Long Term Care Facts and Information

Long Term Care Facts

Here are some facts and tips about Long Term Care. Click on a category of interest.

Medicare
Assisted Living Facilities

Getting Good Healthcare

Aging In Place

Family Caregivers

Medicare

Medicare is a federal health insurance program that provides benefits to those age 65 and older. This program is made up of Part A, which covers inpatient hospitalization, some home health care visits and limited post-hospital care, and Part B, which includes doctor’s services.

Medicare Part A Quick Facts

Approximately 98% of older Americans are enrolled in Medicare.
Under Medicare, skilled-nursing care is provided for 100 days following a hospital stay of at least three days.
On average, Medicare pays about half of beneficiaries’ health care expenses.

Medicare Part B Quick Facts

As of 2002, 78% of claims that were denied at first got fully or partly paid on the second try, and 67% made it on the third try.
Some insurance policies may actually pay for services not identified in their policy if they believe that it will avoid more costly treatment later on.
In 1998, the typical Medicare beneficiary requiring home health care was female, 75 years old and had a median income of $8,365. She required an average of three home health visits per week.
Per capita spending on Medicare is projected to shoot up 44 percent between 2000 and 2025, from $6,213 to an estimated $8,987.
You have 63 days from the date you leave your current HMO to take advantage of a guranteed Medigap plan.

Assisted Living Facilities

Assisted Living Facilities (ALFs). ALFs are live-in communities that provide multiple levels of care. Fees for ALFs are not covered by Medicare or Medicaid; they are generally privately-funded facilities.

Quick Facts

Almost 93% of the assisted living admission agreements surveyed failed to comply with basic legal requirements. In addition, legalistic contract language, poorly organized agreements and small print size made many of these documents difficult to read and to understand. (2003)
Rather than assisted living, RCFE (Residential Care for the Elderly) is a common term to denote a care facility for seniors.
Many of the State Departments of Health Services are developing and submitting waiver applications to the Centers for Medicare & Medicaid Services (CMS) for an Assisted Living Waiver Pilot Project. The project proposes to enable Medicaid eligible persons who reside in Residential Care Facilities for the Elderly (RCFEs). These waivers are still being tested in several states in the U.S.

Quick List For Being Informed

Find out what services are provided by the ALFs in your area.
Finding a new home takes time. Plan ahead and visit as many residences as you can.
Once you’ve decided on your top choices, revisit each facility at least one more time at different times during the day.
Information is essential. Review marketing material, consumer information brochures, the resident contract agreement and state survey information about the residence.
You’re doing business, so ask the right questions about prices and extra costs.

When you are looking for an assisted living or residential care setting for yourself or a loved one, use the following checklist to help you make the best choice:

Click here for the AFL Checklist

Quick Tips to Getting Good Health Care

Be an active participant. When we become an active member of our own health care process, we are likely to get better. Medical records, health plan documents and billing records should be organized and easy to find. It is also important to understand and be able to describe your medical condition in detail.
Keep a record of your appointments. When things get complicated, it helps to write things down. Keep a record of appointments and what occurred at each one. Note what the doctor wants you to do. Write down medication names and dosages.
Keep a daily log. When you are feeling sick, it is difficult to remember that today is still better than yesterday. Write down your symptoms and how they change from day-to-day. Keep track of when you take your medications and how they affect you.
Stay focused at appointments. Put your questions and comments on a note card or piece of paper so that you can stay focused during your appointment. This will help ensure that you will use your time well when you are with your care provider.
Take someone with you to appointments. Sometimes, when we are in pain or are afraid, it is difficult to listen effectively. It’s a good idea to have someone else at appointments who can listen, take notes, and help you remember the questions you wanted to ask.
Remember that you and your care provider are on the same team. Yes, they are busy. But they are still your primary source of information. State your concerns as questions. Ask your providers to help you understand.
Follow the treatment plan. Once you and your doctors have decided, working together, on a course of treatment, give that treatment plan a fair chance. Then, if you don’t get the results you want in a few days, you will then know that the failure is due to the treatment plan, not to your unwillingness to follow that plan. At that point, go back to your doctor and explain the results so that you can work together to modify the plan.

If you follow these guidelines and are still unhappy with the results, then maybe something else is wrong. Perhaps you and your doctor aren’t a good fit, or maybe there is an insurance issue that needs to be resolved.

Aging In Place
Strategies to Remain at Home

Quick Facts

By 2005, 37% of all U.S. workers will face more concern in caring for a parent than caring for a child. (Aragon Consulting)
It is estimated that annual expenditures on home care exceeded $41 billion in 2001. (National Association of Home Care)
The fastest-growing occupation through 2005 will be Personal/Home-Care Aides. Faster than Systems Analyst, Computer Engineers, Medical Assistants, Paralegals, Occupational Therapy Aides and many other jobs. (Bureau of Labor Statistics)
Seniors prefer to remain in the privacy and comfort of their own home versus moving to a nursing home or assisted living center. (Ask Any Senior)

Family Caregiver Tips

Getting details about community-care services available in your area can be a confusing and time consuming experience. The following is a list of suggestions to guide you through the process of locating and accessing appropriate services:

Begin looking for resources before your situation becomes overwhelming. This preparation helps you avoid having to make important decisions during a time of crisis. Begin with the list of resources provided at the end of this process.
Now, using the worksheet at the end of this process, write down all of the information you are given once you contact the resources of interest.
As you make your calls, be prepared with specific information, such as physician’s name, diagnostic information, insurance coverage and Medicare, Medi-Cal and Social Security numbers. Be prepared to answer questions such as, “What type of care is the patient currently receiving and who is providing it?” and “Is there any special equipment in the home to assist with patient care?”
When dealing with agencies, be assertive and specific about your needs.
Mornings are usually the best time to call.
Don’t hang up until you understand the follow-up procedures (i.e., who calls whom, what will be done next, what you need to do next).
Be aware that you might be placed on a waiting list. The demand for existing dementia-related services, in particular, has increased while the funding for some service programs has decreased. By anticipating your needs and the needs of your loved one, you minimize the length of this waiting period.
Don’t hesitate to ask for help. The purpose of most community agencies is to provide services to individuals who need help. You are entitled to these services, since many of them are paid for by your taxes, contributions or fees for service.
Keep in mind that not everyone is familiar with the needs of caregivers. Therefore, many professionals remain uninformed about stresses on you and your loved one. You might find yourself in situations where you need to educate professionalism the community before you can obtain services successfully.