Archive for the ‘Elder Care’ Category
Managed Care Forces Growth
Posted by Hometownpulse | Filed under Elder Care, Health
Managed Care Forces Growth
The absence of a national health policy seems to have created a black hole that has been filled with profit driven managed-care programs. While states such as California have been adapting to the managed-care concept for a number of years, New York is just beginning to feel the effects.
The cost of running Medicare and Medicaid programs has been growing at nine percent per year. Experts say that, by the year 2030, Social Security, Medicare and Federal pensioner programs will exceed the federal government’s revenues. The seemingly insurmountable task of trimming the budget seems to have come down to trimming the payments to the care providers. Massive state and federal cutbacks have severely affected hospital and health programs and the way they do business.
What does this mean to us? The managed care shift has had the tendency to refocus the healthcare industry toward business development and marketing efforts rather than customer service and patient care. The game has become “SURVIVAL”. In the hierarchy of needs, physicians, hospitals, home care agencies, and other programs which rely on insurance to keep them alive have had to find a way to put food on their proverbial tables. This is a challenging task and makes it difficult to meet the more advanced qualitative needs of perfecting patient care.
Aggressive insurance procedures now affect providers on a multitude of levels. Insurance companies reward hospitals for treating patients with higher clinical needs. Medicare pays a certain rate for the treatment of a specific illness and the insurance companies follow suit. The more severe the illness, the higher the reimbursement. They also can refuse to pay for days a patient spends in the hospital on which a significant intervention did not take place. Subsequently, providers now find they need to perform surgery and diagnostic testing on weekends and after hours to promote reimbursement. This means paying additional staff for hard-to-fill time slots. It also includes paying additional staff to process the multitude of paperwork required for patient billing and reimbursement.
The “system” encourages the prompt discharge of less acute patients and begins a ripple effect that forces all parts of the healthcare delivery system to push a patient quickly toward the least restrictive, most cost-effective setting. This ripple effect causes nursing homes, rehab centers, home care agencies and others to need to be available off-hours and on weekends to do intake assessments, admissions, and crisis intervention. This new system presents an arena of discharge planning and case management considerations.
Because nursing home and rehab facilities are reimbursed for patients with higher needs, they also are eager to discharge residents who are more able to manage in a less-restrictive setting. People who one would have been permanent residents in nursing homes are now being encouraged to return home with services or to go to assisted living programs and special care facilities. The system has been forced to be creatively revised in the face of these new regulations. New residential and home care programs have arisen to compensate for the greater number of nursing home and hospital discharges. Some skilled facilities have developed subacute and short term rehabilitative services to capitalize on higher reimbursement levels. More and more independent living programs are offering a concierge of services.
Alzheimer’s Disease is tragically one of the lowest reimbursable illnesses. It is one of the most common, of the longest duration, the most time consuming, and exhibits some of the most frequent repeated use of services in the system. The system does not financially reward providers for caring for people with such disorders.
How we cling to the status quo! Peter G. Peterson, in his book Gray Dawn, gives us a reality check: By 2015, most developed countries will have more elders as a share of their population than the state of Florida today. Caring successfully for older adults in the face of managed care will take a community-wide effort. The population is aging and managed care is here to stay.
Healthcare providers need to develop a positive attitude despite the lack of perfection in the system. This means making a shift from a sickness mentality to a wellness mentality; to prevention vs. cure. It’s about having vision and defining a contributing role within a system that thrives on networking. It’s about being proactive rather than being swept along with the tide of managed care; to begin to create and enhance programs, products and services and to become leaders in a system specialty.
Many US hospitals are forming partnerships with residential and rehab programs, home-care agencies, and primary care providers. Residential facilities are developing day programs and menus of services to expand their markets. Doctors are joining forces to meet the comprehensive needs of their patients.
There are many ways to partner - formally and informally- to meet the needs within the senior healthcare system. Formal alliances allow partners to share operating costs and collectively to meet the needs of the community. Clinical, financial, social, private, and public programs need to be available, accessible, and mutually beneficial to the older population. We need to learn how best to utilize one another to support the needs of those who need us.
Learn to see this as a challenge rather than as a problem. Exciting innovations are already occurring within the Central New York system. Follow the leaders of the community in developing unique programs to offset the negative consequences of managed care.
Loretto and St. Joseph’s Hospital have partnered to meet specific needs which make programs like PACE/Independent Living Services- a program designed to prevent/reduce institutionalization and subsequent costs possible. Crouse Hospital and Community General Hospital together created The Alliance, which proposes to merge with VNA Systems to streamline the continuum of care for their patients. SUNY Health Science Center recently announced participation in WebMD - a full-service Web site for doctors and their patients –made possible by the combined efforts and funding or organizations such as DuPont, Microsoft, and CNN.
Competition is a driving force of the new system. Once we re-establish our equilibrium, we can allow competition to do what it does best: improve quality, reduce costs, and encourage providers to be creative in the marketing and delivery of their services. We must also work collectively to keep the continuum of care smooth and as user-friendly as possible.
The possibilities are endless. Growth doesn’t just “happen” without people making a conscious change. If we don’t promote change on our own, life will inevitably do it for us. It has pushed us to grow in challenging, frustrating and very exciting ways.
ElderPlanning 101
Posted by Hometownpulse | Filed under Elder Care, Health
ElderPlanning 101
We don’t like to think about aging and the potential issues of death, disability, dependence and cognitive loss. Because we don’t like to think about these things, we tend not to plan ahead for the inevitable.
Yes, the “system” has it’s frailties. The “system”, however, is making dramatic strides to try to improve service delivery while at the same time, to reduce the tremendous costs of running federal and state programs such as Medicare and Medicaid.
