Content Provided by The CareAvailability Team
Experts in senior living & care & retirement living industries here to share as much advice, guidance and love as possible.
March is Women’s History Month, and 2022 theme celebrates “Women Providing Healing, Promoting Hope” which according to the National Women’s History Alliance, is “both a tribute to the ceaseless work of caregivers and frontline workers during this ongoing pandemic and also a recognition of the thousands of ways that women of all cultures have provided both healing and hope throughout history.” : International Women’s Day is March 8th.
Women’s History Month was officially created by Congress in 1987, but the movement began with March 8, 1911 International Women’s Day as a global celebration of the achievements of women. In 1975 the United Nations sponsored International Women’s Day; and in 1975 the school district of Sonoma, California organized a weeklong celebration of women’s contributions to culture, and history. President Jimmy Carter issued the first presidential proclamation declaring the week of March 8, 1980 as National Women’s History Week.
“March” is named for the Roman god of war, Mars, because it was the time of year military campaigns would resume fighting after being interrupted by winter. Sadly that seems true in today as well, as the people of Ukraine as fight for democracy.
Other highlights in March include: Daylight Saving Time (13th), St. Patricks Day (17th), a very bright Full Worm Moon (18th) and Spring Equinox (20th). If you are a gardener or an optimist, start planting seeds, even if they are only seeds of hope!
CareAvailability site expands into California to help families navigate more than 14,000 care and senior housing options
CareAvailability is proud to announce its expansion into California. Setting a NEW industry standard, CareAvailability is the first and only website that delivers real-time reporting of availability for senior care up to the minute. The site first launched in Oregon during the COVID pandemic as an effort to help hospitals find care for patients needing to transition out of beds. Washington was added soon after the site went live, followed now by California. Unlike other sites, this online resource lists every provider at no cost, and each can update their current availability at no cost; this significantly increases Family and Patient Freedom of Choice like never before. Until now, there has not been a site that delivers a comprehensive list for families to search without having to give any personal details.
Senior advocates and health professionals rely on Care Availability to put together comprehensive lists of care options, as well as allowing people to self-navigate searching for care providers. Instead of care providers needing to update multiple paid sites, Care Availability is an easy one-stop resource, as they do not charge hospitals, physicians, health clinics, social workers or any health team for their services. Also included are Medicare Ratings to support Patient Freedom of Choice.
When a family starts looking for care or senior housing, the options can be daunting in an already trying time. In California, there are more than 7,000 Care Homes, 2,000 Assisted Living Communities, 1,800 Home Care Agencies, 1,200 Nursing Homes, and 2,900 hospice Agencies. To further complicate matters, many states use different terms to describe the same kind of care, such as: assisted living, residential care for the elderly, board and care, family care home, custodial care, long term care, and other terms that can be confusing for families to understand and differentiate. The team at CareAvailability has taken extra steps to provide educational articles to help families better navigate the maze of Long Term Care and aging, by providing links to state agencies, as well as explaining local terminology and regulations.
“With real-time senior care options and availability, Care Availability is a one-stop-shop for finding and contacting care providers from a source users can trust. There is no login required, no information shared, and it is free for anyone to use, including hospitals, senior case managers, and advisors,” CareAvailability’s CEO, Amy Schmidt, says. Ms. Schmidt further explains, “We wanted to list every housing and care company to have the most comprehensive directory available. We want families to access resources from any smart phone, tablet or computer without sharing their contact details.”
Care Availability’s expansion to California means an additional 16,750 providers are now listed in Care Availability’s database of resources, which includes more than 8,000 assisted living communities, 2,800 home health agencies, 1,800 home care agencies, 1,200 skilled nursing facilities, and 2,900 hospice agencies.
Fun Facts about California
California is one of the most popular destinations in all of North America, and famous for the Golden Gate Bridge, Disneyland, and Hollywood. Other things unique to California are Coachella, the Wine Country, Silicon Valley, and Surf Culture, in addition to less obvious sights.
In 1850, California became the 31st state. Prior to its statehood, California was an independent country for one month in 1846.
African American History Month: Celebrating Black Health & Wellness
February is African-American History Month and celebrates the rich cultural heritage, triumphs and adversities that are an indelible part of our country’s history. February was chosen primarily because the second week of the month coincides with the birthdays of both Abraham Lincoln and Frederick Douglass. Lincoln was influential in the emancipation of slaves, and Douglass, a former slave, was a prominent leader in the abolitionist movement, which fought to end slavery.
I only recently learned that every year has a theme, and this year’s theme, “Black Health and Wellness,” focuses on: the legacy of Black scholars, medical practitioners, and other ways in which the Black community have contributed to healthcare. This month is the perfect time to reflect on America from a public health perspective. The CDC has recognized that institutionalized racism serves as a threat to social determinants of health. Social determinants of health include the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing are just a few. Another important social factor leading to poor health outcomes and economic disadvantage among African Americans is racism, because not only is it a stressor, but it impacts who gets what in America, particularly health care.
CareAvailability, the website dedicated to helping seniors, their families and healthcare professionals find care in real time, is proud to announce the launch of their new and improved website.
Senior advocates and healthcare professionals who have relied on CareAvailability to put together comprehensive lists of care options are delighted to see the website’s new and improved design and functionality while staying true to their mission.
Real-time senior care options and availability. A one-stop-shop for finding and contacting care providers from a source you can trust. No login required, no information shared, free for anyone to use (including hospitals and senior case managers/advisors).
CareAvailability’s new website has also been designed to better serve seniors themselves by making searching easy and straight forward to use.
“There are tons of website that offer senior care and housing listings, but CareAvailability.com is the only one that lists every agency at no cost to the providers to be included, and does not require families to share their personal information to view the search results,” CareAvailability’s CEO, Amy Schmidt, says. Ms. Schmidt further explains, “It is truly the first comprehensive resource site.”
