Archive | February 2012

Finding the Right Kind of Care for your Family Member

Families each day families face the question, my loved one is ill and/or I can no longer take care of him/her so what are my options?

Before, anyone gets started they must first evaluate the situation thoroughly.  One must answer the following crucial questions before proceeding:

  1. What type of illness is affecting the elder? Is temporary or permanent?
  2. Can the person be left alone for any length of time? And if so, how many hours per day does the elder need extra help if they remain in the home?
  3. Has the person’s mental or physical capacity declined to the point where that they now need 24 hour supervision but still need minimal assistance with their activities for daily living (ADLS)? Or have they declined to the point where they need 24 hour nursing care?
  4. What type of assistive devices (canes, walker, wheelchair ) do they use daily? (This often helps determine where the placement of the individual).
  5. What finances are available?

Although many people today plan for their retirement they do not plan for the unexpected illness. So when this happens often times the entire family has a dilemma of how to pay for the type of care your loved one may need. In some cases, the option of long-term care insurance is available and can help. But, long-term care insurance will only pay when the circumstance meets certain criteria. Also, it pays secondary to the person’s primary insurance.

Because of the high cost of medical care outside the home, many times families will opt to take care of their love one at home. Unfortunately, many families find that their elderly parent or other loved one requires much more care than they can provide. So the family and the patient are left wondering what to do next.

Everyone has the right to have a better understanding of the elder care system and the potential costs involved. It is important for everyone involved in the lives of our cherished elderly population and other ill patients to have as much information as possible so that a calculated and overall better made decision transpires.

There are several options available to families these days. Two of the important factors which influence the decision on where to place your loved one are the financial ramifications and the other is the type of care needed.

With the high cost of medical care these days many families opt for taking care of their loved one at home. There are still options available to help make this easier both physically and financially.

The family can hire an outside agency to help care for their loved one, but  often have a  high cost. Services charge an hourly rate usually ranging from about $18 to $25 per hour. If over-night care is necessary then the cost goes up. Many cannot afford this service. Yet, there are advantages to this of type of care as some  agencies are hired for a short amount of time. For example, if the elder just needs assistance with shopping or the lunch meal then the agency can provide a caregiver for 2 hrs per day to assist them. This would be far less expensive than placing the individual in an Assisted Living or Board and Care.

Another way is for families to apply for in-home support services if they meet the criteria. The IHSS Program is available in California (other states may also have similar services available, please check with your Medicaid program).The IHSS Program will help pay for services that will help the elderly person to remain safely in their own home. This is an alternative program to long-term care (nursing homes), assisted living or board and care facilities. Eligibility requires the person to over 65 years of age, or disabled, or blind. Disabled children are also eligible for IHSS. Also listed below are other eligibility requirements:

  • Is the person a currently receiving Supplemental Security Income/State Supplementary Payment (SSI/SSP); or
  • Does the person meet all the eligibility criteria for SSI/SSP except that their income is more than that of the SSI/SSP income levels; or
  • Does the person meet all the eligibility criteria for SSI/SSP, including the income requirement, but still is not receiving SSI/SSP; or
  • Is the person a Medi-Cal recipient who meets SSI/SSP disability criteria?

Some of the approved  IHSS services are housecleaning, meal preparation, laundry, grocery shopping, personal care services (such as bathing, grooming and toileting), assistance with wound dressing changes, stoma care, companionship to medical appointments, and protective supervision for the mentally impaired.  For other services provided check with the program directly.  Family members can provide these services in lieu of an outside agency provide the services.

The problem with this model is that most elderly patients need more than just a few hours of care. The IHSS program will approve up to 4 hours of paid assistance depending on what they determine the need is. In that case the burden falls upon the family to care for the person for the remaining 20-22 hours hrs per day.

If the family finds that caring for the elder in the home is too difficult they can opt for other residential care options such as a Board and Care or Assisted Living Facilities. The term residential care refers to a facility where non-medical long-term care is provided in a single family residence, a retirement residence or in any appropriate care facility.

A Board and Care facility is usually a 1-6 bed facility and has a home like environment being set in actual residential homes. The potential resident must be able to take their own medications with minimal assistance, they should be ambulatory but can use assistive devices such as a walker, should be able to feed themselves with minimal assistance. This type of facility is completely private pay. Meaning the family or resident will have to pay out of their pocket. Some do accept SSI/SSP as payment, but they are difficult to find and the patient has need very little assistance. The cost per month for this type of facility can range from $1500 on the low-end to $ 4500. The cost will depend on the “level of care.” This means, for example, that for the basic room and board there is one price, but if the resident needs more assistance such as with bathing and grooming and/or with taking medications there will be an increase in cost. But on average the cost of a shared room in a 6 bed or smaller facility is $2500 per month and for a single room is it $3500 per month. Again, keep in mind that these facilities do not accept insurance payments.

