Home Care in Medicare
We at Mass Senior Action have been advocating for Home Care VS nursing home care.
We have pointed out the reasons and the disparity in costs with the gap between costs of Nursing homes with keeping the Seniors in the home care system
We now are deeply disturbed to find that the Home Care Industry now seems to be taking advantage of the fact that this differece in cost is a fact and are taking undue advantage by making unreasable increases in the overburdened health care costs
without regard for the clients services.
This was pointed out in the following article in the New York Times Editorial
We must take action here in Massachusetts to protect those in Medicare from
being taken advantage of by the faulty system. Our Seniors are more vulnerable after hospitalization or when needing home care to avoid hospitalization under the presents action of the Home care Industry.
We have made our wants known to the Governor and the Massachsetts State Legislators
with a rally at the State House now lets follow through.
We look for adaguate funding but we should also urge our representatives to look to accountability.
Lets get our membership and the General public to express an opinion on this issue
March 23, 2009
Editorial
Costly Home Health Care
Health care reformers have long advocated providing more care to patients in their own homes or communities instead of treating them in costly institutions like hospitals and nursing homes. So it is disturbing to learn that charges have risen well above reasonable levels in one segment of the home health care market — short-term care provided to Medicare beneficiaries after, or sometimes instead of, hospitalization. The problem is compounded by fraud.
In its annual report to Congress this month, the Medicare Payment Advisory Commission, a group of independent experts, concluded that home health agencies have been paid significantly more than their cost of providing the services in recent years. Their average margins were about 16.5 percent a year between 2002 and 2007, and, even after some rate adjustments, are expected to exceed 12 percent this year in the midst of a recession. Experts say there is room to reduce payments substantially without harming the provision of such services as skilled nursing care, physical or occupational therapy, speech therapy and medical social work.
The overpayment problem is exacerbated by fraud and manipulation, according to a report issued recently by the Government Accountability Office. The G.A.O. looked at seven states that experienced the highest growth rate in Medicare home health expenditures from 2002 through 2006 and found a substantial number of abuses. These included overstating a beneficiary’s condition to get an improperly high reimbursement, billing for patients who were not homebound and thus not eligible for home health care, and making unnecessary visits.
Some of the worst abuses were in Texas and Florida, where spending growth was highest. In Houston, more than 90 percent of the beneficiaries reviewed in one audit had improperly been given the most severe clinical rating. In Miami-Dade County, a disproportionately high number of diabetics were getting skilled nursing visits every day to administer their insulin shots despite lack of evidence that they needed any help; some were coached on how to lie about their need for assistance.
Federal officials are taking steps to reduce fraud, and Congress is pushing them to do more. The bigger cost issue — paying too much across the board for home health services to Medicare beneficiaries — would largely be solved by President Obama’s budget proposals. His budget plan calls for saving a hefty $37 billion over the next decade by reducing Medicare’s projected home health care expenditures in order to help finance his broader health care reforms.
Home health care companies are already complaining that the cuts will hurt patients, but their industry is one of the most profitable parts of Medicare; it needs to do its fair share to curb the relentless surge in Medicare spending. If the nation’s health system is to move toward greater reliance on home care, it needs to be sure it is paying the right price.
Howard McGowan
349 Pleasant Street
Malden, Ma 02148
781 324 8076
Monday, March 23, 2009
Sunday, February 8, 2009
PERSONAL HOME ARE AIDES
OPINION FROM NY TIMES ARTICLE FOR CONSIDERATION OF OUR HOME CARE COMMITEE MASS SENIOR ACTION.
Time for action within the present administration to open the dialog
In its last days in office in 2001, the Clinton administration proposed a revision to the labor rules to allow federal protections to apply to personal home care aides, but the Bush administration promptly threw that out and reasserted the status quo. A 2007 Supreme Court ruling upheld the rules, and a push that year by House and Senate Democrats to pass a bill to update the law went nowhere.
According to the Labor Department, personal and home care aides are expected to be the second fastest-growing occupation in the United States from 2006-2016, increasing by 51 percent, slightly behind the expected growth in systems and data communications analysts.