Hospice and Palliative Care combine pain control, symptom management, and emotional and spiritual support.
Both care methods can offer relief from the symptoms of a serious illness, but have slight differences that most people are not aware of. It is important to understand what those differences are so you can determine which care plan is right for you.
What is the difference between Hospice and Palliative care?
Hospice is traditionally an option for people whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) rather than ongoing curative measures, enabling you to live your last days to the fullest, with purpose, dignity, grace, and support. While some hospitals, nursing homes, and other health care facilities provide hospice care onsite, in most cases hospice is provided in the patient’s own home. This enables you to spend your final days in a familiar, comfortable environment, surrounded by your loved ones who can focus more fully on you with the support of hospice staff.
Palliative Care refers to any care that alleviates symptoms, even if there is hope of a cure by other means. Both palliative care and hospice care provide comfort. Palliative care focuses on easing pain and discomfort, reducing stress, and helping people have the highest quality of life possible. It is appropriate at any age and any stage of a serious illness, not just end-of-life. It is an ‘extra layer of support’—treating the symptoms of an illness and supporting the entire family.
Your disease doesn’t have to be terminal for you to qualify for palliative care and, in the U.S., many palliative treatments are covered by Medicare. In some cases, palliative treatments may be used to alleviate the side effects of curative treatment, such as relieving the nausea associated with chemotherapy, which may help you tolerate more aggressive or longer-term treatment.
When is it Time for Hospice Care?
There isn’t a single specific point in an illness when a person should ask about hospice and palliative care; it very much depends on the individual.
Typically, it is NOT time for hospice care if you are currently benefiting from treatments intended to cure your illness. For some terminally ill patients, though, there comes a point when treatment is no longer working. Continued attempts at treatment may even be harmful, or in some cases treatment might provide another few weeks or months of life, but will make you feel too ill to enjoy that time. While hope for a full recovery may be gone, there is still hope for as much quality time as possible to spend with loved ones, as well as hope for a dignified, pain-free death.
It depends almost as much on the patient’s philosophy of living and spiritual beliefs as it does on his or her physical condition and the concerns of family members.
Signs you may want to explore hospice care:
You’ve made multiple trips to the emergency room, your condition has been stabilized, but your illness continues to progress significantly, affecting your quality of life.
You’ve been admitted to the hospital several times within the last year with the same or worsening symptoms.
You wish to remain at home, rather than spend time in the hospital.
You have decided to stop receiving treatments for your disease.
How and Where is Hospice Care Delivered?
Hospice care is usually provided in the person’s home. It also can be made available at a special hospice residence. Hospice is a combination of services designed to address not only the physical needs of patients, but also the psychosocial needs of patients and their loved ones.
Hospice is primarily a concept of care and not a specific place of care.
Hospice combines pain control, symptom management and emotional and spiritual support. Seniors and their families participate fully in the health care provided. The hospice team develops a care plan to address each patient’s individual needs.
The hospice care team usually includes:
The terminally ill patient and family
Doctor
Nurses
Home health aides
Clergy or other spiritual counselors
Social workers
Volunteers (if needed, and trained to perform specific tasks)
Seniors and family caregivers facing end-of-life decisions often must deal with very difficult issues of grief and loss both before and after their loved one dies. In addition, they may have practical concerns about their legal rights and how to pay the bills now that an important member of the household is gone.
What Care Levels Can Hospice Care Include?
Hospice care can include four levels of care: routine home care, continuous care, general inpatient care, and respite care.
Routine home care is a starting point for most patients in hospice because it allows the patient to live wherever they call home while receiving the care they need to help them feel comfortable.
Continuous care is provided for brief periods when the patient has high needs. Hospice nurses or aids care for these patients round-the-clock to avoid hospitalization.
General inpatient care includes any needs that can’t be managed at home. Patients needing this type of care are sent to a hospital or inpatient care unit until their symptoms are alleviated enough to be able to return to their home.
Respite care is temporary care provided to give family caregivers a break.
How Long Does Hospice Care Last?
Your loved one is welcome to remain in hospice care as long as they meet the criteria. Some patients remain on hospice longer than six months and some improve and graduate from hospice care, moving on to independent living or home health. Others remain in hospice care and receive help and comfort as they and their families prepare.
How Can I Pay for Hospice Care?
Medicare, private health insurance, and Medicaid (in 43 states) covers hospice care for patients who meet eligibility criteria.
Private insurance and veterans’ benefits may also cover hospice care under certain conditions. In addition, some hospice programs offer healthcare services on a sliding fee scale basis for patients with limited income and resources. To get help with your Medicare questions call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. Additional information about how to pay for hospice care can be found at the Public Policy Institute of the AARP.
Who Pays for Palliative Care?
Medicare, Medicaid, many insurers, and healthcare plans will cover the medical portions—physician and nurse services—of palliative care.
Veterans may be eligible for palliative care through the Department of Veterans Affairs. Check with your doctor and healthcare plan to see what insurance will cover in your particular situation. Unlike the comprehensive hospice benefit, there is no comprehensive palliative care benefit.
My Family Member Is Ready For Hospice. Where Do I Begin?
People who qualify for hospice have a life expectancy of six months or less.
To determine if your loved one is ready for hospice, he or she needs recommendations from their physicians. They will determine the life expectancy based on a physical assessment, medical history, and other diagnoses.
A Case Study of Hospice Care
The following case study shows how one patient decided that hospice care was what she wanted and why it was right for her:
Lynda was 57 years old when she was diagnosed with liver cancer. In spite of the best medical treatment her doctors could provide, her cancer proved incurable. Although the prospect of dying frightened her, Lynda wanted to receive professional assistance to prepare herself and her family for her death.
She realized that she wanted to be cared for at home by her sister, Sara. The local hospice service made the arrangements so that this would be possible. Hospice staff made sure that Lynda’s family would have the equipment they needed, and trained Sara in how to administer medications to relieve Lynda’s pain.
