Elder Law Blog
Kalamazoo Estate Planning - Elder Law Blog

Alzheimer's Disease:

Posted January 9, 2017

In general, planning for long-term care is like planning for dementias like Alzheimer’s disease. While many of the same planning steps apply, certain steps take on added importance. The loss of executive function associated with dementia can create hardships for caregivers in arranging or paying for care. The ability to comprehend finances and care choices is often among the first signs of dementia. To avoid problems in planning, the following steps can be taken:

  • Advanced Care Directive — to make sure care choices reflect preferences.
  • Medical Power of Attorney — to make sure decisions can be made for persons no longer able to communicate their wishes.
  • Power of Attorney — to make sure financial and estate decisions can be made to pay for care, apply for assistance (i.e. Medicaid, state based programs) or for the ongoing management of an estate.

Once symptoms appear, dementia makes the long-term care planning process more complex. It causes a specific set of challenges that also must be considered when deciding what your next steps will be. Among these are:

  • Safety issues specific to people with Alzheimer’s;
  • Working with caregivers that understand the symptoms of dementia and how to respond effectively;
  • Medical specialists and products that may add to the cost of care, especially in regards to drugs specifically tailored to your loved one’s needs; and
  • Adult day services that provide socialization and activities in a safe environment to both provide a break to the caregiver as well as giving the people with Alzheimer’s positive stimulus

While people with dementia can stay in the home for some time, for most there will come a time when professional help, or living in a facility, becomes necessary. Today’s options for facility care may include assisted-living arrangements that specialize in care for people with dementia. Here are just a few of the possibilities commonly available:

  • Specialized dementia care facilities, also known as “memory care” assisted living, generally offer supports and protections that go beyond traditional assisted living communities. For example, having specialized staff training, secured exits, and enhanced visual cues to help residents feel more at ease in unfamiliar surroundings can be part of one of these facilities; and
  • Nursing homes include all the services of an assisted living facility with the added service of full-time nursing care, 24-hours a day. Some are designed specifically for people with Alzheimer’s

www. longtermcare.gov

 

Long-Term Care Needs:

Posted December 22, 2016

Long-term care is a range of services and supports you may need to meet your personal care needs. Most long-term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs), such as:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring (to or from bed or chair)
  • Caring for incontinence
  • Eating

Other common long-term care services and supports are assistance with everyday tasks, sometimes called Instrumental Activities of Daily Living (IADLs) including:

  • Housework
  • Managing money
  • Taking medication
  • Preparing and cleaning up after meals
  • Shopping for groceries or clothes
  • Using the telephone or other communication devices
  • Caring for pets
  • Responding to emergency alerts such as fire alarms

Medicare: Only pays for long-term care if you require skilled services or rehabilitative care: In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days). At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time. Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services You will have to pay for long-term care services that are not covered by a public or private insurance program

Medicaid:Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements Such requirements are based on the amount of assistance you need with ADL. Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances

www. longtermcare.gov

 

Medicare Eligibility and Coverage:

Posted November 7, 2016

Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant). Medicare does not pay the largest part of long-term care services or personal care—such as help with bathing, or for supervision often called custodial care. Medicare will help pay for a short stay in a skilled nursing facility, for hospice care, or for home health care if you meet the following conditions:

  • You have had a recent prior hospital stay of at least three days
  • You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay
  • You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy

If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day (as of 2013), and Medicare pays any balance. You pay 100 percent of costs for each day you stay in a skilled nursing facility after day 100. In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:

  • Part-time or intermittent skilled nursing care
  • Physical therapy, occupational therapy, and speech-language pathology that your doctor orders that a Medicare-certified home health agency provides for a limited number of days only
  • Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
  • Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20 percent of the Medicare approved amount

There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days. Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months. If you qualify for hospice services, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare-approved hospice provider, and other services that Medicare does not otherwise cover, such as grief counseling. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

www.longtermcare.gov

 

Medicaid Coverage for Long-Term Care:

Posted October 5, 2016

Medicaid is a joint federal and state government program that helps people with low income and assets pay for some or all of their health care bills. It covers medical care, like doctor visits and hospital costs, long-term care services in nursing homes, and long-term care services provided at home, such as visiting nurses and assistance with personal care.  Unlike Medicare, Medicaid does pay for custodial care in nursing homes and at home.

Overall program rules for who can be eligible for Medicaid and what services are covered are based on federal requirements, but states have considerable leeway in how they operate their programs.  States are required to cover certain groups of individuals, but have the option to cover additional groups.  Similarly, states are required to cover certain services, but have the option of covering additional services if they wish to do so. As a result, eligibility rules and services that are covered vary from state to state.

Medicaid covers nursing home services for all eligible people age 21 and older. Medicaid also covers home and community-based services for people who would need to be in a nursing home if they did not receive the home care services. In most states, Medicaid will also cover services that will help you remain in your home, such as personal care services, case management, and help with laundry and cleaning. Medicaid will not pay for your rent, mortgage, utilities, or food. Check to see whether your state Medicaid program offers alternatives to nursing home care services.

www. longtermcare.gov

 

 

 

 


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