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Paying for Personal Care in PA: Stuck Between a Rock and a Hard Place

Personal Care Homes (PCH) and Assisted Living Residences (ALR) are housing options typically for older adults that provide hands-on care with activities of daily living such as bathing, dressing, grooming and offer three meals a day, activities and medication monitoring. The average annual cost of a personal care home or assisted living in Pennsylvania is $41,400¹. While some older Pennsylvanians are fortunate enough to pay privately for these services, a much larger percentage simply cannot. Either way, many of those who need these levels of care are often mistaken on how it will get paid for. Many seniors and/or their families think that Medicare or Medicaid (aka Medical Assistance) will pay for some or all of personal care or assisted living. But, regrettably neither offer coverage in Pennsylvania, therefore private out-of-pocket payment tends to be the primary funding source for PA seniors. But, a fair number of states like Florida, North Carolina and Maryland do provide full coverage through their state Medicaid program. For full details on all 50 states, click [here].

For many older Pennsylvanians who begin to decline and struggle to live safely at home, moving to a personal care home can be the perfect solution. However, again due to average monthly costs of $3,450¹, it’s just not an option for many.

Of course this is nothing new, so state funded programs through Home and Community Based Services (HCBS), also known as Waiver Funded Services or Waiver Programs, were created to provide alternatives. They provide support and services that enable individuals to remain in a community setting rather than being admitted to a long-term care facility. Some of these waiver funds particularly aimed at helping seniors include adult day programs, non-medical home care, home modification grants and environmental adaptation services. While these are helpful, they may fall short for someone who cannot live alone safely 24 hours a day, for instance those with a dementia diagnosis. In cases where placement is an absolute must, the other option is nursing home placement; because if financially eligible, Medicaid will pay for them to be in a nursing home. The problem with this is that a number of these people don’t actually need true nursing care. For example, someone with moderate dementia may be in decent physical health, but because of safety or behavioral issues coupled with little income and no assets, nursing placement becomes the only option. Thus – “becoming stuck between a rock and a hard place.”

Some good news

There are two direct funding sources that will provide partial or possibly full coverage for PCHs and ALRs in PA. The first is Supplemental Security Income (SSI) and second is the Aid and Attendance Pension Benefit through the U.S. Department of Veterans Affairs.

Not to be confused with Social Security income that most everyone receives after retirement, Supplemental Security Income is strictly a needs-based program determined by one’s income and assets and, of course, physical need. It exists for people age 65+, as well as blind or disabled people of any age, including children.

To meet the SSI income requirements, you must have less than $2,000 in assets (or $3,000 for a couple) and a very limited income. SSI provides a number of benefits like the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. It also provides a monthly payment for the PA “Domiciliary Care or “Dom Care” program. As stated on PA Aging website, “Dom Care was created to provide a home-like living arrangement in the community for adults age 18 and older who need assistance with activities of daily living and are unable to live independently. Dom care providers open their homes to individuals who need supervision, support, and encouragement in a family-like setting.

Dom care residents are matched to homes that best meet their special needs, preferences, and interests. Dom care homes are smaller than the traditional personal care home in that home providers care for no more than three dom care residents. Unlike larger personal care homes, dom care homes are the individual providers’ homes. They are inspected annually to ensure they meet health and safety standards. If the home and provider pass this inspection, they become certified.

The local Area Agency on Aging is responsible for the initial certification and ongoing annual inspections of Dom Care homes in their area. They are also responsible for the placement of individuals into certified Dom Care homes.”

Supplemental Security Income in Pennsylvania will also cover monthly Personal Care/Boarding Home (PCBH) costs at $1,189.30 per eligible person or $2082.40 per eligible couple∗. The drawback to this funding option is that personal care homes must be willing to participate and accept these shortfall amounts. Thus, finding a participating facility can be a challenge. To get a list of facilities that accept SSI payments, please contact your local County Area Agency on Aging.

