Caring for Aging Parents - Equip for Life Session | Session 2

1. Equip for Life
Caring for the Aging
MARCH 4 2017

3. Tale of Two Ladies

4. Is this real????

5. What if this happened?
 Scenario: Your mother calls you and says your father is being taken to the
hospital. He lost feeling on the right side of his body and he can’t talk
anymore. Your father takes care of all the bills, able to drive, grocery
shops, does most of the cooking, handles his own medical health. Your
mom has some medical issues, but can take care of herself and can do
some light housekeeping. You rush to the hospital to meet up with your
mom. After a few hours, the doctor comes out and reports your dad had a
left middle cerebral infarct with residual right sided paralysis, global
aphasia, and dysphagia resulting in the need for alternative nutrition. Your
father has had a stroke. The right side of his body is paralyzed, he cant
speak or understand the words being said, and he can no longer swallow.
They will place a tube down his nose to feed him for the next few days.

6. What if this happened?
 The doctor explains that your father will stay at the hospital for a few days
and then will need to be transferred to a rehab center. You ask “how long
will it take for him to get better”. The doctor says that it could take 3 to 6
months to recover, but his prognosis is that he will not be back to his prior
function. He is predicting that your dad will need some sort of care
moving forward. This will include assistance with dressing, bathing,
toileting, no more driving, limited communication and possibly a special
diet.

8. What do we do???
 So what do you need to consider:
 1) Rehab facility
 2) Financial obligations
 3) Diagnosis education/prognosis
 4) Resources available for care post rehab
 5) Advance Directives
 6) Family dynamics “Who’s really in charge?”

9. Terms to “get to know”
 1) Acute Care/Sub acute/Long Term Care/SNF
 2) ADLs (Activities of Daily Living
 3) ACA/Obamacare/Medicare reform/
 4) Skilled level of Care
 5) Community vs Institutional Medicaid
 6) Long Term Care Ombudsmen
 7) Qualifications/Steps for levels of care
 8) Appeal/Denial/Beneficiary
 9) Case managers/authorizations

11. Various Payor/Insurance information
 1) Medicare A and B
 2) Medicaid/Medical Assistance
 3) Managed Care/Commercial insurance/Private insurance
 4) Managed Medicare
 5) VA benefits
 6) Long Term Care Insurance
 7) Life insurance riders
 8) Medigap/Supplemental insurance

12. Payor Sources
 Medicare A (Classic/Traditional Medicare)- “hospital benefit”. Basic
product is 100% coverage while in acute care setting. Most expensive level
of care. Goal is to transition to safest “step down level of care”. Will pay
100% for 20 days in sub acute setting and then to 80/20 for days 21-100 if
beneficiary qualifies. Pays for Hospice and Home Health Services
 Medicare B (Classic/Traditional Medicare)- ancillary benefit/outpatient
benefit. The beneficiary has to pay a monthly deductible for this product.
For 2017 will range from $134-$180/month based on annual income. This
product only covers 80% of the service provided.

13. Payor Sources
 3) Medigap/Supplemental insurance- Additional insurance product to
cover 20% not covered by Medicare. Common companies in Maryland
include AARP, BC/BS, Aetna and Medicaid.
 4) Medicaid- This is a state specific product that certain criteria must be
met to qualify for this product. There is no monthly premium to be paid.
It is qualifying product.
 5) Managed Medicare- Newest product entering the industry. Companies
like Humana, Optima, etc… assume coverage of beneficiary and charging
lower premiums. Product falls under Managed Care type management.
Will not get the same service as with Classic Medicare

14. Payor Sources
 6) VA benefit- would need to work with Veterans Affairs to determine
qualifications of accessing benefits
7) Long Term Care Insurance- benefits are specific to companies and
premiums. Most do have a case manager approach where coverage has to
be approved and managed. Monthly premiums vary based on coverage
8) Life Insurance Riders- supposedly certain policies have a long term
option

15. Affordable Care Act (Obamacare) and
the Elderly
 Medicare when it all began
 Expiration date and Baby Boomers
 Medicare Reform and Obamacare/ACA- Triple Aim
 1) Improved patient experience- outcomes
 2) Population health- preventative
 3) Lower costs
 What does this mean for our parents and us?

17. Sites and Levels of Care/Settings
 1) “Nursing Homes”- Skilled Nursing Facility/Long Term Care Facility
 2) Subacute versus Acute versus Long Term Care Facility
 3) Assisted Living Facilities
 4) Group Homes
 5) Continuum Care Retirement Communities
 6) Hospice
 7) Home Health
 8) Senior Housing
 9) Private duty care

18. Sites of Care
 Nursing Home/Skilled Nursing- Most are dually certified to provide
services to Medicare and Medicaid recepients. Subacute and Long term
care services can be provided in most. Small portion of sub acute centers
to not accommodate a transition to LTC. Regulated by State Health
Department, Federal Regulations, and Centers for Medicare and Medicaid
(CMS).
 State health department surveys
 5 Star quality ratings
 Payor sources-
 Services available/Level of Care provided

19. Sites of Care
 Assisted Living Facility (ALF)- various environmental models. Cost of
housing is usually dependent on how much care is provided for Activities
of Daily Living (ADLs). Levels are determined based on designated amount
of assistance is needed to complete ADLs and cognitive status. Most
require private pay, but there are options for Md Medicaid waiver
program, but it is quite limited.
 Hospice- Level of Care covered by Medicare A benefit. Can be provided at
designated hospice facility, skilled nursing facility or at home. At home will
not be a 24 provision of services

20. Sites of Care
 Continuum Care Retirement Community (CCRC)- “age in place”. These
communities offer Independent Living, Assisted Living, skilled nursing (sub
acute), long term care all on the same campus. The IL and AL portions of
these campuses are private pay and usually have “buy in” charges.
 Home Health Services- Medicare A product available to “home bound”
patients who need skilled nursing/rehab services. Not established to be on
going.

21. Sites of Care
 Senior Housing- Usually income controlled housing where rent is charged
based on the senior income. Apartments are set up to accommodate
disabilities and might have a system to alarm individuals for any issues
 Group homes- private homes where live in care providers take care of
patients. Some options for Medicaid payment
Private duty nursing/nursing assistants- pay privately for nursing assistants to
care for resident at home. This can vary to driving services to 24/7 care.
Average hourly rate is around $22/hour

24. Diagnosis Considerations
 Dementia
 Diabetes
 Cardiac
 Pulmonary
 Neurological/Muscular
 Cancer
 Orthopedic
 Medically complex

25. What now?????
 Research Now
 Talk to family members now, designate spokesperson
 Develop your plan A, B, C, etc…..
 Stay closely involved with your parents health
 Review your plans regularly and adjust as necessary
 Obtain a copy of your parents advanced directives and legal documents in
case of incapacity

26. Research
 Department of Aging
 CMS.gov
 Nursing home checklist
 Better Business Bureau
 Read Google reviews
 Do spontaneous facility tours
 Keep in touch with local senior center seminars/information
 Consult with lawyer

27. Resource sites
 www.medicare.gov
https://www.eldercaredirectory.orgnihseniorhealth.gov/
 http://www.medicare.gov/NHCompare/home.asp
 www.aging.maryland.gov
 www.mdseniorresource.org
 https://www.payingforseniorcare.com
 https://www.eldercaredirectory.org