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.

Understanding Hospice Care

Hospice is a belief in specialized care. This viewpoint accepts death as the final stage of life. Hospice care is end-of-life care or palliative care which is provided by health professionals. Palliative care is treatment to help relieve disease-related symptoms, but not cure the disease; its main purpose is to improve your quality of life.

The goal of hospice is to allow patients to continue an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and does not accelerate or postpone death. Hospice provides humane and compassionate care for patients in the last phases of incurable disease so that the person may live as fully and comfortable as possible. The person may have lived a long life, but they deserve to be afforded dignity and compassion. Our elder population often gets over-looked when it comes time to let them complete the life cycle.

In order for a patient to be placed in hospice they must to have a terminal illness such as cancer or an end-stage diagnosis. They must also be expected to live 6 months or less. In the elder population the patient usually has an end-stage diagnosis of dementia, Alzheimer’s, cardiac, renal insufficiency, or debility. Of course there are other diagnoses, but these are the most common.

Hospice care begins when the patient is admitted to the program because of a terminal illness such as cancer or end-stage illness, which generally means that a hospice team member visits the home or long term care facility to learn about the patient’s needs. If the patient is elderly and the hospice is Medicare-certified then the hospice company must provide nursing, pharmacy, and doctor services around the clock. If the patient resides in a nursing home the hospice will pay for the nursing care, but they do not pay for room and board charges. Those charges will be paid either through private funds or via Medi-cal if the patient qualifies for the service.

It is important to know that home hospice may require that someone be home with patient at all times. This may be a problem if they live alone, or if other people in the home have full-time jobs and work outside the home.

Who is involved ?

A team of professionals

In Hospice care there is a team of professionals and some volunteers that help provide the care. The health care team also called an interdisciplinary health care team manages hospice care. This means that many interacting disciplines work together to provide care for the patient. Doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers interact and provide care for the patient and their family. Each team member offers support based on their expertise. The team treats the person rather than the disease; it focuses on quality rather than length of life. They not only focus on the care of the individual that is ill but also on the family. They give medical, psychological and spiritual support.


Hospice volunteers play an important role in developing and providing hospice care. They may be health professionals or lay people who provide services that range from hands-on care to working in the hospice office or fundraising.

What Services are provided?

Coordination of care

The interdisciplinary team coordinates and supervises all care 7 days a week, 24 hours a day. This includes when the patient resides in a nursing home. This team is responsible for making sure that all involved services share information. This may include the inpatient facility, the home care agency, the doctor, and other community professionals, such as pharmacists, clergy, and funeral directors. The patient, the family and the caregivers are encouraged to contact hospice team if any problems arise. It does not matter what time of day or night the problem occurs. There is always staff on call to help with whatever may arise. Hospice care assures the patient and their family that they are not alone and help can be reached at any time.

In a long term care facility and/or assisted living facility the staff at the facility will also act on behalf of the patient and family. The hospice company does not remain at the facility unless it is an inpatient hospice facility. The family or patient can speak to the charge nurse at the facility to have questions answered.

Staff support

Hospice care staff members are kind and caring. They communicate well, are good listeners, and are interested in working with families who are coping with a life-threatening illness. They are usually specially trained in the unique issues surrounding death and dying. Yet, because the work can be emotionally draining, it is very important that support is available to help the staff with their own grief and stress. Ongoing education about the dying process is also an important part of staff support.

Respite care

While you are in hospice, your family and caregivers may need some time away (this pertains the patient that is residing at home).Hospice service may offer them a break through respite care, which is often offered in up to 7-day periods. During this time the patient will be transferred out of the family home to a hospice facility or to a long term care facility. This allows families to take a mini-vacation, go to special events, or simply get much-needed rest at home while the patient are cared for in an inpatient setting.

Pain and symptom control

The goal of pain and symptom control is to help the patient be comfortable while allowing them to stay in control of and enjoy your life. This means that side effects are managed to make sure that the patient is as free of pain and symptoms as possible, yet still alert enough to enjoy the people around them and make important decisions. With the elderly population the family would be more likely to make decisions regarding the medications and pain control by discussing any issues with the hospice nurse. In the elderly population there is often a diminished mental capacity making it difficult for an elder to make proper choices. Keep in mind that if the elder is still able to make decisions that the decisions will remain in their control.

Spiritual care

Hospice care also tends to the patient’s and family spiritual needs. Since people differ in their spiritual needs and religious beliefs, spiritual care is set up to meet the patient’s and/or the family’s specific needs. It may include helping them to look at what death means to them, helping them say good-bye, or helping with a certain religious ceremony or ritual.

Bereavement care

Bereavement is the time of mourning after a loss. The hospice care team works with surviving loved ones to help them through the grieving process. A trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls, and/or letter contact, as well as through support groups. The hospice team can refer family members and care-giving friends to other medical or professional care if needed. Bereavement services are often provided for about a year after the patient’s death.

Family conferences

Through regularly scheduled family conferences, often led by the hospice nurse or social worker, or in the case of a long term care facility the IDT members family members can stay informed about the patient’s condition and what to expect. Family conferences also give everyone a chance to share feelings, talk about expectations, and learn about death and the process of dying. Family members can find great support and stress relief through family conferences. Conferences may also be done informally on a daily basis as the nurse or nursing assistant talks with patient and their caregivers during their routine visits.

Where can Hospice care take place?

Hospice care can be given in the patient’s home, a hospital, skill nursing facility, or private hospice facility. Most hospice care in the United States is given in the home, with a family member or members serving as the main hands-on caregiver.

Hospice is a wonderful service for anyone one with a terminal illness or an end-stage illness. But, one of the problems with hospice is that it is often not started soon enough and in the case of the elder population not started at all. Sometimes the doctor, patient, or family member will resist hospice because he/she thinks it means that they are giving up or that there is no hope. Of course this is not true. If the patient’s condition improves the patient would be re-evaluated and possibly taken off of hospice if the improvement changes their life expectancy. The patient can always be placed on hospice later if their condition worsens. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness.