Will Medicare or Medicaid Pay for Long-Term Care Services

Posted on

Feb 26, 2015

Book/Edition

Idaho - Boise and the Treasure Valley

Share This
Will Medicare or Medicaid Pay for Long-Term Care Services? Many people need some sort of long-term care services and support later in life as their ability to care for themselves declines. These services, such as assistance with bathing or showering, dressing, eating, transferring, toileting or continence can be provided in a persons home or long-term care community. May people who need long-term care services are confused about how much these services cost and who will pay for them. Some people think Medicare pays the costs. Others think they merely have to apply for Medicaid to have the government pick up the costs. Neither is necessarily correct. Medicare and Medicaid are two completely different programs which cover different services. Medicare Medicare is a health insurance program run by an agency of the federal government. It is available to all United States citizens above the age of 65 regardless of their income, providing that he or she paid taxes into the Social Security fund. It is basically run the same everywhere in the United States. Patients pay part of the cost through deductibles for hospital and other medical services. Medicare only covers medically necessary care and focuses on medical acute care such as doctor visits, drugs and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve such as a short stay in a rehabilitation facility, or physical/occupational therapy to help a patient regain function after a fall or stroke. Medicare does not cover long-term care services. Medicaid Medicaid is a joint federal and state government program that helps folks who have low income and minimum assets pay for non-medical long-term care services provided at home or long-term care community. Each individual state runs its own Medicaid program. Unlike Medicare, Medicaid pays for personal care assistance on a long-term basis even if there is no expectation that a persons condition will improve. Under the Federal Spousal Impoverishment Act, the government provides protection for married couples whereby a certain amount of the couple's combined assets and income are protected for the well spouse while the other spouse is qualified for Medicaid. For persons who do not meet the low income and asset criteria for Medicaid coverage, private paying from income and savings is the most common source to cover long-term care costs. Long term care insurance helps cover costs for those who purchased a policy earlier in life. Family members also play a large part by providing informal primary caregiving services to loved ones who need help. This article was written by Donna A. Schuyler, Attorney, who practices in the areas of estate planning, elder law, guardianship, and probate. Donna Schuyler Law, PLLC; elderlawboise.com. Phone 208-344-1947

Other Articles You May Like

How to Measure Senior Independence with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