Most home care aides are women, low income and minority, and many of them are immigrants. Some states have taken steps to provide them with basic labor protections. Efforts to unionize home care workers in some states also has led to wage gains and better conditions. But the progress is incomplete without a federal law to recognize and protect the home care work force. It is unconscionable that workers who are entrusted with the care of some of the nation’s most vulnerable citizens are themselves unprotected by basic labor standards.
It is also unwise, because poor pay for long hours leads to high turnover, which undermines the quality of care. Turnover also drives up the cost of providing home care — a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.
Time for action within the present administration to open the dialog
In its last days in office in 2001, the Clinton administration proposed a revision to the labor rules to allow federal protections to apply to personal home care aides, but the Bush administration promptly threw that out and reasserted the status quo. A 2007 Supreme Court ruling upheld the rules, and a push that year by House and Senate Democrats to pass a bill to update the law went nowhere.
According to the Labor Department, personal and home care aides are expected to be the second fastest-growing occupation in the United States from 2006-2016, increasing by 51 percent, slightly behind the expected growth in systems and data communications analysts.
Most home care aides are women, low income and minority, and many of them are immigrants. Some states have taken steps to provide them with basic labor protections. Efforts to unionize home care workers in some states also has led to wage gains and better conditions. But the progress is incomplete without a federal law to recognize and protect the home care work force. It is unconscionable that workers who are entrusted with the care of some of the nation’s most vulnerable citizens are themselves unprotected by basic labor standards.
It is also unwise, because poor pay for long hours leads to high turnover, which undermines the quality of care. Turnover also drives up the cost of providing home care — a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.
Sunday, January 25, 2009
Medicare coverage of home Care
Medicare coverage of home care may be limited.
All four of the following criteria must be met before a client can receive Medicare home health care:
A doctor must decide that care at home is necessary and make a plan of care that the staff of the home health care agency will carry out. The doctor will work with the home health care nurse to decide what kind of services are needed (including medical equipment and special foods), how often the services are needed, and what type of health care professional should provide these services. The plan may also include what the doctor expects from the treatment. The client will receive home health care as long as he is eligible and as long as the doctor says he needs it.
The client must need either intermittent (part-time) skilled nursing care (performed only by a registered nurse or licensed practical nurse), physical therapy, or speech language pathology services. There are limits on the number of hours per day and days per week the client can receive skilled nursing care.
The client must be homebound. This means he/she is normally unable to leave home except for infrequent short visits or to get outside medical care.
The client must receive care by a Certified Home Health Care Agency approved by Medicare,
All four of the following criteria must be met before a client can receive Medicare home health care:
A doctor must decide that care at home is necessary and make a plan of care that the staff of the home health care agency will carry out. The doctor will work with the home health care nurse to decide what kind of services are needed (including medical equipment and special foods), how often the services are needed, and what type of health care professional should provide these services. The plan may also include what the doctor expects from the treatment. The client will receive home health care as long as he is eligible and as long as the doctor says he needs it.
The client must need either intermittent (part-time) skilled nursing care (performed only by a registered nurse or licensed practical nurse), physical therapy, or speech language pathology services. There are limits on the number of hours per day and days per week the client can receive skilled nursing care.
The client must be homebound. This means he/she is normally unable to leave home except for infrequent short visits or to get outside medical care.
The client must receive care by a Certified Home Health Care Agency approved by Medicare,
Sunday, January 18, 2009
Seniors At Home:A continuim of Care for every need
Amy Rassen, LCSW
The hospital discharge planner has a problem. Despite her most persuasive efforts, your patient, Mr. J., an 88-year-old with a broken leg and no friends or relatives to care for him, is adamant. He will not go to a board-and-care facility; he wants to go home. To resolve this impasse, you contact the Seniors At Home division of Jewish Family and Children's Services (JFCS) to do an assessment and either provide Mr. J with home care support, or help him make the transition to a board-and-care or assisted-living facility.
How Seniors At Home Solves the Problem
Sounds simple? Unfortunately, in addition to his physical injury, Mr. J. is also in the early stages of dementia. Consequently, he is unable to remember how long he has lived in his apartment, how much money he has, or even what bank he uses.