The hospice program also sent a registered nurse to the house to oversee Lynda’s care, and the nurse consulted with a doctor to make sure Lynda was as comfortable as she could be during her final weeks. In addition, the hospice service sent a personal care attendant to bathe Lynda twice a week, and a social worker and a clergyman to provide spiritual and grief counseling for Lynda and Sara.
Lynda lived the last six weeks of her life at home before she passed away surrounded by Sara and the rest of her family.
Resources and credits for this article: National Hospice and Palliative Care Organization and US Dept of Health and Human Services, Administration on Aging
Although this is not a new program, not everyone is aware of his or her potential eligibility. “Veterans have earned this benefit by their service to our nation,” said Secretary of Veterans Affairs Jim Nicholson. “We want to ensure that every veteran or surviving spouse who qualifies has the chance to apply.”
This benefit may be available to wartime veterans and surviving spouses who have in-home care or who live in nursing-homes or assisted-living facilities.
Many elderly veterans and surviving spouses whose incomes are above the congressionally mandated legal limit for a VA pension may still be eligible for the special monthly Aid and Attendance benefit if they have large medical expenses, including nursing home expenses, for which they do not receive reimbursement. To qualify, claimants must be incapable of self support and in need of regular personal assistance.
Some Basic Criteria
The basic criteria for the Aid and Attendance benefit include, but not limited to the inability to feed oneself, to dress and undress without assistance, or to take care of one’s own bodily needs. People who are bedridden or need help to adjust special prosthetic or orthopedic devices may also be eligible, as well as those who have a physical or mental injury or illness that requires regular assistance to protect them from hazards or dangers in their daily environment.
For a wartime veteran or surviving spouse to qualify for this special monthly pension, the veteran must have served at least 90 days of active military service, one day of which was during a period of war, and be discharged under conditions other than dishonorable.
Wartime veterans who entered active duty on or after September 8, 1980, (October 16, 1981, for officers) must have completed at least 24 continuous months of military service or the period for which they were ordered to active duty.
If all requirements are met, the VA determines eligibility for the Aid and Attendance benefit by adjusting for un-reimbursed medical expenses from the veteran’s or surviving spouse’s total household income. If the remaining income amount falls below the annual income threshold for the Aid and Attendance benefit, VA pays the difference between the claimant’s household income and the Aid and Attendance threshold.
The Aid and Attendance has an income threshold for a veteran without dependents and the threshold increases if a veteran has a dependent(s). The annual Aid and Attendance threshold for a surviving spouse also increases if there is a dependent child(ren). Information is also available on the Internet at www.va.gov or from any local veterans service organization.
Aid and Attendance Benefits and Housebound Allowance
Aid and Attendance (A&A) and Housebound benefits are benefits paid in addition to a veteran’s monthly pension, providing they meet the benefit criteria.
A veteran may be eligible for A&A when:
The veteran requires the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting himself/herself from the hazards of his/her daily environment, OR,
The veteran is bedridden, in that his/her disability or disabilities requires that he/she remain in bed apart from any prescribed course of convalescence or treatment, OR,
The veteran is a patient in a nursing home due to mental or physical incapacity, OR,
The veteran is blind, or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less.
A veteran may be eligible for Housebound benefits when:
The veteran has a single permanent disability evaluated as 100-percent disabling AND, due to such disability, he/she is permanently and substantially confined to his/her immediate premises, OR,
The veteran has a single permanent disability evaluated as 100-percent disabling AND, another disability, or disabilities, evaluated as 60 percent or more disabling.
A veteran cannot receive both Aid and Attendance and Housebound benefits at the same time.
How to Apply for Aid and Attendance and Housebound Benefits
The unfortunate truth of the matter is that many veterans are unaware they themselves and/or their spouse may be eligible for VA funded care. These benefits have specific criteria that need to be met and the process is often more involved than you’d think, but it’s worth it to get a potentially large part of the cost of their care covered.
You may apply for Aid and Attendance or Housebound benefits by writing to the VA Regional office having jurisdiction of the claim. That would be the office where you filed a claim for pension benefits. If the regional office of jurisdiction is not known, you may file the request with any VA regional office.
You should include copies of any evidence, preferably a report from an attending physician validating the need for Aid and Attendance or Housebound type care.
The report should be in sufficient detail to determine whether there is disease or injury producing physical or mental impairment, loss of coordination, or conditions affecting the ability to dress and undress, to feed oneself, to attend to sanitary needs, and to keep oneself ordinarily clean and presentable.
In addition, it is necessary to determine whether the claimant is confined to the home or immediate premises.
Whether the claim is for Aid and Attendance or Housebound, the report should indicate how well the individual gets around, where the individual goes, and what he or she is able to do during a typical day.
Does the VA Pay for Caregivers? YES!
What are Homemaker/Home Health Aide (H/HHA) Services?
Taking care of another can be mentally and physically demanding. A spouse or an individual trying to do it all can quickly become depressed, injured or just worn out. A Homemaker/Home Health Aide is a trained caregiver who can come to a Veteran’s home and help the Veteran take care of themselves and their daily needs.
A Homemaker/ Home Health Aide can also be used as a way to get Respite Care at home for the family caregiver. They can help Veterans remain living in their own home.
Homemaker/Home Health Aides are not nurses, but they are supervised by a registered nurse who oversees the Veteran’s daily living needs. They are trained, licensed, bonded and insured caregivers. Homemaker/Home Health Aides work for contracted, VA-approved organizations that specialize in assisting Veterans who need skilled services such as assistance with activities of daily living or instrumental activities of daily living. Services can be used in combination with other Home and Community Based Services.
Who is Eligible?
Homecare services are part of a service within the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible if they meet the clinical need for the service. There is no age requirement.