Another type of residential care facility is the large Assisted living facility which provides assistance with Activities of Daily Living (ADLs), but allows one to live as independently as possible for as long as possible. Assisted living exists to bridge the gap between independent living and nursing homes. Residents in assisted living centers are not able to live by themselves, but do not require constant care or 24hr nursing care either. Assisted living facilities offer help with ADLs such as eating, bathing, dressing, laundry, housekeeping, and assistance with medications. Assisted living is not an alternative to a nursing home, but an intermediate level of long-term care appropriate for many seniors. Many of the facilities also have special memory care units for those with Alzheimer and Dementia that are not at the advanced stages which require more medical care. The cost per month for this type of facility ranges from about $3,000 to $5,000. The level of care needed is what affects the cost. You just basic room and board it is in the $3000 range. If the resident needs assistance with meals or dressing for example, the cost will be higher because a higher level of care is provided. Another factor in cost is if the resident lives in a shared room or a private room. Again, these facilities are private pay only. Meaning they do not accept insurance payments of any kind.

The final type of facility is the Long Term Care also known as a Nursing Home. In these facilities they provided total care. Meaning they provide assistance at all levels. There is not just supervision 24hrs per day, there is actual medical care provided 24 hrs per day. Assistive devices such as wheelchairs and walkers are welcome. The main difference is that nursing care such as wound care, IVs, injectable medications, and mechanic feedings are allowed. Resident that require outside care such a hemodialysis can still attend their treatments and then have 24 hr nursing service to monitor them. The care provided is much more extensive in Long Term Care. The cost is much greater, but insurances are accepted and Medi-cal does pay for services at this level. The average cost is about $5200 for shared room to $7000 for a private room. The charges are for the total care of the patient including their medications and the visits with the facility physician. If the resident is a private pay patient then the fees may vary as the medications would not be included in their care unless the resident has Medicare part D.

Our elderly population deserves  treated with respect and dignity.

Fiduciary Abuse- A growing problem

What is Fiduciary Abuse?

This is a situation by which an individual who is legally responsible for managing another person’s assets uses his or her power to benefit financially in an unethical or illegal manner. Fiduciary abuse can be done by anyone such as a financial advisor, power of attorney, or family member.

A Growing Problem

Many times the elderly have a difficult time managing their money, and so they are dependent on others for help. This is when that unscrupulous individuals step in and make attempts to obtain monies from property, land, goods and bank accounts.

Who could provide financial abuse of your loved ones?

To determine if your loved one is being abused financially, we must first clarify who could potentially lead to abuse.

Personal Caretaker

A surprisingly large number of cases of financial abuse occur between an older person and their caretaker. This can include guardian or family members who start out doing the right thing, but are in a strong position only to commit financial abuse because of the temptation. One way this happens is by gaining the confidence of the victim slowly the guardian of the person begins to take control of the victim’s possessions. Another way is through the use coercion. This is when an individual is forced to sign over land, property or access to bank accounts because of threat or feeling intimidated. Guardians can also manipulate the “authority” and the layout of the will.

Another way this occurs is when a loved one is being cared for by a family member who takes advantage of the situation. This can happen several ways. One, the elder person is placed in a long-term care facility and the family member continues to take the SSI check and spend it for their own bills. The SSI money is supposed to be spent of the care of the elder person not on the caretaker’s bills. Secondly, the caretaker charges the elder for their care and is also being paid by in-home support services. This also falls under fraud and should be reported to Medi-cal/Medicaid.

Long Term Care Facilities

Many people are concerned about the quality of care for their relatives in nursing homes. They often forget to keep a watchful eye on the monetary portion of their loved ones care. The family must always make sure the charges for the level of care are correct. If the products and services account shows what you believe has not been provided then it is important for the family to discuss this with the Business Office Manager first then with the Administrator.

Deceivers come in many shapes and sizes and from all over the world. The elderly have a higher probability of being scammed because of the constant evolution of technology and the potential diminished mental capacity. Phone scams often target older people who the scammers think they can manipulate and at times scare them.

One indicator may be an increased number of checks being used or excessive amounts of money being sent to an unknown person or entity. Always follow-up with your loved ones in these financial decisions and keep a watchful eye on their finances when possible.

What can be done?

If there is suspected financial abuse there are several things that can be done to stop it, protect your loved one and to prevent it from happening to others.

First, report it. It must be reported to the local authorities. Many of the law enforcement agencies these days have special units dedicated to fiduciary abuse. If they don’t have such a unit, still request an officer to come out and take a report. You will need the report number when contacting the bank. Also, report it to APS (Adult Protective Services).

Second, assist the victim in contacting the bank. The bank will guide you through the process. Often the account is frozen or closed and moved to a new account. This will also help the victim recover some of the monies in some cases.

If the elder person is in a long-term care facility, report the situation to the Ombudsman, State Licensing and APS. Also, make sure the facility is aware. They must conduct their own investigation and follow-up. Often times the facility is the first to become aware of the situation and will take the initiative in starting the investigation and reporting it to the agencies.

One main thing to remember is to document everything you can. The documentation of all the agencies that have been contacted with the person’s name you spoke to, the date and time are extremely crucial. It may help prevent the investigation from falling through the cracks.

The elderly population is growing and so is fiduciary abuse. Our elders require honest and empathetic people who are willing to be advocates for them and assist in their protection.