A Seniors At Home care coordinator (geriatric care specialist) meets with Mr. J. at the hospital and learns that he has a neighbor who has, on an informal basis, been helping him with bill paying. Later that day the care coordinator meets with the neighbor to enlist his continued involvement and support and works out a formal arrangement for the neighbor to assume durable power of attorney for Mr. J., with oversight from Seniors At Home, to help manage his financial affairs.
Through the neighbor, Seniors At Home also learns that Mr.J.'s house has not been cleaned for some time and has become not only unhealthy, but also dangerously cluttered for someone in Mr. J.'s physical and mental condition. Accordingly, the care coordinator arranges for a grant to pay for a single heavy cleaning prior to Mr. J.'s release from the hospital.
This accomplished and the support of the neighbor in place, Mr. J. is able to move back home to a safe, familiar living environment. To help him maintain independent living, the Seniors At Home care coordinator arranges for a home care worker to help Mr. J. on a regular basis with housecleaning, laundry and meal preparation. A Seniors At Home escort driver is also provided to take Mr. J. to doctors' appointments and shopping and he is able to remain safely at home until his death several years later.
This care is typical of hundreds of clients Seniors At Home handles each year-referred to us by physicians, health plans, hospital staff, family members and friends of the Bay Area's elderly. For the senior, Seniors At Home is affordable. Often health plans or long-term care insurance pays for these services and we have a sliding scale for people who pay privately.
Options: Staying At Home or Assisted Living
Luckily for the seniors who live in the Bay Area, many options are available to them. Our goal at Seniors At Home is to carry out the wishes of the seniors and their families, either helping them live safely at home or helping them move to a facility with an appropriate level of care. The Seniors At Home team of professionals works with seniors and their families-often in the language of their choice-to create a personalized assessment and a plan of care designed to meet their unique individual needs.
Staying At Home
Care provision at home is the method of choice for most elderly, so much so that Americans spend $100 billion a year out of their own pockets and 26 percent of caregivers spend up to 10 percent of their monthly income on caregiving. Twenty-six percent of home health and home care expenses for the elderly are paid out-of-pocket; 28 percent are paid by Medicare; 23 percent are paid by other government sources and 23 percent are paid by Medicaid.(1) Community-based care (versus institutional care such as skilled nursing facilities) has developed and expanded rapidly in the past decade. As a result of the increasing number of women in the work force-our country's primary caregivers for both children and elderly-fewer women are available to assume the on-site support of their aging parents. Increasing numbers of elderly are forced to rely less on "informal" support mechanisms and more on "formal" support systems.
Seniors' problems and needs vary greatly, too. If frail, they may need help with daily chores and transportation. If homebound and isolated, they may require ongoing care management as well as volunteers to bring them warmth and caring. If well, they may feel depressed because someone close to them died and need counseling. And if poor, they may need financial support including help with food and shelter. But regardless of their individual circumstances, they all need to feel that the community cares about them, understands their special needs, believes in their inherent value and is committed to providing services that are culturally appropriate and responsive. This is what we do at Seniors At Home.
Working with the physician, the senior, and his/her family members, our care coordinators arrange for and monitor the full spectrum of services needed to create a comfortable and safe environment and enable your patient to successfully manage at home. This involves using your patient's own informal network as well as community resources, such as Meals on Wheels or Paratransit, enrolling him/her in adult day health centers and providing private home health aides, counseling, and even durable medical equipment-everything that is needed to fulfill the agreed-to plan of care. Especially helpful to many seniors is our corps of dedicated community volunteers who provide companionship and help with out-of-the-home errands, transportation to medical appointments and reassurance through telephone contact.
Assisted Living
The unprecedented growth of the retirement industry is another reliable indicator of the shift from informal to formal care arrangements. Once only for the poor, senior services and senior housing complexes are developing all over the Bay Area. Most congregate and assisted living facilities are geared toward the moderately healthy senior who is financially independent, approximately 80 years old, requires some help with activities of daily living, but is no way immobilized.