A co-pay for Homemaker/Home Health Aide services may be charged based on the veteran’s VA service-connected disability status.
Services are based on the veteran’s assessed needs. A veteran or family caregiver can talk with a VA social worker to find out what specific help they may be able to receive. For example, a caregiver may be able to come to the home daily, several times a week or just once in a while, depending on the veteran’s needs and what the VA has approved.
What Services Can I Get?
A brief list of daily activities you may be able to receive help with include:
Eating
Getting dressed
Bathing
Using the bathroom
Moving from one place to another
Shopping for food
Cooking & Cleaning
Doing laundry
Taking medication
Getting to appointments
Using the telephone
What About Help for the Spouse Caring for a Veteran (Respite Care)?
For the Family Caregiver, it can be hard to find time for a much-needed break from the daily routine and care responsibilities. Respite care is time for relaxing and renewing energy. If a Veteran requires a Caregiver, the spouse is eligible to receive up to 30 days of respite care per year. The care can be offered in a variety of settings including in your home.
Respite care may also be provided after family caregiver’s unexpected hospitalization, a need to go out of town,
or a family emergency. Staying strong while caring for your Veteran means staying strong for yourself. By taking an opportunity
to be refreshed through respite care, you may be amazed at how your fresh outlook will help you and your Veteran.
There are Resources to Assist You…
If you’d like to find out if you or a family member is eligible, you’ll want to start the process sooner rather than later as it can take up to 6 months to get approved.
We recommend asking trusted sources for help with the application process, such as your care community, the local senior center, the local Senior & Disability Services office or a senior care referral agent.
The simple answer: Medicare and Medicaid are two different healthcare programs with different functions and beneficiaries. The oversimplified answer: Medicare is a federal healthcare insurance program primarily for seniors regardless of income. Medicaid is a joint program between federal and state agencies to provide healthcare to low income people of all ages.
Here is a short video with mnemonic cues to help explain by Pixorize.
What is Medicare?
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs.
Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
Medicare is a federal health insurance program for:
People age 65 or older.
People under age 65 with certain disabilities.
People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Consumers contribute to some of the costs of Medicare through premiums, deductibles and copayments.
How do I enroll in Medicare?
You can call the Social Security Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their website at www.socialsecurity.gov.
The Medicare.gov website also has a tool to help you determine if you are eligible for Medicare and when you can enroll. It is called the Medicare Eligibility Tool.
If you already receive benefits from Social Security:
If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2010, your Medicare effective date would be February 1, 2010. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2010, your Medicare effective date would be January 1, 2010.)
If you are not getting Social Security benefits:
If you are not getting Social Security benefits, you can apply for retirement benefits online. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213.
If you are under age 65 and disabled:
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. (Note: If you are under age 65 and have Lou Gehrig’s disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 1-800-772-1213 or visit the Social Security website. See alsoSocial Security’s Medicare FAQs.
Medicare Benefits are broken into Medicare part A,B, C and D that help cover specific services
Medicare Part A (Hospital Insurance) –
Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
Medicare Part B (Medical Insurance) –
Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.
Medicare Part D (Prescription Drug Coverage) –
Medicare Part D is also known as Medicare Prescription Drug plan. Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.
Medicare Advantage Plan-
Medicare Advantage Plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. In most cases, Medicare Advantage Plans also offer Medicare prescription drug coverage. A Medicare Advantage Plan can be an HMO, PPO, or a Private Fee for- Service Plan. May sometimes be referred to as Medicare Part C.
Medicare Certified-
Medicare Certified facilities can offer services to individuals receiving Medicare benefits in exchange for reimbursement from Medicare.
Medicare Advantage Plan – Medicare Part C
Medicare Advantage Plan is offered by a private company that contracts with Medicare to provide you with all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage Plans also offer Medicare prescription drug coverage. A Medicare Advantage Plan can be an HMO, PPO, or a Private Fee for Service Plan.
**Formerly known as Medicare Part C or “Medicare+Choice– These are Medicare-approved private insurance plans, including HMOs, PPOs, private fee-for-service plans, and medical saving accounts. These plans may or may not include prescription drug coverage.The M+C program in Part C of Medicare was renamed the Medicare Advantage (MA) Program under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was enacted in December 2003. The MMA updated and improved the choice of plans for beneficiaries under Part C, and changed the way benefits are established and payments are made. Under the MMA, beneficiaries may choose from additional plan options, including regional PPO (RPPO) plans and special needs plans (SNPs).
Medigap (Medicare Supplement Health Insurance)
Medicare Supplemental Insurance is private insurance (often called Medigap) that pays Medicare’s deductibles and co-insurances and may cover services not covered by Medicare.
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.
If you’re a person with Medicare or help a person with Medicare, visit Medicare.gov to find more information about Medicare.
What Is Medicaid?
Medicaid is an general assistance program. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required.
Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Each state Medicaid agency has full responsibility for all aspects of the administration and operation of the Medicaid program in their state, including determining eligibility for and enrollment into their program.
Medicaid eligibility criteria vary from state to state. Many states have expanded their Medicaid programs to cover more low-income adults. If you are unsure if you might qualify for Medicaid, you should apply.
You might be eligible depending on your household income, family size, age, disability, and other factors. You must be a United States (U.S.) citizen, a U.S. national, or have a satisfactory immigration status to be eligible for full benefits.
In order to assist you in getting a timely response, please contact your State Medicaid Agency (click your state link above) for any questions on the following:
Medicaid Eligibility
Coverage and Services
Liens and Third Party Liability (other insurance)
Provider Enrollment
Medicaid Claims
Lost Medicaid Card/ Replacement
Finding a Medicaid/CHIP Provider
Status of a Medicaid/CHIP Application
If you need assistance in any of the areas noted, you will need to contact the agency for Medicaid/CHIP in your state of residence or the state you have questions about in order to receive assistance. Please contact your state for all state-related Medicaid questions.