Next, the V.A. Aid and Attendance benefit provides an additional monthly pension to eligible veterans and/or their surviving spouses. Eligibility is based on income and assets, war-time service status and physical/medical need. This additional monthly stipend can be used for community based services, but can also be used to cover costs associated with placement in a personal care home or assisted living setting. To learn more click [here].

Lastly, another alternative in Pa, which falls under the category of community support is the LIFE (Living Independence for the Elderly) program. A person continues to live at home, but LIFE offers heavier partial day services and care to keep them there for as long as possible. “…it is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual [such as physician, nursing and rehab services, transportation and heavy physical assistance.]

Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania have “LIFE” in their name. The first programs were implemented in Pennsylvania in 1998.” This is a program, if eligible, Medical Assistance (Medicaid) will pay for.

Final thoughts

In Pennsylvania, those who can afford to pay privately for the assistive care facilities, the burden is mostly on you. If you are someone who might qualify for coverage based on low income and assets, you may be fortunate enough to find a local option. But for a large chunk of older adults who fall between these two extremes, I wish I had more options to share. My advice is to be more proactive and anticipate the possibility of needing care as we age. Be mindful of unnecessary spending or gifting after retirement. Become more familiar with placement options and related costs. And most importantly, save more for retirement and earmark it for future care! We’re all living longer and care is not getting any cheaper. And although senior advocacy groups like LeadingAge™ PA continue the push to have ALR/PCHs receive partial government funding; current legislation is trending away from covering institutional types of care.

For more information or help on this topic, please contact Messiah Lifeways Coaching at 717.591.7225 or coach@messiahlifeways.org.

¹Genworth Financial Cost of Care Survey 2017
∗Current SSI rates as of 2018

 

Thinking about moving to personal care?

Are you or a loved one considering a move to a Personal Care Home? One of the region’s newest options is Hopewell, which is the most recent edition to the Enhanced Living neighborhoods at Messiah Village. Check out the Top 10 Reasons to consider why a move to Hopewell might be the right choice for you.

  1. Hopewell embodies a new living option in personal care for individuals and couples. 26 new private apartments offer some of the largest personal care apartments in the region with four floor plans ranging in size from 532 to 767 square feet.
  2. Messiah Village offers a full range of daily living support options. Gain independence by obtaining your care needs without sacrificing your social needs.
  3. The Hopewell neighborhood is the newest addition to Messiah Village’s comprehensive care continuum – when skilled nursing or rehab needs arise, there’s no need to worry. A skilled team of outpatient physicians, clinicians, and therapists are available to meet your post-hospital needs.
  4. Your care will never be compromised, even if down the road financial worries loom. Our $16 million Endowment Fund for Benevolent Care means there is financial assistance if needed.
  5. Three well-balanced, chef-prepared, daily meals in the Asbury Room offer a delicious reason to leave your apron and skillets behind. If you crave a cappuccino or want to celebrate a special occasion with family, you can conveniently dine, at your own expense, in one of our four restaurants (3 of which you can access without ever going outside).
  6. Messiah Lifeways is a non-profit ministry governed by a local board of directors who live, work, and volunteer in Central Pennsylvania. You can rest assured that strategic decisions about your home are being made by people who believe in our mission.
  7. As a Messiah Village resident, trusted services from health professionals are available to you; no need to drive. You can schedule podiatrist, optician, audiologist, psychiatrist, and psychologist appointments on campus.
  8. Hopewell’s Asbury Room and Great Room are designed to resemble the inviting gathering spaces of private homes. Whether you’re entertaining family or playing games with neighbors, you will find a perfect spot to relax.
  9. Need a massage or manicure? Time for a new hair style? Leave the car keys aside and enjoy all-weather access to campus salons including the new Cerise Day Spa.
  10. So much more than your average retirement community…Amenities include a new Center for Vitality & Wellness with a warm salt water pool, lifelong learning courses, organized trips and more.

