Free is not really free

Professional Geriatric Care Managers are often Registered Nurses or Social Workers with diverse experiences in long term care, hospitals, assisted living and independent living communities. They offer the family and the client their expertise in these areas that most free services cannot offer. Care options are based on an in depth personal assessment of the client which includes, but is not limited to, a functional assessment, mental status assessment/depression scale, financial evaluation, knowledge of Medicare and Medicaid services, Medicare and Medicaid home services, VA benefits, alternative options and referral resources. A Geriatric Care Manager works for the principal not for a facility fee. The offer for "free" services is most valuable to those who are looking for an open bed or an apartment at the "best price", but this does not necessarily mean that the placement service is providing the best care options/alternatives for their loved one. This costs the client and the family/legal representative precious time, money and perhaps quality of care. While it is true we are in the same market a free service is much different than the service provided by a Geriatric Care Manager. Many times we provide free information when someone calls our office because it's the right thing to do. C&S Care Management, Inc. is free from conflicts of interest and discloses all business relationships. Only the client's interests are considered. Geriatric Care Managers offer support even after a placement is made. They act as advocates for all clients. My recommendation to families is to contact a Geriatric Care Manager and have a conversation to learn how a GCM can best meet your needs. Try caremanager.org for a Geriatric Care Manager in your state.  C&S Care Management, Inc. in Houston is a comprehensive care management/care coordination firm with over 35 years of experience in the healthcare field.

Call C&S Care Management, Inc. for peace of mind 281-550-8444.

Update from the Center for Medicare Advocacy, Inc.

On August 2, 2013 the Centers for Medicare and Medicaid Services (CMS) made a decision on Observation Services.  The decision was not to make a decision related to Medicare beneficiaries!  After pages and pages of regulatory discussion and evaluation, it appears that CMS did not make a conclusive decision on whether the time spent in observation status will be counted toward the three day hospital stay to qualify for Skilled Nursing Facility (SNF) care.

Be an advocate for all Medicare beneficiaries by calling your local representatives and bringing the unfair practice of cost shifting through observation status to their attention!  Help end observation status now!  Go to www.medicareadvocacy.org  and read Observation Status: OIG Provides an Analysis and CMS Issues Final Regulations and Now is the Time to End "Observation Status."

Are You or Your Loved One Covered by Medicare?

Are you or your loved one covered by Medicare? Yes?  Then educating yourself about Observation Services/Observation Status may save you money.

When a patient is under observation status, Medicare only covers outpatient costs.  The beneficiary must pay a co-payment for all treatments, medications, testing and labs.  As you enter the ER, you are stopped to complete paperwork for your very ill loved one.  Do you read and understand every document?  Probably not.  You are concerned that they are receiving the best care and quickly!  What you may not know is that the hospital is asking you to sign a document that says the beneficiary may be under observation services/status (outpatient) and is responsible for co-payments.  This is cost shifting, shifting more of the cost of medical care to the beneficiary.

ASK if you are an inpatient or an outpatient.  It may seem that you are an inpatient because you are wearing a gown, in a bed and receiving x-rays, treatments, medications and even having blood drawn.  But...that doesn't mean you are ADMITTED to the hospital as an inpatient.  You may even go to a room and stay 3 or more days...and still not be an inpatient.

ASK your doctor, the case manager and the billing department if you are admitted as an inpatient or outpatient.  ASK the billing office to estimate your out of pocket costs as an outpatient.

ASK if you are an inpatient and qualify for rehabilitation under Medicare in a Skilled Nursing Facility.  Have the Skilled Nursing Facility verify you were admitted to the hospital as an inpatient for three consecutive 24 hour periods and are covered by Medicare for rehabilitation services.  Otherwise you may be responsible for a huge bill from the rehabilitation facility.

Ask those in the House of Representatives to support H.R. 1179: Improving Access to Medicare Coverage Act of 2013 and in the Senate to support S. 569: Improving Access to Medicare Coverage Act of 2013.