Since Medicare and Medicaid do not pay for assisted living, accessibility to assisted-living facilities is restricted to seniors with the ability to pay an average of $3,500 to $4,500 per month for rent, food and services, or to those with several hundred thousand dollars to purchase their living unit at a life-care facility. These seniors now frequently choose assisted living settings before they experience declining health. It is the "next step" for those seniors who want the security of 24-hour professional staff, three meals a day, easy opportunities for socialization and help when they need it.
Seniors At Home Continuum of Care
Seniors At Home's continuum of care for seniors is both comprehensive and substantive and includes an extensive range of services that help seniors to live at home with a quality of life appropriate to their age and health. In-home assessments, long-term care planning, home care and skilled care, care coordination, counseling and bereavement services, money management (including conservatorship), adult day health, volunteer services and most recently, assisted living at Rhoda Goldman Plaza (2) are some of the many services that are available through Seniors At Home.
Rhoda Goldman Plaza is a residential community located at 2180 Post Street in San Francisco. The building is a well-appointed, seven-story, competitively priced rental community with 155 one- and two-bedroom residences, studios and alcove apartments. For the ever-growing number of elderly with dementia or Alzheimers, the Terrace, located on the fourth floor, is designed with suite-style rooms clustered in neighborhoods with additional staff available for personalized care and supervision. It offers many resources to nurture independent living. Residents are also able to take full advantage of Seniors At Home services because JFCS is located right next door at 2150 Post Street.
Amy Rassen, LCSW, is the associate executive director of Jewish Family and Children's Services of San Francisco, the Peninsula, Marin and Sonoma Counties. She initiated the SeniorsoAtoHome managed care division and has been responsible for ensuring its growth throughout JFCS' five county service area. She is responsible for the quality of services and new program development in a $24 million multi-county agency with 16 offices, 40 programs and over 800 staff. She provides vision, direction and leadership for strategic planning, priority setting and program development. She also develops and ensures revenue-generating streams, including fee for service income and grant funding, and is on multiple local and national boards of directors and task forces. Her phone number is 415/449-1219 and e-mail is arassen@jfcs.org.
References:
1. Through the Medicaid 1915 ( c ) waiver program, states provided home care services to approximately 135,000 aged and disabled persons in 1991. The Long Term care Campaign, P.O. Box 27394, Washington, D.C., 20038. 1996.
2. Rhoda Goldman Plaza was founded by JFCS and Mt Zion Health Fund and is incorporated as a non-profit licensed residential care facility (RCFE# is 385600125).
Wednesday, December 24, 2008
Non-Profits cooperation remaining in Service to clients
It has been an exceptional year in many many ways. Without a doubt, 2008 has presented the most difficult economy for nonprofits to operate in, during my career. The downside, of course, is that many nonprofits across the United States, are being forced to reduce services, merge, or (sadly) close permanently. Nonprofits fill all kinds of voids such as complacency, indifference, lack of access, little research, poor or no funding, lack of public knowledge, lack of expertise, infringements on legal oversight, etc. Nonprofits are often a last hope for many. As nonprofit organizations, ours' is an extended hand and it is staggering to think that many of those hands will be removed from our communities. Amid most governments' budget cuts, reduced donating, financial instability, financial scandals, and an uncertain economic outlook - we're all sort of sitting up a little more straight in the chair, and gripping the sides of the seat.
The up side to this kind of adversity is that we're all going through this together. Adversity can unite and unify and has already begun to. In the face of a challenge Americans, historically, have risen to the struggle innovating, pulling together, and sticking in the fight. This economy has forced the very same amongst nonprofits, across the United States. Professional nonprofit affiliations are hosting all kinds of nonprofit forums to provide a public commons for us nonprofit professionals come together for an hour or two to discuss the financial issues we, individually, are facing at each of our organizations, and to then share or brainstorm solutions. Out of adversity comes exceptional leaps forward in theory, method, and best practices. Despite how concerned I am for this country's nonprofit sector, I look forward to learning about your innovation, new methods, and learning about what you 'invented' and shared, in effect, adding to our sector's best practices. Yes, I'm looking at you. Where else does this unification, brainstorming, trial and error, innovation, and discovery come from? I'm standing right next to you, on this front line, doing my work to move us all forward, too.