Medicaid Contact Information by State and Territory
Department of Public Health and Social Services / Division of Public Welfare ☎ 735-7519, 735-3540, 735-7256 or 735-7375 (Central Office – Mangilao) ☎ 635-7429 or 635-7488 (Northern Office – Dededo) ☎ 828-7542 or 828-8524 (Southern Office – Inarajan)
Senior Homecare Options: How to find the right fit for you
It’s never too early to choose a home care agency that you can rely on when life doesn’t go as planned. Whether it’s a little help around the house or more involved care, you should look for a home care agency that can safely meet all of your needs every step of the way.
Are you or a loved one resistant to the idea of receiving care?
Chances are that you just haven’t found the right agency. Simply starting the conversation with a reputable home care agency and building trust can do wonders for melting away resistance. We hope you find this guide helpful as you go forward in search of the right In Home Care Provider in your community.
When is the right time to hire home care?
Most of us want to remain as independent as possible. Sometimes, all that may be required is a simple medication reminder. However, if getting ready for your day has become more difficult and you require some assistance with activities of daily living (ADLs) such as bathing, grooming and getting dressed, there are caregivers that can assist with these tasks. The first step is realizing that you need additional support and then asking for it.
Asking for help and the fear of losing independence and control can be challenging. There are community resources available to discuss these very topics, including: Registered Nurses and social workers. These professionals are well versed on what resources are available in your area.
Next, take some time to consider whether or not you’ll stay in your home or move to community. Monthly charges range from $2,000 to $12,000 per month (depending on the level of care). Your financial situation and family support system will likely influence your decision to stay at home with extra help; or move to a community. This is a tough decision and may require downsizing and selling your home.
How do I pay for home care services?
Although paying for home care can be expensive, there are many options for seniors and their families. Learning more about Medicaid, Medicare, long-term care insurance, and various state programs can help older adults as they navigate the financial aspect of long-term care.
Medicaid: Funding for those with limited financial resources may receive assistance with some or all of their home care expenses from Medicaid.
Medicare: Available to all adults 65 and older. However, Medicare is meant for acute health episodes, and not long-term care. Those that are homebound, need skilled services, and require intermittent help may be able to receive some home health care services under Medicare funding.
Long Term Care Insurance: Each policy is different, with some covering only nursing home costs- but many current policies allow for homecare services.
State Programs: Older adults that do not qualify for larger government programs like Medicaid may qualify for more local state programs, because states have greater freedom in establishing requirements for their programs.
Private Pay: Many families choose to perform many of the home care services for a loved one themselves. Yet, some seniors require skilled services. For families that do not meet eligibility requirements of certain programs, out of pocket funding may be unavoidable.
Non profit support: There are many other non-profit organizations, volunteer groups, or faith based organizations that may also help. Check your local area agency on aging for more information.
Comparisons & Definitions for Care At Home
There are so many choices for caregiving services at home. Which one is right for me, my loved one or my client? Let’s define each avenue, looking at the differences to help you determine the best fit.
Full Service Home Care:
Licensed Agency; Services not limited with memory loss or dementia
Provides non-medical, skilled caregiving, case management & nursing services
Required to screen, employ & supervise caregiver
Cost based on services provided, comparable at non-medical level
The most comprehensive package of services
Non-Medical Home Care:
Limited to non-medical services, and companion care
May provide medication reminders or assistance to oriented client only
No skilled services provide, No Nurse on staff
Required to screen, employ & supervise caregiver
Cost comparable at non-medical level
Caregiver Registry:
Licensed Caregiver Registry Agency
Screens & verifies competency of caregivers
Does NOT employ or supervise caregiver, client takes on employer responsibilities & risks
No skilled care, case management or nursing services
Cost Registry Fee + Caregiver Cost; comparable-higher at non-medical level
Case Management Company:
Not Licensed to provide caregiving or nursing services
Does not employ caregivers, client takes on employer responsibilities & risks
Professional Case Manager’s & RN’s supervise, usually $70-$110.00/hour
Cost Professional fee + Caregiver Cost; comparable-higher at non-medical level
CEP (Client Employed Provider) Program:
Not Licensed; Caregiver Registry; State of Oregon; Medicaid
Program does not screen, employ or supervise, client takes on employer responsibilities & risks
Screens with Criminal Background Check only
Operates much like an on-line listing service
How to Choose an In-Home Care Agency
You will need to “shop around” to find a Home Care provider in your community that has the correct licensure, experience, and knowledge to provide the care you or your loved one will need. Costs for care giving services are, in general, similar across In Home Care providers in a given geographical area regardless if they are licensed to provide non-medical services only or are able to provide medication management, skilled care giving, case management & nursing services as well.
Take your time and do this in steps.
1. Do your homework, evaluate the care needs:
Before you make your first phone call, thoroughly consider what the care needs are. Ask yourself the following questions:
Do we need assistance with companionship, cooking and light housework?
Do we need someone who can provide hands-on care? For example: assistance with bathing, dressing or mobility.
Do we need a caregiver that speaks a particular language?
Do we need a care provider who can drive?
Will your family have the support of a Home Health Agency or a Hospice Agency that the In Home Care Provider will need to work with?
You will need to contract with an agency who has the ability to provide the services needed now and those that can be reasonably anticipated in the future.
Non-medical agencies cannot remind or assist with medications for client’s who have a memory loss or dementia diagnosis. Further, in order for any In Home Care Agency to remind or assist you with medications, you must be able to tell the representative of the agency what, how much, when and why you take each of the medications your doctor has ordered you to take. In other words, you must be assessed competent to “self direct” the caregiver who will work with you. If you cannot do this, you must contract for In Home Care services with a full service agency.
Starting care with a Home Care Agency that is strictly non-medical means that if your needs increase, the agency will not be able to progress with you to provide the needed services. This will force you to establish a new relationship with a more qualified agency, all at a time when you or your loved ones health is declining.