How to Measure Senior Independence with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)As our relatives age, maintaining their independence and quality of life becomes a top priority. But how do you determine if your senior loved ones are able to continue living independently?In this article, we will explore how to measure senior independence through the lens of Activities of Daily Living (ADLs). The ability to perform ADLs independently often serves as an indicator of a person's overall health and their need for assistance or care. Understanding how to assess and support older adults in their daily routines is crucial for ensuring their well-being and helping them lead fulfilling lives.What are Activities of Daily Living (ADLs)?Activities of Daily Living (ADLs) are the fundamental, routine tasks that individuals typically perform in their daily lives to maintain personal care and physical well-being. The six basic ADLs are:BathingDressingGroomingEatingToiletingTransferring or moving from one location to another (e.g., from the bed to a chair)These activities are often the building blocks of personal independence and are crucial for an individual's basic self-sufficiency.What are Instrumental Activities of Daily Living (IADLs)?Instrumental Activities of Daily Living (IADLs) are a set of more complex tasks that are essential for living independently. IADLs encompass activities that involve functioning effectively within the community and managing one's daily life. Common IADLs include:CookingCleaningManaging financesGrocery shoppingManaging medicationsThe ability to handle these tasks independently can provide insights into an individual's capability to remain self-sufficient and engaged in their community. Managing IADLs requires more complex thinking skills, so it is common for these activities to be affected if a senior is having difficulty with memory or cognitive function.What is the Difference Between ADLs and IADLs?ADLs and IADLs are both important measures of someone's independence. But they differ slightly.The primary difference between Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) lies in the nature and complexity of the tasks they encompass.ADLs are centered on a person's ability to maintain essential self-care and personal hygiene. IADLs include more complex activities related to managing one's household, paying bills, community involvement, shopping, and meal preparation. Both sets of activities are critical for assessing a senior's functional independence and are used to determine the level of assistance or care they may need.Why are ADLs and IADLs important for caregivers and medical professionals?Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are important for professional or family caregivers and healthcare professionals. Assessing an older adult's physical and mental capabilities to perform ADLs and IADLs provides critical insights into their level of functional independence and their specific needs.ADLs offer a window into a senior's ability to manage essential self-care tasks, enabling them to tailor care plans to address deficits and provide appropriate support.Similarly, IADLs offer a broader perspective, assessing an individual's ability to live independently within their community.Occupational therapists and physical therapists often assess ADLs and IADLs so they can provide treatment for a senior to recover the function of--or compensate for--a certain activity of daily living.Recognizing a person's strengths and challenges in these areas is fundamental to creating comprehensive, personalized care plans for seniors. Identifying older adults' specific daily living needs improves the overall experience for both the caregiver and the care recipient.When to Assess ADLs and IADLsAssessing Activities of Daily Living and Instrumental Activities of Daily Living is a dynamic process that should be carried out at various key junctures in the lives of older adults.Initial assessments are often conducted when someone's health status changes significantly, such as if they experience an illness, injury, or disability.Regular assessments are also essential for seniors to monitor their functional abilities over time and to adjust care plans accordingly.Routine assessments are particularly important for caregivers and healthcare professionals, enabling them to provide timely support and interventions as needed to ensure seniors can maintain their independence and quality of life.How to Assess ADLs and IADLsAssessing Activities of Daily Living and Instrumental Activities of Daily Living involves systematic evaluation of an individual's ability to perform these tasks independently. Assessment typically includes direct observation, interviews with the individual and their caregivers, and sometimes the use of standardized assessment tools.For ADLs, a professional or family caregiver may observe and inquire about the person's ability to perform the six major activities of daily living: bathing, dressing, eating, toileting, grooming, and transferring.For IADLs, a family member or professional can ask questions about tasks such as meal preparation, housekeeping, and transportation to gauge independence.Standardized scales, like the Katz ADL Scale for basic activities or the Lawton-Brody IADL Scale for instrumental activities, can provide a structured framework for assessment. You can also use Florida Senior Consultings simple ADLs and IADLs checklist to assess your loved ones abilities.The goal of these assessments is to gain a comprehensive understanding of an individual's capability to live independently. Furthermore, assessments help caregivers identify areas with which older adults require assistance, and tailor care plans accordingly to support their functional independence and overall well-being.How ADLs and IADLs Affect the Senior Living ProcessWhen considering the transition of a senior to a senior living community, assessing their ability to perform ADLs and IADLs becomes crucial.This assessment helps determine the most suitable senior living environment, whether it is independent living, assisted living, memory care, or a skilled nursing facility.Assisted living communities often assist with IADLs like medication management, meals, and housekeeping. Some assisted living facilities offer additional ADL assistance for an added cost. Memory care communities may also include ADL support.To accurately determine a potential resident's needs, most communities request ADL and IADL assessments as part of their evaluation process.In SummaryThe assessment and understanding of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) hold a profound significance in safeguarding and enhancing the independence of seniors.These assessments provide a roadmap for tailoring care and support to meet their specific needs, ensuring they can continue to lead fulfilling lives while maintaining their dignity and autonomy. Recognizing and addressing challenges in ADLs and IADLs not only empowers seniors to age with dignity but also fosters a sense of self-worth and well-being.By focusing on these essential daily tasks, caregivers, healthcare professionals, and families can play a pivotal role in preserving the quality of life for our older loved ones and, in turn, promote a more compassionate and respectful approach to aging.What to do if Your Senior Family Member Needs Help with ADLsWhen a loved one requires assistance with ADLs or IADLs, sometimes it is best to enlist a professional.Florida Senior Consulting's team of expert senior advisors has a wealth of knowledge and experience in senior care. We help families make informed decisions about the most suitable senior living and care for their loved ones.Get peace of mind about your loved ones' safety and quality of life. Give us a call at (800) 969-7176 or visit FloridaSeniorConsulting.com.Senior living on your terms. The choice should be yours.