Despite these difficulties, we must keep the very inspiration, passion, or whatever the flame is, inside you, that brought you to the nonprofit sector alive in ourselves and one another. We've attempted to be there for you and your organization by providing our 'free consultations' series, these past months, on this blog. It isn't a time to horde knowledge or expertise. Our communities' weakest, most under-represented, or disenfranchised are at risk. If your local United Way or just some unofficial but sincere group of nonprofit leaders, in your community, is getting nonprofit representatives together to discuss the challenges of this economy - consider joining that talk. Be there for that brown bag lunch. Make time after work, that evening. Move that meeting, or whatever you need to do to be a part of the solution making. You may think that you have nothing new or innovative to contribute; but who knows, before they discover or innovate something new that they were about to? In a discussion with our professional colleagues, you'll likely learn something new that you and your organization could use in these tough times; and listening to others who also live and work in your community may stimulate ideas or resources that you just haven't thought of (yet), on your own. Despite a common misconception that we are all competing for the exact same single donation dollar; we can come together, as professionals in the same sector, to share. The truth is that donors give to different causes, in different geographic locations, for different reasons. We are not all competing for one donor's single dollar. Also, donors give to what they are passionate about and often that's more than one cause or issue. We are all developing donors interested in our organization's single cause and the work that our organization succeeds at. Be confident in your constituency's dedication and open up to the community, for the sake of each and all of our organizations' missions.
It's a difficult time, but we can be there for one another, even as professionals. Your organization, the organization down the street, and my organization benefits when you and I show up for the 'fight'. In 2009 keep your eyes on the horizon. Watch for the innovation and new professional nonprofit best practices that comes out of this tough economy.
Posted by Arlene M. Spencer at 11:02 AM
The up side to this kind of adversity is that we're all going through this together. Adversity can unite and unify and has already begun to. In the face of a challenge Americans, historically, have risen to the struggle innovating, pulling together, and sticking in the fight. This economy has forced the very same amongst nonprofits, across the United States. Professional nonprofit affiliations are hosting all kinds of nonprofit forums to provide a public commons for us nonprofit professionals come together for an hour or two to discuss the financial issues we, individually, are facing at each of our organizations, and to then share or brainstorm solutions. Out of adversity comes exceptional leaps forward in theory, method, and best practices. Despite how concerned I am for this country's nonprofit sector, I look forward to learning about your innovation, new methods, and learning about what you 'invented' and shared, in effect, adding to our sector's best practices. Yes, I'm looking at you. Where else does this unification, brainstorming, trial and error, innovation, and discovery come from? I'm standing right next to you, on this front line, doing my work to move us all forward, too.
Despite these difficulties, we must keep the very inspiration, passion, or whatever the flame is, inside you, that brought you to the nonprofit sector alive in ourselves and one another. We've attempted to be there for you and your organization by providing our 'free consultations' series, these past months, on this blog. It isn't a time to horde knowledge or expertise. Our communities' weakest, most under-represented, or disenfranchised are at risk. If your local United Way or just some unofficial but sincere group of nonprofit leaders, in your community, is getting nonprofit representatives together to discuss the challenges of this economy - consider joining that talk. Be there for that brown bag lunch. Make time after work, that evening. Move that meeting, or whatever you need to do to be a part of the solution making. You may think that you have nothing new or innovative to contribute; but who knows, before they discover or innovate something new that they were about to? In a discussion with our professional colleagues, you'll likely learn something new that you and your organization could use in these tough times; and listening to others who also live and work in your community may stimulate ideas or resources that you just haven't thought of (yet), on your own. Despite a common misconception that we are all competing for the exact same single donation dollar; we can come together, as professionals in the same sector, to share. The truth is that donors give to different causes, in different geographic locations, for different reasons. We are not all competing for one donor's single dollar. Also, donors give to what they are passionate about and often that's more than one cause or issue. We are all developing donors interested in our organization's single cause and the work that our organization succeeds at. Be confident in your constituency's dedication and open up to the community, for the sake of each and all of our organizations' missions.
It's a difficult time, but we can be there for one another, even as professionals. Your organization, the organization down the street, and my organization benefits when you and I show up for the 'fight'. In 2009 keep your eyes on the horizon. Watch for the innovation and new professional nonprofit best practices that comes out of this tough economy.
