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The Michigan Long
Term Care Companion Chapter 2 Care Options: An Overview
Mr. Cooke and his son, like thousands of other loving family members, are facing a difficult situation that has no easy answers. Watching someone we love become physically or emotionally frail is terrifying. Experiencing deterioration yourself may be just as frightening. Deciding how to give or get the best care can be an overwhelming task. Where once Mr. Cooke’s only alternative would be a nursing home, there are now other options. Long term care is a phrase that describes health and personal services needed by people of all ages with ongoing health needs. This includes people with diabetes, Alzheimer’s Disease, cancer, stroke and those who are too frail to do essential things for themselves. Long term care takes many forms. Personal care. Nursing services. Therapy. Help with meals or household chores. Managing finances. Shopping and transportation. Medical care. Services may be needed occasionally or around-the-clock. They may be provided by medical personnel, nurses, aides, family members, neighbors, volunteers and others. Long term care services are as diverse as the people who need them. Long term care services can be given in your own home or in other settings such as nursing homes, homes for the aged, adult foster care homes, and other assisted living environments. These living options offer a wide variety of care services. However, determining which service or facility best meets your particular needs and which are available in your local community can be difficult. Just acknowledging that you or a loved one needs help can be heart-rending. Both Mr. Cooke and his son are beginning to realize that Mrs. Cooke needs more help than they can give. As they start their long term care journey, their best companion will be information - and lots of it! Information is power, and becoming familiar with available options paves the way to wise decisions. Hopefully, it will also reduce some of the anxiety and pain inherent in the process. So, we begin our travels with an overview of long term care services and facilities. Each of the topics outlined below is explored in more detail in later chapters. Care in the Home Fifty years of marriage is a long time of living and loving together. The mere thought of breaking up such a team, abandoning one who has stuck by you through all of those years of ups, downs, laughter, sorrow, joys, disappointments, successes, failures — devastating!! Facing the same issue with a parent, grandparent or other loved one who has shared all of those same moments is no less excruciating. Fortunately, it often isn’t necessary to leave the comfort of your home and family to find the help you need. No government program or private insurance policy currently pays for 24 hour in-home care. There are programs, however, that provide periodic visits and assistance. Medicare, Medicaid, the Michigan Family Independence Agency, area agencies on aging – among others – fund these services. Each program has its own eligibility requirements. Medicaid pays health costs for qualified low-income individuals of any age. Medicare pays health care expenses for beneficiaries at least 65 years old, regardless of income or assets. The following list summarizes basic care services that help people with care at home. Your local area agency on aging can help you find these services. Area agency on aging offices are listed in appendix 2. Care Management: Finding and arranging long term care services delivered at home can be an especially difficult and confusing task when multiple services are needed. The services may be available from a variety of sources, all with unique eligibility requirements, prices and funding sources. Care management is a planning service offered by or through area agencies on aging to help families identify and arrange needed long term care services. This service is offered to adults who have significant or complicated care needs that are comparable to the type and degree of help needed by nursing home residents. Care management services are usually delivered by a small professional team, including a nurse and social worker. Services start with a thorough assessment of the adult’s needs. Assessment findings and the adult’s preferences guide development of a care plan. The care management team implements this plan by arranging needed services, periodically reviewing the client’s needs and revising the service plan when appropriate.