To determine if you need a full service agency now, ask yourself the following questions:
Is there a memory loss diagnosis such as: short term memory loss, dementia or Alzheimer’s disease or is the client becoming more confused & forgetful?
Do we need skilled medical assistance for things like blood pressure, blood sugar testing, medication administration, wound care or tube/drain/bag maintenance?
Do we need a care provider trained to perform a special task of nursing, to use special equipment, to assist with transfers or ambulation, to manage medications, tube feeding or provide end of life (Hospice) comfort care?
Do you need case management services? The services provided by a case manager include assessments, planning, advocacy, and presenting options to meet the individuals specific needs.
2. Evaluate the Home Care Agency Candidates:
Now that you have an idea of the services you or your loved one will need, it’s time to call each agency and ask each In Home Care Agency Representative these questions:
How long has the agency been in business in this community?
Is the agency a local private agency or a franchised agency?
Is it possible to interview a caregiver to determine compatibility prior to the caregiver working for me?
Does the agency employ the caregiver and act as the employer of record?
How are the caregivers who work for the agency screened, trained & supervised?
Does the agency have a nurse on staff who provides service planning, oversight and training?
Is the agency licensed to provide medication and nursing services as well as non-medical services?
Does the agency provide bonding & workers compensation insurance?
How much will the needed services cost?
How much notice & what is the process for starting services?
How does the agency assist me to bill and receive payment from my insurance?
What happens if I don’t find the provider the agency sends acceptable?
What if I need to speak to the agency representative after hours?
3. Make the right choice for you or your loved one:
Based on the answers to the above questions & your conversation with the agency representative, ask yourself these questions:
Was I satisfied with the answers to the questions I asked the agency?
Was I satisfied with the reviews I found on-line and/or the testimonials I found on the agency’s web page?
Did I feel comfortable with the experience, knowledge and ability of the agency to provide my services?
Did the person I spoke to follow through with any promised information request?
Is the agency licensed to provide skilled care giving, case management & nursing services, as well as non-medical services?
Is the agency available by phone at all hours for assistance with any issues I have that may need immediate attention?
Is the cost for services appropriate to the level of care I will receive?
Additional Questions you may want to ask a home care agency
Agency Information
Is the agency a franchise or locally owned and operated?
Is the agency licensed by the State Department of Health?
Is the agency licensed for both home care and home health?
Does the agency have liability insurance?
Can the agency respond to you 24/7?
Caregiver Information
Are employees licensed, bonded & insured? Or are they independent contractors?
Does the agency test skills, conduct behavioral interviews and verify caregiver credentials?
Are caregivers required to have current certifications for First Aid, CPR, and TB?
Are caregivers provided continuing education/training?
Can authorized individuals monitor care and make requests online in real time?
Does the agency offer a caregiver replacement when the “fit” may not be right?
Documentation and Supervision
Does an RN/MSW/Care Manager conduct a free home care assessment?
Does an RN/MSW/Care Manager create a home care plan?
Does an RN/MSW/Care Manager supervise the caregivers?
Do caregivers receive client orientation before arriving at a client’s home?
Policies and Cost
Can services be cancelled with a 4-hour notification?
Does the agency offer flexible scheduling, custom care plans, and a continuum of care?
Does the agency have weekly or monthly minimums?
What is the hourly minimum per shift?
Does the agency offer home care discounts?
What is the required deposit?
Will the agency accept long-term care insurance?
Elder care tips: Ensuring a beneficial relationship with a care provider
Developing an elder care plan for your aging loved ones enables you to ensure your parents get the care and assistance that will meet their physical, cognitive, medical, mobility, and emotional needs on a daily basis.
While it is completely normal for you to want to take on all of the responsibilities of caring for your seniors, handling all of these tasks on your own would likely not work out in the long term. Trying to add all of these responsibilities to everything you already do to take care of your own personal lives can leave you exhausted and incapable of giving your best to any of your responsibilities.
Hiring an elderly health care services provider as part of your elder care plan enables you to entrust that professional with some of the responsibilities of caring for your parents so that you can focus your time and energy more efficiently and effectively.
Use these tips to help your parents enjoy the best relationship possible with their care provider:
1. Plan Thoroughly:
Have a clear idea of what you and your parents expect from the relationship with your care provider. Clarifying these expectations enables you to pursue the factors of the relationship that you see as most important and allows you to narrow your focus when seeking out a care provider.
2. Think Family First:
Before you get a care provider involved, consider your family contribution to the care plan first. Determine how much you can practically do for your parents and ask how much your siblings would like to do. This makes it easier for you decide how much responsibility the care provider will need to take so you can give clear guidelines from the beginning and avoid confusion.
3. Communicate Openly:
It is important to see the elderly health care services provider as an employee rather than someone who is doing you a favor by taking care of your parents. Communicate openly with the care provider about your expectations, your standards of performance, and your feelings about their care for your parents so that they can continue to improve.
4. Support Individuality:
You want to be an active part of your parents’ care, but in order to support a quality relationship, you need to give them the space and freedom to create and build that relationship on their own. Support your parents’ ability to get to know the care provider and enjoy spending time with them on their own terms, including participating in activities, going on outings, and creating their own approaches to handling care tasks.
Navigating Senior Housing: Advisors and Referral Agencies, Transitions, and Your Security
When you or a loved one is faced with needing to find the best options for senior housing it can often feel like a maze. We know how important it is to not only be aware of what options are available but also to know where you can go for additional help. That’s why we created this article to help you navigate the complex world of senior housing and how to work with a senior care advisor.
Where do I begin when navigating housing options?
The doctor just informed you that it would be unsafe for your senior loved one to return to their home without 24/7 supervision. You have limited time to find a new ‘home’. Where do you begin to find your way through the maze of housing options, care needs, budget and amenities?