Posted by Arlene M. Spencer at 11:02 AM
Sunday, December 21, 2008
The Costs of Senior Housing Vs. Home Care
In recent years, there has been a drastic shift away from institutionalized care for aging seniors. In the last two decades of the twentieth century rest homes began disappearing rapidly. The percentage of people over 75 in nursing homes fell from 9.6% in 1985 to 6.4% in 2004, according to the AARP Public Policy Institute.
Elder care experts say the decline reflects the growth of less-restrictive types of care, ranging from assisted living to supervised adult day care. These alternatives are usually less expensive than nursing homes and often provide a superior quality of life.
Elders, whether they are relatively independent in their care needs or require daily assistance, now have choices that have become increasingly popular since the latter part of the 20th century. Choices include publicly subsidized elder housing for those who are largely independent but are living on a modest fixed income.
For the more affluent senior a new and different housing option has grown rapidly since the 1980s. Known as continuing care retirement communities, or CCRCs, these elder housing options often resemble five-star hotels both inside and out.
With few exceptions continuing care retirement communities are not an option for those living on a modest income. Most require a large "entrance fee" that can be in the range of $250,000 or more, with additional monthly fees in the range of $3000-$5000 per month. Meals are served in an elegant dining room, ordered from a menu of several items prepared by well-trained chefs. Amenities include movie theaters, swimming pools, and many more attractive features.
As the term continuing care implies, as residents of a CCRC get older and require more assistance with daily care, they can move to other sections of the community where assisted-living units and even skilled nursing beds are available.
A related but separate housing option has also grown rapidly throughout the United States in recent years. Usually referred to as assisted-living facilities (ALFs) and sometimes as "intermediate care facilities," these new housing options offer attractive hotel-like surroundings without requiring a steep entrance fee.
For a fixed monthly rental fee, and some optional fees, monthly costs range from $2500 to more than $6000 a month depending on the facility, the level of services provided, and the size of the unit rented. A certain amount of daily assistance with activities, such as bathing and dressing, meal preparation, and transportation, are provided in assisted-living facilities.
Most Elders Still Want to Stay at Home Until They Die
Ask a room full of 80-year-olds where they would like to spend the last years of their lives, and 80% or more will state, "I want to stay in my own home until I die."
Just as the last 20 years has seen the growth of a variety of new senior housing options, so also has there been a rapid growth in "community-based alternatives" to allow frail elders to stay at home.
With a family member or a home health aide to assist with bathing and dressing and light housekeeping, a few hours of assistance each day can allow an elder to remain at home for an indefinite period of time.
Those with severe impairments, such as the advanced stages of Alzheimer’s disease, can’t be left home alone. This is where home care becomes an expensive alternative. At an average cost approaching $25 an hour, keeping someone at home with 24-hour care is more expensive than a nursing home. A typical nursing home on the east and west coast of the U.S. runs about $300 to $350 per day, while round-the-clock care at home can run as high as $600 per day. In an Age of Scarcity, Who Will Care and Who Will Pay?
A USA Today/ABC News Gallup Poll of baby boomers in 2007 found that 41% who have a living parent are providing care for them — financial help, personal care or both — and 8% of boomers say their parents have moved in with them.
It´s estimated that 34 million Americans serve as unpaid caregivers for other adults, and they spend an average 21 hours a week helping out, according to another study released last year by AARP.
Finding a suitable living situation with the level of care an elder may need has become increasingly difficult for the middle class. The USA Today poll report states: “…few (ALFs) are publicly funded... The majority of these units are only available to those who can pay for them out of their own resources.
In the fall of 2007, the U.S. Department of Health and Human Services announced it was dedicating $5.7 million in matching grant funds for “nursing home diversion programs.” While this sounds like an expansion of services, it’s really a shift of funds away from already inadequately funded nursing homes to pay for a modest amount of home care services.
"The upper-income white population has other options than nursing homes,” according to the Brookings Institution. "They´re moving to assisted living or their well-off, baby boomer children are taking care of them in other ways."
For those elders and families of modest means the question of which living situation is best suited for their personal needs is superseded by a much more challenging one: “Where will we get the money to pay for the care that is needed?”
CARE PLAN COST COMPARISON
Assisted Living Home Care Nursing Home Cost
1 Bedroom Unit 2 Bedroom Unit (not available in every facility) Non-Care Costs of Staying at Home Home Care 24 X 7 x $23/hr Home Care Live in Aide Private Room
$4500-$6000 monthly
$54,000-$72,000 annually
$6800-$8000 monthly
$82,000-$96,000 annually
Maintenance Property taxes Utilities Groceries Transportation $550 daily
$15,500 monthly
$186,000 annually
$235-$250 daily
$7000 monthly
$84,600 annually
$325-355 daily
$118,000- $130,000 annually
(Semi Private Room $285-$315 daily)
Bob O’Toole, MSW, LICSW is a clinical social worker with more than 25 years of experience in the field of aging. He is CEO of Informed Eldercare Decisions, Inc., a private eldercare consulting firm in Dedham, Massachusetts. He can be reached at bob@elderlifeplanning.com
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Elder care experts say the decline reflects the growth of less-restrictive types of care, ranging from assisted living to supervised adult day care. These alternatives are usually less expensive than nursing homes and often provide a superior quality of life.
Elders, whether they are relatively independent in their care needs or require daily assistance, now have choices that have become increasingly popular since the latter part of the 20th century. Choices include publicly subsidized elder housing for those who are largely independent but are living on a modest fixed income.
For the more affluent senior a new and different housing option has grown rapidly since the 1980s. Known as continuing care retirement communities, or CCRCs, these elder housing options often resemble five-star hotels both inside and out.
With few exceptions continuing care retirement communities are not an option for those living on a modest income. Most require a large "entrance fee" that can be in the range of $250,000 or more, with additional monthly fees in the range of $3000-$5000 per month. Meals are served in an elegant dining room, ordered from a menu of several items prepared by well-trained chefs. Amenities include movie theaters, swimming pools, and many more attractive features.
As the term continuing care implies, as residents of a CCRC get older and require more assistance with daily care, they can move to other sections of the community where assisted-living units and even skilled nursing beds are available.
A related but separate housing option has also grown rapidly throughout the United States in recent years. Usually referred to as assisted-living facilities (ALFs) and sometimes as "intermediate care facilities," these new housing options offer attractive hotel-like surroundings without requiring a steep entrance fee.
For a fixed monthly rental fee, and some optional fees, monthly costs range from $2500 to more than $6000 a month depending on the facility, the level of services provided, and the size of the unit rented. A certain amount of daily assistance with activities, such as bathing and dressing, meal preparation, and transportation, are provided in assisted-living facilities.
Most Elders Still Want to Stay at Home Until They Die
Ask a room full of 80-year-olds where they would like to spend the last years of their lives, and 80% or more will state, "I want to stay in my own home until I die."
Just as the last 20 years has seen the growth of a variety of new senior housing options, so also has there been a rapid growth in "community-based alternatives" to allow frail elders to stay at home.
With a family member or a home health aide to assist with bathing and dressing and light housekeeping, a few hours of assistance each day can allow an elder to remain at home for an indefinite period of time.
Those with severe impairments, such as the advanced stages of Alzheimer’s disease, can’t be left home alone. This is where home care becomes an expensive alternative. At an average cost approaching $25 an hour, keeping someone at home with 24-hour care is more expensive than a nursing home. A typical nursing home on the east and west coast of the U.S. runs about $300 to $350 per day, while round-the-clock care at home can run as high as $600 per day. In an Age of Scarcity, Who Will Care and Who Will Pay?
A USA Today/ABC News Gallup Poll of baby boomers in 2007 found that 41% who have a living parent are providing care for them — financial help, personal care or both — and 8% of boomers say their parents have moved in with them.
It´s estimated that 34 million Americans serve as unpaid caregivers for other adults, and they spend an average 21 hours a week helping out, according to another study released last year by AARP.
Finding a suitable living situation with the level of care an elder may need has become increasingly difficult for the middle class. The USA Today poll report states: “…few (ALFs) are publicly funded... The majority of these units are only available to those who can pay for them out of their own resources.
In the fall of 2007, the U.S. Department of Health and Human Services announced it was dedicating $5.7 million in matching grant funds for “nursing home diversion programs.” While this sounds like an expansion of services, it’s really a shift of funds away from already inadequately funded nursing homes to pay for a modest amount of home care services.
"The upper-income white population has other options than nursing homes,” according to the Brookings Institution. "They´re moving to assisted living or their well-off, baby boomer children are taking care of them in other ways."
For those elders and families of modest means the question of which living situation is best suited for their personal needs is superseded by a much more challenging one: “Where will we get the money to pay for the care that is needed?”
CARE PLAN COST COMPARISON
Assisted Living Home Care Nursing Home Cost
1 Bedroom Unit 2 Bedroom Unit (not available in every facility) Non-Care Costs of Staying at Home Home Care 24 X 7 x $23/hr Home Care Live in Aide Private Room
$4500-$6000 monthly
$54,000-$72,000 annually
$6800-$8000 monthly
$82,000-$96,000 annually
Maintenance Property taxes Utilities Groceries Transportation $550 daily
$15,500 monthly
$186,000 annually
$235-$250 daily
$7000 monthly
$84,600 annually
$325-355 daily
$118,000- $130,000 annually
(Semi Private Room $285-$315 daily)
Bob O’Toole, MSW, LICSW is a clinical social worker with more than 25 years of experience in the field of aging. He is CEO of Informed Eldercare Decisions, Inc., a private eldercare consulting firm in Dedham, Massachusetts. He can be reached at bob@elderlifeplanning.com
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Friday, December 19, 2008
Elder Mediation Resolves Family Conflicts
Florida Elder Law Attorney - Blog
A blog by Florida elder law attorneys Ellen S. Morris and Howard Krooks, partners of Elder Law Associates, based in South Florida. The blog covers all issues that encompass elder law, including Medicaid Planning, Estate Planning, Trusts, and Guardianships.
Thursday, December 11, 2008
Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.
"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.
Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.
"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.
It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.
The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.
A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.
Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.
Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.
It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.
A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.
WHAT IS ELDER MEDIATION?
Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.
Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.
• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.
There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.
In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.
In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.
“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”
Seniors Use Mediators to help the family plan for long term care.
In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:
“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.
If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”
“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm
Where to Find an Elder Mediator
• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books
Labels: Elder Care, Florida Elder Law Attorney
posted by Noah Davis at 7:40 PM
0 Comments:
Post a Comment
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Previous Posts
Eight Unselfish Ways to Put Yourself First
Being Social - One Key to a Longer Life
Holiday Blues - Depression in the Elderly
Medicare Enrollment Starts November 15, 2008
The State of Florida and Poor Senior Care
Dealing with the Sudden Crisis of Eldercare
Speakers for First Annual Elder Law Forum
Play Golf and Fight Alzheimer's
Ten Tips for Helping Families with Special Needs
Elder Law Article in New York Times
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A blog by Florida elder law attorneys Ellen S. Morris and Howard Krooks, partners of Elder Law Associates, based in South Florida. The blog covers all issues that encompass elder law, including Medicaid Planning, Estate Planning, Trusts, and Guardianships.
Thursday, December 11, 2008
Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.
"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.
Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.
"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.
It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.
The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.
A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.
Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.
Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.
It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.
A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.
WHAT IS ELDER MEDIATION?
Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.
Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.
• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.
There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.
In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.
In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.
“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”
Seniors Use Mediators to help the family plan for long term care.
In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:
“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.
If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”
“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm
Where to Find an Elder Mediator
• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books
Labels: Elder Care, Florida Elder Law Attorney
posted by Noah Davis at 7:40 PM
0 Comments:
Post a Comment
<< Home
Previous Posts
Eight Unselfish Ways to Put Yourself First
Being Social - One Key to a Longer Life
Holiday Blues - Depression in the Elderly
Medicare Enrollment Starts November 15, 2008
The State of Florida and Poor Senior Care
Dealing with the Sudden Crisis of Eldercare
Speakers for First Annual Elder Law Forum
Play Golf and Fight Alzheimer's
Ten Tips for Helping Families with Special Needs
Elder Law Article in New York Times
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