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 Often long-term care and its details can be misinterpreted, miscommunicated, may be outdated or, in some cases, difficult to thoroughly understand.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

 

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

Finding the Right Place (Part 2- Assisted Living Residences)

As I mentioned in last week’s blog, part 1 of this 3 part series, one of the biggest challenges that a caregiver can face is helping an aging parent or loved one choose the right place to move when living at home is no longer an option. This includes those living alone with help coming into the home, and those who actually live with their primary caregiver. The willingness to admit there is a need for change is the first step in what should be a consensual decision to find the right nursing home, or personal care home, or today’s main focus, an assisted living residence.

Last week’s blog focused on choosing the right personal care home for your loved one. And while many of the tips and ideas are almost identical to choosing an assisted living, we have to again differentiate these two similar yet different levels of care specific to Pennsylvania. For the long version please refer back to my blog from March 2013. For those who want the abbreviated version, here goes. Up until January 2011, facilities like Bethany Village, Country Meadows, and Messiah Village offered a level of care called “assisted living”; however, they were all licensed as personal care homes by the PA Department of Public Welfare (DPW). Technically the term assisted living was inaccurate, but sounded more appealing, so that’s what most providers went with and identified themselves as. Meanwhile, legislation was brewing for nearly a decade in the Commonwealth that would change all of this and looked to create an alternate level of care to nursing care and personal care for aging and disabled Pennsylvanians. The goal was to create another option for care that promoted, provided, and allowed more care than what a personal care home could do. It was also meant to reduce or offset the need for the heavier care and more expensive option of a nursing home. The basis was to serve the gap or niche of clients that fell between these other two levels. This new level became known as an Assisted Living Residence (ALR), and it finally became a reality in January, 2011. From that point on in Pennsylvania, a facility had to be licensed as a Personal Care Home (PCH) or an Assisted Living Residence. They were no longer one and the same.

However, this reality has been a bit less than stellar. One of the other main differentiators of assisted living residences was supposed to be means-tested reimbursement through Medical Assistance to help pay for those who could not afford it privately. That, unfortunately, has not become reality due to state budget issues. The recycling of the name “assisted living” has also created much confusion for consumers, plus many healthcare professionals are still using assisted living and personal care interchangeably. Another problem has been a lack of interest by many facilities across the state to change their offerings and licensure to an ALR. For some companies it could require them to structurally alter their buildings and increase the square footage in resident rooms and would require more staffing and additional training. Consequently, the monthly costs would also likely increase; although it would be less expensive and provide a more homelike setting than most nursing homes. Unfortunately, a year and half later, there are still only about 2 dozen or so assisted living residences spanning 12 counties in PA, while there remains well over 1200 personal care homes located in just about every county across the state. Locally, Bethany Village and Columbia Cottage are the only two communities licensed to provide assisted living. Time will tell if ALRs are truly a viable option. I hope they are.

I digress – back to the topic at hand. Whether you are looking at a personal care home or at one of the scant assisted living options across the state, the same principles apply. First to locate the elusive ALRs, contact your county Area Agency on Aging, because the state’s online ALR directory is currently not available. They should be able to tell if one exists close to you. If so, you’ll want to ask for the facility contact information, whether it’s for-profit or non-profit, and most importantly access to the inspection surveys.

Just as with a personal care home, be sure to call for availability and ask about admission criteria and financial guidelines. Remember, you’ll want to streamline your list before you start to schedule one of the most vital steps, which is taking a tour. Again, schedule mom to have lunch or partake in an activity or ask if they have an ambassador program where they can speak directly with another resident one-to-one. Get copies of the menu, activity calendar, and newsletters. Don’t forget to ask about a respite program to let mom stay for a week or two to “try it out.” And finally don’t forget that, with non-profits in particular, you’ll want to ask if a benevolent or charitable care fund exists to pay for their care once your loved one’s assets are depleted.

As far as the question I mentioned last week about what happens when your loved one needs more care, this is where assisted living residences differ a bit from personal care homes. Its main concept is to help residents “age in place,” stay put, and get more care into them rather than moving them onto a nursing home. However, there still may be a point where nursing care may be needed if their medical treatment and care requires daily oversight by a physician and 24 hour care by a licensed nurse.

Lastly, and I cannot stress this point enough, whether it’s a personal care home or assisted living residence, do your research sooner rather than later. Don’t make such an important decision without thoroughly researching the options ahead of time.

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

Please stay tuned next week for the third and final part of this series, as we cover how to choose the right Nursing Home (Part 3).

 by: Matthew Gallardo, Messiah Lifeways Coach

“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?!”