As a nurse that works in the community I find that most people do not understand that care-giving or housing needs are not in fact covered by medical insurance. Families will often call or meet with our liaisons ready to "order" their care or service shell shocked when they discover they will be paying out of pocket. This has made our company very knowledgeable on back up strategies. This is a simple layout of some options. Having a back up plan could have saved hundreds of hours of stress with families in the emergency room. Consider the tips listed at the bottom of the page to help get your family on track.
Medicare covers the skilled nursing home stay when an individual has had a hospital stay that includes 3 midnights and has a skilled reason to be admitted to a rehabilitation center. When an individual has managed care there may be exceptions to the 3 day stay in a hospital. This has been a blessing for individuals who have had a setback with their care but no medical reason to have a hospital stay. With Medicare discouraging hospital admissions for custodial reasons managed care insurance has helped many a family we have worked with in getting some immediate assistance until long term planning can be initiated.
Medicaid is a state program and is great once in place. However many families contact or first see medical personnel once the care is already needed. The process to apply and be approved can be at least a month or two. If families have not planned ahead for this time period then planning with the family becomes our strength. We utilize our Chart Your Own Course programs to help families do some planning with guidance. Often times the family will have to step up and provide the care until Medicaid does begin.
Long Term Care Insurance is a wonderful plan for people wanting to pay for all levels of care. The package and level of coverage varies but many a family has sighed once discovering their loved one has this insurance. It helps families meet wishes for families. Often times Long Term Care insurances will also pay for care coordination (a care manager) without a waiting period allowing you to have some assistance.
Individual entitlements such as Veteran's, L&I, Government Grants are very individualized and there is no immediate assistance with these programs. Though they are excellent ways to fund someone long term some funding will need to be provided up front and possible for as much as a year before they kick in. Rarely do these programs cover the entire amount of care.
Privately paying can be the most challenging for individuals that haven't planned for a medical or physical setback or increase in care needs. Some tips that we can offer:
1. A referral agency can help negotiate a decreased rate with facilities. We aren't just saying this because we are one. It is the agency's job to know who is currently more willing to work with you.
2. A Care Manager can help advocate for care assessment changes when health improvements occur.
3. A Care Manager can evaluate potential entitlements an individual may qualify for.
4. A referral agency will know local deals that are happening offering the most creative plans.
5. Paying for a facility that will work with you finances will make a difference.
6. Other Veteran's benefits besides just a veteran's pension. Aid & Attendants is one but there are others.
7. Beware of just placing at a location that was recommended by someone. This doesn't mean the place they recommend isn't a great facility. It is just is it the right one for your loved one? Many a dollar has been spent only to be spent again elsewhere because a facility wasn't really the right fit for the individual.
Good luck with your search!
www.caycare.com
Lisa Doyle is an registered nurse and a certified care manager and healthcare advocate. She has worked in healthcare since 1995 serving mainly a geriatric population. She has worked with pediatric and young adult cases with chronic disease management or developmentally delayed challenges. She serves on a board for helping serve families with medically intensive infants since 2009. She believes strongly in advocating for the medical services for the healthy senior regardless of the age. Lisa herself had cancer while pregnant in 2002 and two premature children since then. Lisa also lost a son shortly after birth, Djeran Will Doyle. Lisa speaks regularly to small and large groups on many topics including advocacy, hospital care transitions- enabling the client, aging and dealing with death, humor in chronic illness, miracle of life-regardless of the age.
To have Lisa speak at your next engagement email: contact@caycare.com
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