Don’t go it alone, referral agencies and placement consultants are a valuable resource to save time and anxiety. These professionals are familiar with the numerous options and availability. Many also review the state survey and public disclosure file for any record of criminal activity or lack of compliance with laws/rules.
Step 1: Gain detailed knowledge of the assistance/needs of the resident.
This will narrow the type of community to those that are licensed and capable of providing the proper care. It may be awkward for families to ask the personal questions related to care needs and personal assistance; sometimes an objective third person is able to ask more detailed questions and uncover concerns or fears while helping the resident maintain a sense of privacy.
Step 2: Know your budget.
Community fees may vary, with application fees, deposits, levels of care and ancillary services. A placement consultant may be able to help you to better balance the big picture.
Step 3: Focus on the geographic area that fits best.
This is a new chapter in their life, and they will be creating a whole new social network. The goal is to accommodate frequent visitation of the resident’s support system. Proximity to an established network of friends and family is an important factor, should any healthcare or emotional changes occur.
Step 4: Visit the communities.
After narrowing the field to those that best fit your needs, you will be better able to look at the amenities, services and activities. Get to know the activities offered, meet the staff, and try the food. These are the things that make a community feel like home and help aid the adjustment process.
What is a Senior Care Advisor, or Referral Agency?
Every industry has experts that can be used to educate and guide you along the best path. A quality expert is going to help avoid common pitfalls and mistakes, as well as maximize your time and money.
The process of aging and finding Long Term Care is no exception. Those who choose to take that next step in education can obtain this title and show they have studied the wide range of issues that could arise as someone ages. An advisor should also research licensing, inspections reports, and any state violations of every facility to ensure they are only recommending the highest quality options for any given situation.
Why work with a referral agency?
A Senior Care Advisor is your expert in the challenges of aging. It is someone who can sit down and learn everything about your situation to best guide you. Some examples of information an advisor should ask are: Medical/Health Information, Geographic Needs, Financial Requirements, Veteran Status, Long-Term Care Insurance, Mobility Concerns, Cognitive Abilities, Personal Care Needs, Meal Preferences, Socialization/Hobbies, and/or Estate Planning.
An advisor really must have a clear understanding of everything that is going on before they can start looking at next steps. This process can be equated to assembling a puzzle. You give an advisor an idea of what the end result should look like, hand them all of the pieces needed for assembly, and let them go about piecing everything together. A quality advisor will know all of the options and help navigate this confusing industry to find the perfect solutions for your needs. Keep in mind an advisor is not making decisions on your behalf; this is why it’s crucial you find an advisor you connect with and trust.
The advisor is typically compensated by the long-term care facilities; because of this compensation model an advisor should not be a sales person pushing one particular solution. Their goal should be to provide the highest quality options and present them so you can make the best decisions possible. Given that they have already visited hundreds of these long-term care options, you do not have to start from the beginning. They can quickly recommend the best options and you only have to visit a handful of places. This gives you the ability to focus time and energy on your loved ones. So if you find yourself in need of guidance in these areas, find a quality Senior Care Advisor for help.
Benefits of a Referral Agency
People tend to fall into two broad categories when it comes to big decisions or difficult tasks… the first are those who are determined to take care of it themselves, just wade right in and see what happens; and the second are those who look for input from those who may have been there before or at least have seen how things turned out.
Neither one is right or wrong, just different. For example: there are two families needing to find suitable housing for an elderly parent who has specific needs and definite preferences to be addressed, referral agencies are well-equipped to be of help to both camps.
For the “do-it-myselfer”, the referral agency can help by giving information on what the senior housing industry looks like, what major things to look for, and avoid, and to provide some explanation of terminology. This family is then better prepared to go out and find options for their elder.
For the “I-could-use-some-help” types, the referral agency is a trove of information and experience regarding the whole issue of helping seniors move along on their journey. The agency gathers pertinent information regarding care needs, likes, dislikes, geographic preferences and financial parameters. With this information the agency provides the senior and/or family with options, tours the options with the family, answers their questions and provides a sounding board to allow them to make an informed decision.
The time saved by the family seeking help from a referral agency is better used to get the senior integrated into their new environment and to get the whole family back on track.
The best parts about actively taking a referral agency’s help are: (1) they know the options, (2) they know the providers and (3) they take on the leg-work. Oh, and the best part, (4) the referral agency helps you for free.
How you benefit from having a neutral third party
Referral agents begin by asking questions to become clear on how they can best help you. Whether you choose to look at options on your own or whether you enlist the help of a referral agency, the rent and care fees you pay are the same.
The senior referral industry is regulated by your State’s Department of Human Services. In some states, senior referral agencies are required to register with the state as well. In Oregon, all agents must meet DHS guidelines to register and must follow the rules set forth by DHS to ensure families are receiving quality information by qualified individuals. Referral agents do not make decisions for you, but they help frame situations to allow you to understand what options you have and they support you in your decision-making process.
Be extremely cautious about providing your contact information to online referral agencies when searching for the options.
Placing your name into various websites can launch a barrage of phone calls of solicitations from businesses and agencies that aren’t even of interest to you. If you plan to work with a referral agency, select a local senior advisor that will tour and be with you each step of the way.
Why is the transition and moving to assisted living or memory care so hard?
We have hope for improvement
When we love someone, we never want to “give up” on them. We hold a deep-seated belief that if we keep looking for solutions, treatments or therapies, our loved one will get better. Unfortunately, the aging process of both the body and the mind is a downhill path. What makes things confusing is that in our world of information and options, we are compelled to continue seeking solutions. Further clouding the situation is that the downhill decline is not always noticeable. Older adults have good days and bad days. When a loved one has good days, we don’t want to disrupt the quality of life we see them experiencing.
We remember them as they were.