    Call 717.790.8201 for a private tour today!

       Adapted from the March 2018 Messiah Lifeways Preview Guide.

 

True or False: Long Term Care for Seniors

Long-Term Care: True or False?

From nursing homes to hospice care, or Medicare to power of attorneys, there are many myths and misconceptions about long-term care in Pennsylvania. Often long-term care and its details can be misinterpreted, miscommunicated, may be outdated or, in some cases, difficult to thoroughly understand. As older adults and/or their families begin to navigate the waters of long-term care, the journey can become complicated. With numerous options and decisions to be made, coupled with medical and insurance jargon and the fast pace of healthcare, making the right decision about the care you or a loved one needs is a challenge. This is especially true for those entering this labyrinth for the very first time.

Below is a sampling of a few common myths and misconceptions people have about long-term care, along with the answers to some of these often asked questions. Some answers may surprise you; others may affirm your knowledge, and some will help you make swifter and more educated choices. It should also help individuals plan ahead and get a better handle on terminology, plus shed light on the cost of care and whether you are financially prepared. Take the test and see how you fare.

TRUE OR FALSE?

1.      Personal care homes and assisted living facilities in Pennsylvania are one in the same. 

2.      Medicare pays for personal care/assisted living in Pennsylvania. 

3.      The monthly median cost of a one-bedroom in an assisted living residence or personal care home in Pennsylvania is $3,555. 

4.      The percentage of those 65+ living in nursing homes at any one point across the U.S. is approximately 15%. 

5.      The percentage of those 65+ that will need some form of long-term care (community based and/or facility based care) is 95%. 

6.      Medicare pays for long-term care in a nursing facility indefinitely. 

7.      The annual median cost of a semi-private (shared) nursing bed in Pennsylvania is $73,753. 

8.      Nursing Homes take all your money up front including your home, even if your spouse is still living there.

9.      The percentage of U.S. retirees with $100,000 or less in savings and investments is 71%.

10.   Hospice care neither prolongs life nor hastens death.

11.   Hospice is not limited to the 6-month terminal illness diagnosis.

12.   A person must be competent to sign a Power of Attorney or Advance Directive/Living Will. 

Answers:

1.      False! In 2011, the Office of Long-Term Living under the PA Department of Human Services began to license Personal Care Homes (PCH) and Assisted Living Residences (ALR) as two separate levels of care in PA. Though similar, there are differences based on concept, construction, and level of care. Currently there are approximately 1,200 licensed personal care homes in Pennsylvania as compared to only 35 licensed assisted living residences.²

2.      False! The only level of domicile/residential care that Medicare Part A covers is nursing care. This coverage is based on medical necessity and most often requires a qualifying stay in an acute care hospital.

3.      True! The average median cost is $3,555, which is an annual median cost of $42,660.¹ Despite their being a difference in licensure; current financial data for the cost of personal care and assisted living are lumped together. In Pennsylvania, these costs are out-of-pocket almost exclusively. 

4.      False! Estimates between 2013-2015 states anywhere from 3.1 to 3.4% of those ages 65+ live in institutional settings such as nursing homes at any one point. 

5.      False! The number currently stands around 70%.² Though most seniors won’t move into a nursing home long-term (see question 4), this statistic shows that a majority will need care and services provided by family and/or professionals both inside or outside the home. 

6.      False, False, False! Medicare Part A covers the cost of skilled nursing care for a limited benefit period. For more details on coverage and benefit periods, please go to Medicare.gov

7.      False! The annual average median cost for a shared nursing accommodation in PA is $105,485.¹ 

8.      False!!! Nursing homes are fee-for-service and charge a daily rate and bill on a monthly basis, much like paying a monthly rental. Therefore there is no upfront payment or entrance fee. Secondly, thanks to the enactment of spousal impoverishment rules, if a spouse or dependent child still lives in the house, the home is protected from having to be liquidated to pay for nursing care. Furthermore, a specific amount of joint assets is protected for the spouse still living in the community. To learn more about spousal impoverishment rules, visit LongTermCare.gov.

9.      True! Very sadly almost ¾ of retirees in the U.S. have less than $100,000 saved for retirement.³ Compare that to the annual median cost of a semi-private nursing room in PA, and you get a sense of how long (or not) your retirement savings might last.

10.   True! Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management. The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.

11.   True! Hospice services can extend well beyond 6 months as long as their physician certifies the need.

12.   True! In PA, after the Power of Attorney (POA) or an advance directive is drafted, the principal (the person making the POA) must be capable of understanding the document in order to sign it. However, elder law attorneys state that if a person suffering from dementia or Alzheimer’s disease has a “lucid moment” and are competent at the moment, they can still sign these documents and they would remain valid even if they do not remember signing it later on.

Scoring:SHOCKED

12 correct – very impressive!
8-11 correct – good job!
4-7 correct – definite room for improvement
0-3 correct – you better call the Coach for help! >

This list of questions could go on and on, and there is so much to learn. So if you have another question that isn’t on this list, please contact Messiah Lifeways Coaching at 717.591.7225 or email coach@messiahlifeways.org.

¹Genworth Financial Cost of Care Survey 2015
²Pennsylvania HealthCare Association, Long-Term Care Trends and Statistics
³Employee Benefit Research Institute and Greenwald & Associates, 2004-2016 Retirement Confidence Surveys

 

A Retrospective of Assisted Living versus Personal Care in PA

Similar yet different

Back in March 2013, I wrote an article examining the differences between Assisted Living Residences (ALR) and Personal Care Homes (PCH) in Pennsylvania. It stated that prior to January 2011 there was no true difference between these levels of care across the commonwealth. They were essentially synonymous, interchangeable terms. However, most facilities referred to themselves as “assisted living” rather than a “personal care home” because it sounded more pleasant and inviting. But if pressed to see their provider license, every single site would have donned a Personal Care Home certificate.

That all changed when PA Senate Bill 704 was signed in 2007 and then enacted in January 2011 by the Intra-Governmental Council on Long-Term Care. It defined and established assisted living as a separate form of long-term care in Pennsylvania.

Fast-forward 4 years  and the landscape has not changed much. Many consumers and even healthcare professionals still aren’t aware or fully understand the difference. Also the number of Personal Care Homes still far outweighs the number of ALRs across the state. For this reason, I am re-releasing the article to continue help others understand and appreciate the difference and to spark conversation about its future.

So Why the Change?

What prompted this additional level of care across the commonwealth? First, the state felt it needed to do better job of balancing public funding of institutional care with home and community programs for the PA’s seniors. Secondly, the philosophy of more choice was essential. Also according to an AARP study, “95% of older Pennsylvanians want alternatives to nursing home placement,” plus “another option was needed for many individuals who couldn’t live at home anymore, but didn’t require round the clock nursing care services.” The study also said national research showed “assisted living facilities would cost between one-half and two-thirds of the cost of daily skilled nursing care.” Additionally the bill was to be a starting point to help shift Medicaid (Medical Assistance) dollars to assisted living and away from nursing homes and therefore reduce the reliance on the much more expensive alternative.

Essentially assisted living was created to bridge the gap in care between Personal Care Homes and skilled nursing homes, but at a lower cost than nursing and in a setting that could allow residents to “age in place” for a longer period of time.

Specific Differences

Assisted Living Residences are licensed under 55 Pa. Code, Chapter 2800 by the Office of Long-Term Living. Though it does provide similar care to Personal Care Homes, they do have the capability to care for people that require heavier care for a longer period of time. Personal Care Homes are governed by the Department of Public Welfare whose regulations maintain certain limits on the care and setting that they can provide.

