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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 Often long-term care and its details can be misinterpreted, miscommunicated, may be outdated or, in some cases, difficult to thoroughly understand.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

 

Medicare Snafu Continues to Cost Seniors

To compound the pain and suffering seniors endure during a hospitalization, financial heartache can make things worse, especially for those who may need skilled nursing care or rehabilitation after being discharged from the hospital. In order for Medicare A to potentially pay for up to 100 days of post-acute care in a skilled nursing facility, a patient must meet two Medicare criteria for coverage. First, they must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge. Secondly, they must have a condition that upon discharge requires skilled services such as physical therapy, IV antibiotics, or wound care. However, some Medicare beneficiaries are finding out that Medicare will not cover their post-acute skilled nursing stays because they technically did not have the necessary three-day stay in the hospital despite being there three days or even longer!

How’s this possible? This is where the snafu or technicality plays a role. Once in the hospital their status may remain as an “observation” patient rather than an actual inpatient admission. The observation period is meant to be used for testing and performing diagnostics to determine their illness or injury and whether full hospitalization is necessary. However, observation periods are stretching well beyond 24 hours and can go for several days and they do not count towards the required three-day stay. Some of these patients are then transferred to nursing facilities for further care or rehabilitation without any insurance coverage due to not meeting the first criteria for coverage. Plus, in some cases with communication breakdown, the individual may not find out they have to pay out-of-pocket until they receive the bill from the nursing facility a few weeks later. This all leads back to what they thought was a qualifying stay in the hospital. At a range of nearly $200 to $300 a day for skilled nursing care, that non-qualifying technicality becomes a very costly surprise.

This issue affects many seniors as well as younger disabled Medicare beneficiaries who need skilled nursing care. They run the risk of substantial out-of-pocket costs for post-acute care. Worse yet they may settle on going back home despite the physician’s recommendation or could be admitted to a lesser level of care that could jeopardize their health or safety, simply because they don’t want to pay out-of-pocket for a nursing facility.

Back in 2012, the Improving Access to Medicare Coverage (Act S. 818 in the U.S. Senate) and (H.R. 1543 in the U.S. House of Representatives) was introduced to help resolve this issue. The bill would not change the three-day stay requirement, but rather it would stipulate that Medicare beneficiaries hospitalized for “observation” for more than 24 hours would be deemed an inpatient, thus making that 24-hour period count as an admission day toward the necessary three-day stay.

Unfortunately, the bill never passed, and this problem has not yet been resolved. In 2015, there is bipartisan support in Congress to alleviate this issue. Senator Sherrod Brown (D-OH), Senator Susan Collins (R-ME), Senator Bill Nelson (D-FL), Senator Shelley Moore Capito (R-WV) and Representative Joseph Courtney (D-CT) have initiated an updated version of the Improving Access to Medicare Coverage Act of 2015 (S. 843/H.R. 1571). Again, like in 2012, this bill would require that time spent in observation would be counted towards meeting the necessary three-day prior inpatient stay.

This is an expensive and potentially harmful snafu that seniors and those with disabilities should not be saddled with. To learn more about this topic and the legislation trying to change it, go to LeadingAge.org. If you have questions about Medicare A coverage and eligibility for skilled nursing coverage, please contact the Messiah Lifeways Coaching Office at 717.591.7225 or email coach@messiahlifeways.org.

Originally posted September 4, 2012
Revised June 8, 2015
by Matthew J. Gallardo

Finding the Right Place (Part 3- Nursing Care)

So far in this three-part series, we have examined finding the right personal care home [part 1] and assisted living residence [part 2] for a loved one. Now the focus turns to nursing care, which includes skilled or intermediate nursing care, as well as rehabilitation.

Of all three levels to research this may be the most challenging and angst-ridden choice of all. Let’s face it, most people do not want to go to a nursing home, and family members can feel a great deal of guilt and trepidation during this process. At least with personal care or assisted living your parent or spouse is likely healthier and fairly independent and can embrace and even enjoy making a move. But when it comes to the point of needing nursing care, often times you may be making the primary decisions for a loved one who may be too ill or incapable of choosing on their own.

Defining Nursing Care
First, let’s clearly define nursing care. Skilled nursing provides continual daily nursing care and rehabilitation under the supervision of a physician. Examples of skilled care include physical therapy, intravenous injections, and wound care. Medicare A will pay up to a maximum of 100 days per benefit period, as long as there continues to be a skilled need within that period. Otherwise, if custodial care, like assistance with bathing, tolieting, feeding, or medication monitoring, becomes the exclusive need, it is then considered intermediate nursing care, which Medicare does not pay for. Intermediate nursing care is either private pay or covered by privately purchased long-term care insurance or by Medicaid (aka Medical Assistance) for those who qualify. And just like personal care and assisted living, the healthcare professionals involved with their care should be able to recommend whether nursing care is necessary.

A Wild and Emotional Goose Chase
First off, health care has changed and time is typically of the essence, especially when choosing a nursing home. The entire process of picking a nursing home will differ from the other two options for several reasons. First, the pace will be much faster. Most of the time with personal or assisted care, you’re not dealing with an emergency or critical placement. But with nursing, if an injury or illness occurs in the blink of an eye, the ever-shrinking time someone spends in the hospital doesn’t give you much leeway to research and choose a facility before their discharged and deemed unsafe to return home. Another issue is that you may have to negotiate or settle on a choice because of no availability, or certain facilities may not be able to meet your loved one’s needs, and in some cases insurance may influence your options. For instance, does the facility take Medicare or Medicaid? Meanwhile as you’re on this goose chase you’re likely dealing with the physical, emotional and mental complexities that you and your loved one are enduring. This is not meant to send you into a panic, but rather to provide a dose of reality that many families face after a loved one is hospitalized and or is recommended for nursing care.

If you are comfortable using a computer, which I assume you are if you are reading this, then technology can help expedite this process much faster. Just as with choosing a personal care home or assisted living, there are online resources to obtain a clear concise list of nursing homes in your area. The PA Department of Health- Nursing Care Facility Locator link provides a list county by county. It details their contact information, and you can compare the following information: non-profit versus for-profit status, number of beds, payment options, and nursing hours per resident per day. As you peruse this link, please note that the state required nursing hours per resident per day is 2.7 hours. You can also key in on the patient care and building safety inspection surveys. Medicare.gov also offers a nursing facility locater by zip code and displays the national five-star rating-system for nursing homes in your area. You can also visit eldercare.gov or call 1-800-677-1116 for more information on long-term care choices nearby.

As you begin to whittle down those choices based on the information you’ve gathered online, you can start to apply some of the previous principles to narrow the choice even further. Again to streamline the search, be sure to call for availability and ask about admission criteria and financial guidelines. Recommendations from the doctor, clergy or a social worker can at times be helpful. However, remember to ultimately make your own judgment. Next comes the all-important tour. Once you arrive for your scheduled tour, don’t be afraid to ask questions. Now is the time to ask. Also if a resident or a resident’s family allows, talk to them about the care and their experience. Take notice of your surroundings using your eyes, ears and especially your nose. Inquire about amenities on-site for your loved to go to like an activity area, gift shop, restaurant or library. Ask to talk with the activity or enrichment staff, or request an activity calendar and menu. For further questions to ask and a nursing home checklist, go to medicare.gov/NHCompare.

Once you have toured your revised list, submitted an application, and the facility has accepted your loved one and offers a bed, you will then work with their admissions department and the hospital to coordinate the sign-in and the admission itself. Be sure that you have their insurance cards and other important documents like a power of attorney and living will available for copy. And remember, this quite often is a rapidly moving process.

Plan Ahead as Much as You Can
Despite that finding nursing care is the most challenging to plan ahead for and can be a sensitive subject to discuss, be as proactive as you can be. If you recognize that a parent’s or spouse’s health is declining, doing some preliminary research can be a great help. Planning ahead also gives them a bigger role in the decision-making process, which is important in making this difficult transition. It’s also good to have several options, in case the first option has no openings. The hospital won’t let mom hang out until her first choice opens up. However, you do have the right to move her from that nursing facility to her first choice once they have an opening. Lastly, you’ll find that most facilities require an application and typically don’t have an application fee. So, if you really want get a jump on planning, submit an application ahead of time for future need. Hopefully you or your loved may never need to make that move, but if you do, you’re that much ahead of the game.

For more tips and information about choosing the right nursing home for a loved one, please contact the Coach at 717.591.7225 or email coach@messiahlifeways.org.

A Medicare Technicality Can Cost Seniors

To compound the pain and suffering seniors endure during a hospitalization, financial heartache could make things worse especially for those who may need skilled nursing care after being discharged from the hospital. In order for Medicare A to potentially pay for up to 100 days of skilled nursing care, the beneficiary must be “admitted to” and spend at least three days in an acute-care hospital. A second condition is that upon discharge they require skilled nursing services such as physical therapy, IV antibiotics, or wound care. However, some Medicare beneficiaries are finding out that Medicare will not cover their post-acute skilled nursing stays because they technically did not have the necessary three-day stay in the hospital despite being there three days or even longer!

How’s that possible, you ask? This is where the technicality plays a role. The reason is that they were kept in the hospital for “observation” rather than actually being admitted as an inpatient. The observation period is meant to be used for testing and performing diagnostics to determine what the illness or injury is and whether full hospitalization is necessary. However, that observation can go for several days and not count towards the required three-day stay. Some of these patients are then transferred to nursing facilities for further care or rehabilitation without any insurance coverage. In some cases with communication breakdown, the individual may not find out they have to pay out-of-pocket until they recieve the bill from the nursing facility a month later. This all leads back to what they thought was a qualifying stay in the hospital. At a range of nearly $200 to $300 a day for skilled nursing care, that Medicare technicality becomes a very costly surprise.

Senator John Kerry (Conn.) and Representative Joe Courtney (Mass.) recently introduced the Improving Access to Medicare Coverage Act S. 818 in the U.S. Senate and H.R. 1543 in the U.S. House of Representatives to help resolve this issue. The bill would not change the three-day stay requirement, but rather it would stipulate that Medicare beneficiaries hospitalized for “observation” for more than 24 hours would be deemed to have been an inpatient, thus making that 24-hour period count as an admission day toward the necessary three-day stay.

This issue affects many seniors as well as younger Medicare beneficiaries who need skilled nursing care. They run the risk of substantial out-of-pocket costs for post-acute care. Worse yet they may settle on going back home despite the physician’s recommendation or could be admitted to a lesser level of care that could jeopardize their health or safety, simply because they don’t want to pay out-of-pocket for a nursing facility.

To learn more about this issue and the legislation trying to change it, go to leadingage.org. If you have questions about Medicare A coverage and eligibility for skilled nursing coverage, please contact the Lifeways Coaching Office at 717.591.7225 or email coach@messiahlifeways.org.