“The concept of care management became popular because the large health, social and long term care systems developed to serve the needs of vulnerable people across the age and disability spectrum have proven to be largely inadequate.” In addition to the area agencies on aging, community mental health offices and other agencies offer care management services to people who qualify. Private geriatric care managers also provide this service for older persons, but usually charge a substantial fee. If you go this route, it’s a good idea to find out if the care manager is certified by a professional care management association, such as the National Association of Professional Geriatric Care Managers (520/881-8008). It is one of several private trade groups that set professional standards for care managers and make referrals to their members. AARP publishes a free guide on this topic, Care Management, Arranging for Long Term Care. For a copy, write AARP Fulfillment, 1909 K Street, N.W., Washington, DC 20049. Home Health Services: When prescribed by a physician, Medicare and Medicaid help pay for these services. Provided by home health agencies, two basic types of service are offered: Home Nursing Care is provided by licensed nurses and therapists. Nursing services can include changing dressings, checking blood pressure, administering prescribed medications and giving injections. Therapists provide needed physical, occupational and speech therapy. Most government-funded home health services are usually time-limited, delivered and paid to help restore your health and ability for self-care. Personal Care Services can include help with bathing, dressing, light meal preparation, light housekeeping and monitoring medication intake. Nurse aides who provide the services are supervised by licensed nurses. Homemaker and Home Chore Services: These help people with routine household duties. Services may include meal preparation, laundry, shopping, light housecleaning, essential errands, yard work, and other necessary tasks. Home Delivered Meals: Most often known as Meals-on-Wheels, this service provides one or more meals a day, five to seven days a week, delivered to an older person’s home. Area agencies on aging contract with other agencies to provide this service at no cost. Eligibility is based on age and need, but there may be long waiting lists. Private agencies and some hospitals also provide these services, but usually for a fee. Home Repair, Maintenance and Security: This service provides minor home repairs and improvements such as constructing wheelchair ramps, reducing utility consumption, clearing drains and repairing roof leaks, faucets, toilets, steps, furnaces, burglary damage and adding security devices. Friendly Visitor Program: Someone comes to the home, usually weekly, to check on the disabled person. In some communities, the local police will make periodic visits. Telephone Reassurance Program: Someone calls regularly to find out how the individual is doing. Some hospitals and agencies offer an emergency alert response system that allows clients to signal for help using a small electronic communication device. If distressed, the individual activates the device, notifying the response center that help is needed. If a monitor cannot reach the client by telephone, someone is dispatched to the home to evaluate the need for help. There usually is a monthly charge for this service. Hospice: This is a full-care program for the terminally ill. Medicare generally pays all costs except for a minimal charge for some medications. A doctor must certify that the patient is not expected to live more than six months, although services can continue beyond that time until the patient dies. Added to the usual services are physician visits, prescription drug coverage, social work services to the entire family, religious and spiritual services, and bereavement services to the family following death. Respite Care: A qualified person comes to the home to relieve temporarily the family caregiver. Home and Community Based Waiver Services: This long name describes a relatively new Medicaid-funded program that helps disabled adults avoid nursing home care. Medicaid pays for your care at home if your needs are comparable to people living in nursing homes. To qualify, you must also meet Medicaid’s income and asset qualifications (see chapter 9). These services are only available in certain counties, although Michigan plans to expand them statewide during 1998. Home care services and options are discussed in Chapter 12. Hospice services are described in Chapter 13. Services Outside the Home Not all care needs can or should be met in the home. No doubt, the caregiver needs some time away for personal needs. Time to go to work. Time to run errands and do chores. Time to rest and relax. Caretaking can be an exhausting experience no matter how joyful and rewarding it may be. It’s critically important for caregivers to take care of themselves. People receiving care also benefit from a change of scenery and routine. Adult Day Care programs offer daytime supervision, help with personal care, health services and social activities at a local center. Although most adult day care programs are operated by non-profit human service agencies or religious groups, some are operated as for-profit businesses. They are not licensed in Michigan, but the Michigan Office of Services to the Aging has set standards for centers funded through the area agencies on aging. The National Institute on Adult Day Care has also set voluntary standards for these programs. Ask whether centers you are examining comply with either set of standards. If so, ask to see a copy of the standards and consider whether they seem to be met. Respite Care provides a substitute caregiver to relieve temporarily the regular caregiver. The substitute may be a trained volunteer or a professional caregiver. Respite services are usually offered in the older adult’s home for brief periods at a