According to the Office of Long-Term Living, Assisted Living Residences are different from a Personal Care Home in 3 ways: concept, construction and level of care. The concept focuses on allowing a resident to “age in place” for a longer period of time before having to move to a nursing facility when their needs increase. Next, ALR construction would require larger units, private bathrooms, and the “capacity” for kitchen facilities. This model would allow for more privacy and maximum independence. Regarding level of care it would provide more assistance for a resident whose needs become too great for a Personal Care Home.

Two examples of a Personal Care Home resident needing to move to a nursing facility could include the following: if the resident requires multiple caregivers to transfer them from their bed to the toilet or if another resident needed help emptying their catheter. However, if those two people lived in an Assisted Living Residence they could remain there because of the required higher staffing ratios and specialized training for needs such as catheter care.

Interestingly, larger Personal Care Homes meet certain ALR requirements, particularly in the area of construction, but also by the concept of aging in place. This is achievable by the resident hiring supplemental care to assist them during the day along with adaptive equipment or modifications to their rooms.

The Current Outlook

The introduction of Assisted Living Residences in PA as a cheaper alternative to nursing homes that will allow seniors to delay or avoid a move to nursing facility in essence is great. However, the reality is a little less promising, at least presently. As of December 2014, there are only 33 licensed Assisted Living Residences spanning just 19 counties as compared to 1,221 Personal Care Homes in just about every county¹.

Why such a low number after so long? First, for many Personal Care Homes, the consideration to make the change to an Assisted Living Residence or even offer both on one campus is a massive strategic decision and commitment. Many communities would have to make structural changes to their buildings or enlarge apartments, add staff, provide additional training, plus put forth a major marketing and promotions effort. All of this, of course, costs money and takes time to make happen. Secondly, the prospect of reimbursement through Medicaid is just is not there due to a lack of state funding. Lastly, there is still hesitation by some providers to wait and see how those that have obtained their Assisted Living Residences license fair in the market and perform under the new regulations.

As I stated in my initial article, (more) time is needed to determine whether the growth and viability of  Assisted Living Residences will work in congruence with Personal Care Homes and nursing homes in Pennsylvania. I think the jury is still out on ALRs, but ultimately (in theory) it’s a better option for consumers, and I think it needs to replace it’s predecessor to become sustainable on a long-term basis.

For more information, please visit the Pennsylvania Department of Human Services website: www.dhs.state.pa.us

¹ PA Department of Aging website, Dec. 2014

This article was originally published March 2013 & updated Jan. 2015

What Is Aging in Place?


What exactly does it mean to “Age in Place”? Ideally, aging in place is leading a healthy and engaging life in your own “home” for as long as one chooses. And “home” should be considered a fluid term. But, if we delve deeper, we’ll discover its meaning becomes situational, conditional, and distinct to each person facing difficult life choices as they grow older and or more dependent on others.

Aging in place has become a broad term bandied about in the senior and long-term care industries for many years. At work, I use the term several times a day and provide guidance to older adults and their families on how to “age in place.” However, for those who have little or no exposure to an aging or disabled loved one struggling to live independently or safely at home, it may be an unfamiliar concept.

One way to help define aging in place, or muddy the waters, depending on how you look at it, is to dispel what it is not:

•It’s not exclusively defined by age. When you retire at 65 you’re not suddenly aging in place. Furthermore, is a healthy 81 year old still working full-time and leading a very active lifestyle aging in place? I wouldn’t necessarily say that he is. Plus, if I claimed he was, he might respectfully disagree, since I’m referring to my father-in-law. Conversely, we could reference a 45 year old female with a traumatic brain injury in which the family is doing everything they can to keep her at home as she becomes more dependent each passing year.

•It also is not defined necessarily by where you live. Someone residing in a place other than their house, such as in a retirement or 55+ community, a personal care home or assisted living, has the opportunity to age in place. Therefore, you can age in place in multiple stages and locations too.

