in the long term care setting.
I have seen the struggle that families go through when placing a loved one in a long term care facility. I would like to do my part to make it a little easier. It is my hope that by giving a voice to the perspective of the Long Term Care Administrator, I will offer something of value that is not readily available. The role of the administrator is a combination of, business manager, social worker, and therapist. The interplay between the residents, families, and staff make the Long Term Care setting one in which each day is different.
Please feel free to ask questions and I will do my best to answer them for you from the perspective of an administrator.
I have three disclaimers and they are 1- anything I post is simply my opinion nothing more, nothing less. Don’t count on me or any other one resource to make decisions for you. 2- is that every community is different in how they operate and state laws specifically in Assisted Living vary greatly. 3- The last piece is please keep in mind that I am currently working in the field and my comments and references will be fairly generic as the privacy of my residents and family members is paramount. Please keep these things in mind. I look forward to being a resource for you.