time. In some cases, the care may occur away from home in a special hospice, an Alzheimer’s care center, or any type of long term care facility. In this situation, professional staff from the facility give respite care for whatever length of time has been agreed upon. Congregate Meals are hot meals and activities provided at a central location in a community. Transportation to and from the nutrition or senior centers may or may not be available. Transportation Services are rides, mainly to medical appointments and possibly a few other essential destinations, such as grocery stores. Many communities offer free or low-cost public transportation to frail or disabled people. Community-based services are gaining in popularity and availability. The reasons are obvious. Quality of life is enhanced and costs are often reduced. Using one or more of these services may be the right solution for the Cooke family and for you. But before you make a decision, you’re wise to become knowledgeable about other options, too. Senior Citizen Housing As we get older, some tasks we once found pleasurable, or at least necessary, become unwise or impossible to do. Shoveling the snow, mowing the lawn, even cooking or doing the dishes may become more than we can handle. Let’s not even talk about the steps to the basement to do the laundry! Mom might tell you that the couch is much more forgiving on her creaking bones than that old excuse of a mattress in the upstairs bedroom. These challenges are all a natural part of aging and they don’t mean it’s time for a nursing home. For people who are still relatively independent, senior citizen housing may offer them the safe and supportive living setting they need. Senior citizen housing is a term used to describe apartment buildings designed specifically for older and disabled adults. Many are large, highrise buildings. Some newer ones may be smaller and look more like conventional apartment complexes. Some are government subsidized. Others accept only private payment. They are sometimes called retirement communities. Meals, social events, activities, services and transportation may be available, often at an extra charge. Senior housing is operated by both for and not-for-profit corporations such as churches or public housing commissions. In federally subsidized units, rent is based on your income. The rent does not exceed 30 percent of your monthly income. There is no rent ceiling for non-subsidized units. Long waiting lists are typical for subsidized housing. For many disabled and elderly people, senior citizen housing provides the companionship and limited services needed to live independently. Many of the in-home services described earlier are also available to people living in senior citizen housing. Among other advantages, this option enables couples like Mr. and Mrs. Cooke to continue living and loving together, while minimizing risks to their health. If you’re interested in the availability of senior citizen housing in your area, contact your local area agency on aging office (see appendix 2). Assisted Living: Michigan’s Adult Foster Care Homes and Homes for the Aged Full independent living with desired services isn’t always possible. Even when it is, some people are more comfortable in an atmosphere that provides more social contact than a privately owned home or apartment setting. Walking down the hall for a good game of cards or joining a group to watch your favorite T.V. program can do much to chase away the blues. Having a new audience for your tales can stave off the loneliness of solitary living.Assisted living is a marketing term used to describe a combination of housing, support services, and health care. This term generally describes a range of living settings and services, designed to serve older and disabled individuals who cannot or prefer not to live alone.Most assisted living in Michigan is provided by adult foster care homes and homes for the aged licensed by the Michigan Department of Consumer and Industry Services. There are also a growing number of businesses marketing and providing assisted living services without a state license or oversight. If you are unsure whether an assisted living facility is licensed, ask the operator to see a copy of the actual state license. Your local long term care ombudsman office (see appendix 1) can also help you determine if an assisted living facility is licensed. Adult foster care facilities and homes for the aged provide room and board, special diets, supervision and some personal care. They serve people who need some help with daily activities but do not have complicated health problems requiring daily nursing care. Personal care may include help with bathing, dressing and taking medications. Residents of these licensed homes pay for their care with personal income and, if eligible, Social Security and Supplemental Security Income. Medicaid sometimes pays partial costs for this type of care. Medicare pays no portion. However, residents with either of these health plans generally continue to receive Medicare and Medicaid benefits as if they lived in their own homes. Some adult foster care homes specialize in care for the mentally retarded, the chronically mentally ill, and the elderly, including those with dementia such as Alzheimer’s Disease. They house from one to 20 people. Your Family Independence Agency (FIA) office has listings of nearby foster care homes. Ask to speak to the Adult Services or Adult Community Placement worker at your county FIA office. Homes for the aged give the same kind of care as adult foster care homes and their fees are paid the same way. They differ from adult foster care in that residents must be 60 years of age or older and they are larger, housing 21 or more residents. Like adult foster care homes, they do not provide medical or continuous nursing care, although some are attached to nursing homes and may provide nursing care on a limited basis. Lists of homes for the aged in your area and information