Thoroughly confused yet? Don’t be. You can boil the term down to whether a person has a fundamental deficit or inherent need, that without help may not be able to live independently or safely. These deficits can be quite broad. It could be that because of aging, impairment or disability that person needs some home modifications: a ramp into the house, a bedroom on the first floor, or a walk-in shower rather than a bathtub. A deficit may also be due to a loss, such as the loss of driving privileges or loss of physical or mental capacities. Aging in place manifests itself if you now need assistance coming to your current living situation for the safety, welfare or maintenance of you or your household.

Another way to understand aging in place is to talk about its primary alternative. Typically, this is choosing to move to a retirement community or care facility because it could make life easier or more enjoyable or safer than living in a private residence. Statistically, if we examine the choice of aging in place versus making a move among older adults, the percentage of those who move into a facility for care is less than 15%. Thus, the majority of older adults will be living at home and opt to age in place.

There are a multitude of different services and resources that can help people stay at home and age in place. Family or hired caregivers and/or professional home care are keys to aging in place. Other options include: adult day programs, home modification, and technology such as emergency call systems, telemedicine and even the use of web cams. Additionally, home health care and hospice services, durable medical equipment, outpatient therapy and diagnostic programs bolster the effort of people living safely and healthy at home. Wellness programs, volunteering, community membership groups like Messiah Lifeways Connections, senior centers, and transportation services can help round out a healthy and engaging life in the comfort of your own home.

To learn more about aging in place options available through Messiah Lifeways Community Support Services, call 717.790.8209 or go to MessiahLifeways.org/community-support.

“Dirty Words” the Series, Avoiding a Faux Pas

“Aunt Edna lives in a rest home in Pittsburgh.”
“She works at an old folk’s home.
“His parents moved to a home last year.”
“My neighbor just visited a retirement facility.”

These bolded terms are like nails on a chalkboard to many of us who work for Messiah Lifeways. So this week we continue our blog series to identify more dirty words and phrases given to the places where older adults, baby-boomers and those 55 and better may want to live and call home. We will also highlight some of the more contemporary vocabulary so you can help us change the conversation about aging.

Let’s start by going way back with glum terms like:

Sanitarium: rather scary
Sailor’s safe harbor: huh?
Almshouse: that’s so 1800’s.
Rescue: we know that one from our early heritage.
Home for the aged: yikes.

Ok, those names are out of circulation, so help us do the same for these next terms, some of which I have heard all too recently:

Rest home: for narcoleptics, I guess.
A home: that simple “a” in front of it gives it a negative connotation.
Convalescent home: straight out of the 1980’s.
Old folk’s home: that’s just not nice.

My personal favorite is when someone lumps all levels of living together and calls it a facility. Such as saying “my aunt lives in a facility across town”. It sounds as if she lives in an institution or a military installation or worse yet – a bathroom! “I had too much lemonade, and I need to use the facilities.”

The term facility is very main stream and is used to generalize a number of different levels of living, but like rest home or old folk’s home, it needs to go away or be used less frequently or as a blanket term. Over the last two decades industry marketing efforts as well as government agencies have dropped the term facility for home, residence or living, because they offer a more accurate representation. You’ll likely recognize personal care home (PCH), assisted living residence (ALR), independent or residential living. Several more contemporary and suitable terms usually contain the word community, such as active adult community, continuing care retirement community, (CCRC), 55+ community, and retirement community .

(The word “facility” just doesn’t do justice to the 3 pictures above from the Messiah Village campus)

It is also essential when referring to a specific level of living, that you identify it as such. There are significant differences between them – sometimes subtle, sometimes great. Quite honestly those living in a CCRC, assisted living or active adult community don’t want to be lumped in with a broad term like facility. Now I wouldn’t call facility an appalling word, but it just not representative of what and how older adults view where they live. That word pigeonholes them. So no more faux pas’, be sensitive, be in the know. They want it be known as my community, my village, my residence, my home.

Again, please join the conversation. Also stay tuned for next week’s post in the “Dirty Words” Series, “You Called a Resident What?!”