It’s easy for us to take notice when a friend is struggling with caring for an aging parent; when it’s our own parent, we frequently can’t see the obvious changes that are occurring. We remember the strong and capable adult of the past. We don’t want to acknowledge the changes because then there will have to be difficult and disruptive decisions that needs to be made. Don’t go it alone, referral agencies and placement consultants are a valuable resource to save time and anxiety. These professionals are familiar with the numerous options and availability. Many also review the state survey and public disclosure file for any record of criminal activity or lack of compliance with laws/rules.
Family dynamics can cloud the real issues.
Family members may disagree on what care is needed, and it is often the case that one or more people may purposefully attempt to convince the family to allow the older adult to remain in their own home. Sometimes in-home care is a good solution, and other times it is not a workable or feasible long-term solution. Allowing our own personal preferences to cloud our thinking is not helpful to a frail senior. Enlisting knowledgeable outside help who look at your situation and help introduce you to specific senior care communities will reduce the amount of family conflict.
Security and Online Senior Living Referral Services
While researching Senior Living options online for yourself or a loved one you may be unaware of what happens with your information, and the level of your own security.
If you google search Assisted Living, a list of Online Senior Referral companies will appear. They require you to enter your information that includes: phone number, email, address, health and finances. All before being directed to a list of options.The companies also put you on a “list.” That list is sent to numerous communities where your information will be entered into multiple databases and viewed by anyone that can access that data. You will then receive emails and phone calls from every community on the “list.”
Once the online service puts you on their list they “own” you as a “lead.” This remains true whether you move in soon, years later or even correspond with that company. This is how they receive compensation.
DO NOT give out your information to receive pricing or a list of communities.
A secure way to narrow down Senior Living options is to use a Local Senior Living Advisor. They will be willing to meet with you, in person, to assess your loved ones’ specific needs. The Advisor will then, recommend the best options, coordinate the tours and take you to see those recommended options. A Trusted Senior Living Advisor visits communities regularly and knows whom has stable staff, happy residents, good food and quality care. Online Referral companies are unable to provide this level of service.
A Local Senior Living Advisor will be your one point of contact. Only that advisor will have your information unless you wish to give it to the toured communities. This will eliminate needless contact from multiple communities and from the online referral service itself. A Local Advisor can assist you with negotiating costs, recommend resources for: downsizing, selling a home, moving and assist with the necessary paperwork to get moved into a community.
An Important Difference:
On CareAvailability, we do NOT require your contact details to search, and we provide the contact information for each provider. CareAvailability is NOT a referral agency, only a database of providers and we list all of them to create a comprehensive list. You can contact the community when you are ready and you can decide what information you wish to share.
You can search our affiliate site, Retirement Connection for “Referral Service and Housing Specialists” for local referral agencies and additional help.
Several different agencies contributed to this article, Including: 1st Choice Senior Placement, Dedicated Care Solutions, Portland Senior Housing, Senior One Source.
Benefits, Services, and Costs of Medicare Advantage Plans
More than 23 million Americans currently receive their health benefits through a Medicare Advantage plan. There’s much to like about these plans, which provide extra services and make coverage more affordable than traditional Medicare by capping out-of-pocket costs. It’s no surprise that a 2018 pollfound a whopping 90% of people with Medicare Advantage plans are satisfied with their coverage. But do you understand the ins and outs of Medicare Advantage?
What is a Medicare Advantage Plan?
Medicare Advantage plans (also known as Medicare Part C) are offered by private health insurance providers that have been approved by Medicare. These companies receive government funding to cover your Medicare benefits and keep you healthy.
With traditional Medicare, the federal government pays your providers directly.
What do Medicare Advantage Plans Cover?
If you join a Medicare Advantage plan, that plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. But that’s not all.
Medicare Advantage plans cover many things that traditional Medicare doesn’t cover. These extras can include vision, hearing and dental benefits, as well as wellness programs. Many Medicare Advantage plans give seniors access to affordable prescription drug plans, often at no additional cost.
And all Medicare Advantage plans limit the amount you must spend out of pocket for deductibles, copayments, and coinsurance each year for covered Medicare services.
Who is eligible to purchase a Medicare Advantage plan?
You must already be covered by Medicare Parts A and B to join a Medicare Advantage plan. You also must live in the Medicare Advantage plan’s service area.
The Medicare Annual Election Period (AEP) which lasts from mid-October until early December, is when you can initially sign up, switch, or leave your Medicare Advantage plan. You can also switch Medicare Advantage plans or from Medicare Advantage to traditional Medicare from January 1 until March 31 if you change your mind.
Are all Medicare Advantage plans the same?
There are different options to meet different health and financial needs. Just as with individual or employer-sponsored insurance, several types of Medicare Advantage policies are available. The most common types of Medicare Advantage plans are:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
You also may see Medicare Advantage plans called Private Fee-for-Service (PFFS) and Medical Savings Account (MSA) plans.
If you are eligible for Medicaid, have a chronic condition, or live in a nursing home, you may also be able to sign up for another type of Medicare Advantage tailored to your specific needs called a Special Needs Plan (SNP).
While many Medicare Advantage plans are available at no additional cost, some charge premiums or have costs for optional services. Which providers are in the plan’s network also varies. That means it’s important to comparison-shop carefully, just as you do for other important expenditures.
You’ll want to understand specific costs and benefits before you join. The online tool Medicare Plan Finderat Medicare.gov can help you can find and compare policies in your area.
Is a Medicare Advantage plan the same thing as a Medicare Supplement Insurance (Medigap) policy?
No. A Medigap policy is private insurance that helps supplement traditional Medicare. This means it helps pay some of the health care costs that traditional Medicare doesn’t cover (like copayments, coinsurance, and deductibles).
While a Medigap policy does help to supplement the Medicare Hospital (Part A) and Medical (Part B) coverage, it does not include Prescription Drugs (Part D) and this would need to be purchased separately, if choosing Medigap.