Start a conversation with your loved one about the care they want and need.  Discuss the options for care, how to stay out of the hospital and if they want heroic measures performed.

Stay tuned for the changes coming to Medicare!

Family Matters

The American Association for Marriage and Family Therapy states that "more than ever before, families are providing long-term care to older adults with limitations in the ability to perform tasks necessary for independent living. Nearly 25% of American households are providing care to people age 50 years and over. Families are the alternative foundation for a stressed healthcare system. Hospital stays are shorter than ever and family caregivers are often expected to do what healthcare professionals once did."

Family caregivers take over various responsibilities for their elders. It may be just handling finances, running errands, going to doctor appointments or taking on full 24 hour care services. In most cases one sibling in the family will become the main caregiver, but most successful ventures are supported by the entire family.
 

There is a saying that it takes a village to raise a child. This may be true, but it takes a family to care for an aging parent. As seniors lose physical and cognitive function they become vulnerable and unable to manage their own care. Who better to know their needs and desires than their own children. Even if professional care givers are providing services, family involvement makes the difference in quality of life for their parents.

"If one family member has been designated caregiver other members can give support with respite care, transportation to doctors, etc., everyone needs to be aware of all that is needed and be in total agreement to do it." "The 4 Steps of Long Term Care Planning"

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent’s home, others can easily be suspicious of ulterior motives and fear to lose their inheritance. On the other hand, the child doing the entire care taking becomes bitter and feels there is no support or help from siblings.

One example of a family misunderstanding is that of a brother accusing his sister of stealing all of the money from the sale of his parent’s home.

Karen, who was a single mom with two children, moved in with her parents when her father had a stroke to help her mother take care of him. Her mother was also disabled. Needing money to pay for a home care service, Karen helped her mother do a reverse mortgage on the home, which gave the needed funds. If communication had been open and Karen’s brother had known the need and been involved with his parents care, he would not have reacted so negatively when he eventually found out about the reverse mortgage.

Every family is different. Some families are close and some have never been compatible. If your communication is strained, consider having a professional mediator present at a family meeting. The mediator will be able to keep things calm and running smoothly and help work out each persons concern.

Family matters. The experience of working together for their parents' care can give aging parents and family members a peaceful, memorable experience.

 

Changes - Factors that determine more help at home or a higher level of care is needed

 

There is an overwhelming amount of information about housing options for senior adults which causes confusion and frustration for the caregiver/adult child.  The greatest challenge is finding the “right” level of care.  Most seniors prefer the comfort of their home to an assisted living or nursing home setting.  They want to maintain their independence for as long as possible.  

 

However, the truth is some need more than “just a little” help.  

 

How do you determine when it is time for additional help or plan a move into a community where twenty-four hour assistance is available?  Here are some CHANGES to look for that signal more care or a move is needed. 

·       Safety – Leaving the gas stove on, setting fire in a microwave oven, forgetting a driving route they have traveled for years, unexplained injuries or car accidents, and letting strangers in their home without hesitation.

·       Falls – Falling without tripping, from weakness, poor balance, coordination, and  visual impairment.

·       Medication Mismanagement – Does not take medications as prescribed, forgets to take medication, improper storage, incorrect dosages, continuing to take discontinued medications.

·       Loss of Executive Function – Difficulty planning or processing information.  Inability to organize thoughts. Inappropriate social behavior.

·       Memory Loss – Unable to manage a schedule or remember appointments. Makes repetitive significant financial errors. Compensates for memory loss by asking others to “remember” for them.  Requires verbal cuing for activities of daily living, i.e., dressing, bathing, and ambulation.

·       Functional Limitations – Unsafe when stepping over a tub or getting in and out of a car.  Finds it difficult to put on clothing or shoes due to pain or limited range of motion in joints.  Visual and hearing impairments limit social interaction and miscommunication with healthcare professionals.

 

These changes signal an ALERT!!  Planning before a crisis helps you make the best decision for your loved one.  Start the conversation NOW.  Ask questions and look for these subtle but very important changes.

 

Next….what are Levels of Care?