The Elder Orphan: How to Plan for the Potential of Aging Alone

The Elder Orphan: How to Plan for the Potential of Aging AloneHow to Plan for the Potential of Aging AloneA significant portion of the population is faced with the prospect of growing old alone - that is, not having family or friends around for support in times of trouble or when independent living is no longer practical. Moreover, as the baby boomer generation continues to age, the number of people aging without a family will likely increase.The prospect of aging alone can be intimidating, but it doesnt have to be. If you understand the challenges you may face and plan for them ahead of time, you may find that you can navigate this stage of life without fear or uncertainty.What is an Elder Orphan?Elder orphan is a term that has been coined to describe people who are growing old alone, without the support of spouses, children, or other close family members or caretakers. It is difficult to assess just how many people in the United States are in this situation because many physicians do not inquire about patients marital, familial, or social status. However, a 2016 study estimated 22% of the population 65 and older are at risk of becoming elder orphans.The study calculated older peoples risk of becoming elder orphans based primarily on whether they were married or had children, since these are the relationships that typically take on responsibility for caring for an older adult. An increasing number of Americans aged 45 to 63 are single, and fewer people in this age group have children. This means that the number of people at risk of becoming elder orphans will rise.Nevertheless, that study fails to tell the whole story. Not everyone with a spouse or children is safe from becoming an elder orphan, and not everyone who lacks these relations is destined to become one. Adult children do not always live close enough to provide adequate support, or they may be estranged from older parents. One may find themselves aging alone following the death of a partner. On the other hand, people without partners or children may find other caretakers in siblings or trusted friends who live nearby and therefore avoid becoming elder orphans.What Challenges Do People Aging Alone Face?People growing old without a family face several significant challenges:Health Problems: As you age, your risk for developing chronic health problems increases. These health conditions may affect your mobility and mental capacity, making it more difficult for you to care for yourself.Legal and Financial Affairs:There are significant financial and legal matters that can arise as you grow older. It can be difficult to find help with these if you have no children or close family members to assist.Isolation and Loneliness: Isolation and loneliness are not the same things, but they can relate to one another. Loneliness is a subjective feeling of being alone, while isolation is the objective state of having minimal contact with others. Whether occurring separately or concurrently, isolation and loneliness put you at greater risk for cognitive decline.What Can You Do to Prepare to Age Alone?The difficulties involved with aging alone are significant but not insurmountable. The key is to recognize the challenges you may encounter and plan ahead of time to meet them. Here are some steps you can take early on:Build a Support System: If you do not have close family members, you need to build a network of people you can rely on. Your old friends may be deceased or may not live nearby, but there are many opportunities for seniors to make new friends through volunteering, classes, clubs, and other community resources for older people.Make Use of Technology: Many older people are intimidated by adopting smartphones and all the technological advances that come with them. However, some of these new or relatively new technologies can be very helpful to seniors. Communicating via phones and social media apps can keep you from becoming isolated by connecting you with virtual communities, while medical alert systems and monitoring devices allow you to access help in an emergency.Get Your Paperwork in Order: For many people aging alone, one of the biggest concerns is what happens if they become incapacitated. You should express your wishes clearly in a living will and choose someone you trust as a health care proxy. This does not need to be a family member; in fact, it may be in your interest to choose a friend who understands your wishes and lives nearby.Turn to the Professionals: If you dont have family members who can help you sort out legal and financial matters, hire a professional trained in handling them, such as an elder law attorney or accountant.Consider Florida Senior Living Communities One of the biggest concerns you may have when aging without a family is where you will live. A senior living community allows you to live among peers and access care and support when needed.Florida Senior Consulting offers hundreds of senior living choices in communities across Florida to meet the needs of every senior we serve. Between assisted living, independent living, memory care, adult day care, and other options, there are plenty of communities in Florida that are suited for your own personal preferences and needs. This can be a very difficult landscape to navigate, and you should always engage the services of a professional to avoid the pitfalls and make the best decision possible the first time.Interested in Getting Help or Support from the Professionals at Florida Senior Consulting? We are a mission-driven company that believes deeply in purpose over profit. Our focus is helping every senior we encounter in the markets we serve to live their best life with the least amount of worry and the most support possible. We dont charge anything to sit down, get to know you, get to know your situation, and help you plan the best path forward.Call (800) 969-7176 today for your free consultation, or visit FloridaSeniorConsulting.com. Youll be glad you did!Senior living on your terms. The choice should be yours.