about them are available from your local Long Term Care Ombudsman office. See Chapter 14 for information about finding, evaluating and paying for assisted living care. Nursing Homes Mr. Cooke’s son is urging him to move his wife to a nursing home. That is an incredibly difficult decision to make, regardless of how much a person may need such care. Few people relish the idea of moving to a nursing home. Yet, there are situations where it is a wise, loving decision. Nursing homes care for people who require more nursing or personal help than can be provided or is available in other settings. Chapter 16 examines Michigan nursing home services and profiles resident needs. Nursing home care is very expensive, with annual costs in Michigan averaging between $40,000 to $50,000 per year, sometimes more. Government nursing home coverage through Medicare and Medicaid is limited to people who meet specified eligibility criteria. Chapters 7 to 10 analyze nursing home financing options, Medicare and Medicaid coverage, and long term care insurance. Chapter 11 gives a brief overview of managed care’s future impact on long term care financing. Government programs recognize two types of nursing home care: skilled and basic. Skilled care requires the services of licensed health personnel, such as nurses and therapists, on a continuous basis. Basic care includes many routine nursing services, such as medication management, and help with personal care needs. Most nursing homes offer skilled and basic care. Medicaid pays for both kinds of care, but Medicare pays only for skilled care. Selecting and gaining admission to a nursing home can be difficult. Chapter 17 explains how to choose a nursing home. Chapter 18 discusses admission requirements, rights, contracts, and problems with discrimination. Nursing home residents are entitled to the best possible care and to be treated with dignity and respect. Chapter 19 describes the key role that nursing home staff have in delivering quality care. Chapter 20 describes nursing home residents’ rights, ranging from the right to privacy to protections against involuntary transfer or eviction. Chapter 21 explains nursing home care standards. Chapter 22 reviews a resident’s right to be free from restraints. Quality of life is an important issue that is attracting more attention in nursing homes. We must tend to the spirit and minds of nursing home residents as well as to their bodies. Chapter 23 examines quality of life opportunities and rights. Chapter 24 explores sexuality and intimacy issues. There are a variety of options to address problems in nursing homes. Chapter 25 describes steps consumers can take if they experience problems or concerns during a stay in a nursing home. Chapter 26 explains how nursing homes are inspected and how standards are enforced. Lists of nursing homes, information about services, care quality and more are available from your local long term care ombudsman office (see appendix 1). Special Dementia Care Programs Dementia is a progressive disease that affects the brain and results in impaired memory, thinking and behavior. The most common type of dementia is Alzheimer’s Disease, affecting an estimated four million American adults. Older people with dementia have special care needs that require specialized training. They also have common needs like laughter, affection and love. Some long term care facilities advertise special care units and programs for residents with dementia. Chapter 15 offers suggestions on how to evaluate programs and facilities that market these services. Hospital Care Unlike the Cookes, who appear to have some time to plan, many people first face long term care needs during a hospital stay, following a serious illness or accident. Hospitals must give patients all the medical treatment required and help arrange services they will need following the hospital stay. Chapter 6 explains hospital patients’ rights and hospital discharge planning. Advance Directives and Guardianship None of us like to believe that a time may come when we might lack the ability to make or express decisions for ourselves. Unfortunately, this is a common predicament in late life. Advance directives, which are discussed in chapter 4, are documents such as a power of attorney or living will that describe who we want to make decisions in this event or describe our choices in advance. All of us should consider preparing an advance directive. If an incompetent person lacks an advance directive, a probate court may appoint a guardian and conservator to manage the individual’s personal and financial affairs. Chapter 5 explains guardianship and conservatorship procedures. When There Is Abuse, Neglect or Exploitation The elderly and people with disabilities may be vulnerable to abuse, neglect and/or exploitation. This may happen in their own homes or in any type of long term care facility. There are laws against the abuse, neglect or exploitation of a vulnerable adult. Chapter 27 discusses this problem and guides you on how to identify, report and prevent incidents. Now that the Cookes have some initial information about various care options, it’s time for them to take the next step on their journey towards quality care. They know about several options that may meet their needs. Now they must explore which option is the best fit, taking into account availability, location, cost, quality, degree of help, and most importantly, their personal preferences. Return to Michigan Long Term Care Companion - Table of Contents Order your own copy of The Michigan Long Term Care Companion! Copyright © 1998 by Citizens for Better Care. All rights reserved. No portion of this book may be reproduced in any form or stored in a retrieval system without permission in writing from the publisher, except short passages for review in print or electronic media. ISBN 1-880697-05-X |
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Long
Term Care:
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