The Importance of Medical Alert Systems for Seniors Who are Aging in Place

Weve all seen the commercial with the infamous line: Help, Ive fallen and I cant get up! The advertisement itself may have been a bit melodramatic, but it raises an important question: what should seniors do if they actually fall and cannot get up?This is where a medical alert system can be critical.What are Medical Alert Systems?Medical alert systems, sometimes referred to as life alert devices, are emergency monitors for seniors to use as they go about their everyday lives. Many medical alert systems are used in the seniors home. These usually consist of a base unit and sensors that are mounted on the wall of the home. These types of systems can detect a fall in the home and trigger an automatic call to emergency services.Some systems also come with a portable option for the senior to wear wherever they go. The main feature of mobile options is the help button. When an emergency such as an injury or fall occurs, seniors can press this button to send out an alert and get the help they need.Oftentimes seniors wear these portable monitors around their neck like a long necklace, on their wrist like a bracelet, on their belt loop, or in their pocket. These monitors should be small and portable so the senior can wear them at all times, and waterproof so they can wear them in the bath or shower a common location for falls.How Do Medical Alert Systems Work?Most medical alert systems allow for real-time tracking through the use of voice, data, and GPS technology. This is important because it gives emergency services the seniors exact location in case of an emergency.With a mobile device, seniors can press the help button after a fall to alert emergency personnel. An in-home system will automatically alert emergency services when it detects a fall. Many basic systems simply alert emergency services once the help button is pressed. More elaborate systems are connected to a 24-hour call center that fields the emergencies and determines the next move. They are able to either alert the seniors emergency contacts (set up ahead of time) or send for emergency services if needed.Who Should Use Medical Alert Systems?All seniors could benefit from having a medical alert system, since you never know when an incident may occur. But, these emergency alert buttons are especially important for seniors who live alone or are aging in place. If a senior who lives alone has a fall and no one is there to help, a medical alert system is not just beneficial; it can actually be lifesaving.Additionally, wearing a medical alert system is one way for seniors to maintain their independence at home while still being prepared for an emergency. And it also provides peace of mind for family members and caregivers that their loved ones can access help in case of an emergency.Why Should Seniors Use a Medical Alert System?The main reason for seniors to use a medical alert system is to allow for fast action in case of a fall or other emergency. According to the CDC, around 36 million falls are reported among seniors every year. Falls can be caused by a number of reasons, such as certain health and cognitive conditions, loss of muscle mass, and weakened eyesight, reflexes, and balance. They can also be caused by unsafe footwear or safety hazards inside and outside the home, like steps, rugs, spills, and clutter.Falls should be taken seriously when they occur. Falls are the leading cause of accidents, serious injuries, and accidental deaths in seniors. To that end, emergency departments treat 3 million seniors for injuries from falls every year. That is more than 8,000 falls every day.The risk of falling can also be a major source of anxiety for seniors, as falls can threaten their independence, mobility, and physical health.Oftentimes when a senior falls, they need help from someone else to regain their balance and get back up. But, if they live alone or no one is around, they may not be able to get themselves up at all. Being stuck on the ground for a long period of time is extremely dangerous for seniors and prolongs their risk of serious injury. Therefore, getting help quickly after a fall is key. With a medical alert system, even a senior who lives alone can have peace of mind that help is available when they need it all at the push of a button. How Much Do Medical Alert Systems Cost?As with all technology, the price of medical alert systems can vary based on equipment, activation, monitoring type, extra devices, and additional features.Some companies allow you to rent their medical alert system equipment, and some require you to buy it. Buying the items may cost anywhere from $50-$350 depending on the type of equipment.In addition, many medical alert systems charge a monthly fee to use their service. This fee pays for access to the 24-hour emergency call center.Generally, the service cost for at-home medical alert systems is around $25 per month or $239 per year. The service cost for on-the-go-devices is slightly more expensive at around $30-$45 a month. Sometimes there is an additional one-time installation or activation fee that can range from $25-$100. However, this fee is often included in the package when you purchase and initiate a medical alert system.Are Medical Alert Systems Covered by Insurance?Usually medical alert systems are not covered by insurance. But, some options might be available to help you cover the cost.For example, your HSA or FSA may offer a deduction for medical alert systems. Medicare Advantage may also cover some of the cost of medical alert systems. You may be able to get coverage through Veterans benefits as well. However, make sure you check with your insurance provider or your states Medicare/Medicaid program, as benefits can vary by policy or state.If you need assistance funding a medical alert system, be sure to contact your local sheriffs office or Area Agency on Aging, which sometimes have grants or resources available. Best Affordable Medical Alert Systems for SeniorsThere are hundreds of companies that sell medical alert systems. Some of the top-rated, affordable options are as follows:MobileHelp - The National Council on Aging (NCOA) voted this company as Best All-Around System. Their monthly fees start at $19.95 and fall buttons are available for an additional $10 per month. They also offer a free trial period.Bay Alarm Medical - The NCOA voted this company as Best for the Price. Their fees start at $25 per month and fall buttons are available for an additional $10 per month. They also offer a free trial period.Lively - Voted Best Health Services by the NCOA, this companys fees start at $25 per month, with fall detection buttons for an additional $25 per month.Other options include Get Safe as a basic option, Medical Guardian MGMove as a wearable option, and Fast Help as an easy, quick option available on Amazon. Some other notable providers of medical alert systems are ADT Medical Alert and Life Alert.How to Help Your Senior Loved OnesMedical alert systems are one impactful way to gain confidence about your senior loved ones safety as they age. For some seniors, this is all the reassurance they need about their safety and independence. But, other seniors may need a little more support.Having a fall can reveal or trigger the need for additional support. Whether you are looking for support in a senior living community or are seeking home health care services, Florida Senior Consulting can help. Our expert senior advisors will find your loved one the care they need to lead a healthy lifestyle, stay safe and lower their risk of falls and injuries. With this peace of mind ultimately comes a better quality of life for seniors and their families.When the decisions become too overwhelming, our experts are here for you. And, we offer these services at no cost to seniors or their families.Senior living on your terms. The choice should be yours.For peace of mind, call us at (800) 969-7176 or visit us at FloridaSeniorConsulting.com.