The Managed Care system is changing health care delivery by attempting to reduce and eliminate unnecessary costs and treatments of medical health care. While far from perfect, this has in part caused a dramatic shift in the care and lengths of stay in hospitals, rehabilitation facilities, and nursing homes. Hospital stays have shortened, rehabilitation while nursing home facilities are now meeting more acute care needs of their residents. The newer residential concept of Assisted Living is now meeting the needs of many people who normally would have required nursing home care. Home care programs have been recharged to meet increasing needs of those who wish to remain at home.
Granted, there are many weaknesses in the system. Therefore, we need to be accountable for planning for our own future and the future of our aging families. Never underestimate the power of the “private pay dollar” when it comes to buying what you need and want in the health care system. That “dollar” buys your choice of caregivers, physicians, residential options and other preferred services.
How do you maximize the private pay dollar? By starting as early as you can to plan for your retirement. By saving and investing your money wisely. By maximizing your retirement income and pension plan. Have a solid health insurance plan that best supplements Medicare and a Long Term Care(LTC) Insurance plan that will fill the remaining “gap” of financing your long term care needs in the future.
Find out about medically-deductible expenses which can include the costs of nursing home care, home care, medications, home improvements due to a disability, insurance payments, copayments and a portion of your LTC insurance premium. You may qualify for a dependent-care credit if you are caring for a dependent parent at home and if you contribute to your parent’s medical expenses, those expenses may be deductible if you itemize.
Investigate the possibility of creative options such as a Reverse Mortgage or a HUD conversion loan which allow you to use the equity in your home to fund the costs of your long term care. Open a Medical Savings Account (implemented in 1996 on a demonstration basis) which allows you to invest your money and then reap your earnings tax free if applied to your personal health expenses. Look at your life insurance portfolio; you may want to borrow from your insurance to pay for your current needs.
Respectfully encourage your parents to plan for the future, if they haven’t already done so. Think about and implement Advance Directives such as a Living Will or Health Care Proxy. Establish a Power of Attorney and a legal and financial plan to attend to future needs.
Involve a team of objective, competent professionals to help you design a plan that is best-suited to your situation and personal goals. The ideal team will consist of an attorney, a financial adviser, an accountant, an insurance specialist and a geriatric care manager. The involvement of this team will help you in making sound decisions in the areas of financial, tax, estate planning and personal long term care planning.
Many Baby Boomers will find that they will spend more years caring for their aging parents than they did raising their children. Some will find themselves in the overwhelming situation of caring for both at the same time! Only 5-7% of our elderly population resides in nursing homes. The others are being cared for by families, home care agencies and informal caregivers. Many more are living active, independent lifestyles.
Gather your team of advisers, save and invest your money wisely and learn what choices are available to you. Communicate with your family and create a healthy lifestyle for yourself. When you have the support of those who love you and the advantage of good physical, emotional and financial health, you will find yourself surrounded with unlimited choices as you face the days ahead.
GCMs Help Reduce Hospitalization and Crisis for Older Adults
Posted by Hometownpulse | Filed under Elder Care, Health
GCMs Help Reduce Hospitalization and Crisis for Older Adults
Geriatric Care Managers (GCMs) work with all professionals concerned with eldercare: physicians, hospitals, health centers, home care providers, elder law attorneys, financial advisors, legal guardians and clinical social workers and nurses. Many people, however, have never heard of a geriatric care manager.
GCMs have been in existence for over twenty years. It has only been with the changing demographics that geriatric care management has become one of the fastest growing professions of the new millennium. In 1985, the first professional organization devoted to care management, The National Association of Professional Geriatric Care Managers (NAPGCM) was created with 30 members. Today, the membership has grown to nearly 1500.
What is a GCM?
GCMs are trained to evaluate all aspects of an older person’s life including legal, financial, nutritional, medical, home safety, and housing issues. They are knowledgeable about resources in the community and have the ability to match an individual’s needs with appropriate agencies and services.
Most GCMs are graduate level social workers or registered nurses, and are licensed through their professional associations. A certification program exists for those care managers who meet education and experience requirements and who show proven competency in care management. Before you hire a GCM, ask about credentials, licensing and experience. In the process, determine the GCM’s communication skills and integrity. Choose a GCM who is well-respected, well-connected to service providers and who has the right chemistry in working with you and your family to meet your most personal planning needs.
Some GCMs are affiliated with geriatric centers and home care agencies. While it can be beneficial to have access to these “systems”, the essence of the true private geriatric care manager is objectivity and freedom from affiliations. Your GCM should provide full disclosure regarding business, professional or personal relationships with each recommended business, agency or institution.
What is the role of a GCM?
A GCM assists with short term solutions as well as long term arrangements. The GCM can help a family in the midst of crisis by setting up an “action plan” to deal with the issue at hand. A GCM can also complete a comprehensive assessment to plan for long term care needs. This customized “care plan” will help you to determine the extent of services and care needed by the older person addressing overall goals of safety, security and independence. It includes an evaluation of the individual’s physical, emotional, financial and psychosocial well-being.
Once the care plan is developed, the role of the GCM is to help the client to meet established personal goals. The GCM may be a part of that plan, visiting on a regularly scheduled basis to evaluate progress and to respond to any changes that may occur. Roles may include such things as overseeing the older person at home, monitoring services, accompanying to doctors appointments and coaching through the transitions such as relocation to or from a hospital, nursing home or other residential program. If requested, the geriatric care manager keeps the extended family informed and recommends adjustments to the care plan as needed. A good GCM takes every opportunity to encourage communication and understanding between family members. A GCM will counsel and educate clients and family caregivers to help them learn what to expect from complications of aging, dementia, chronic illness and to prepare for the costs and long term implications of these issues. At times of transition, the GCM “coaches” clients in making the best possible decisions.
COSTS
Care managers usually charge by the hour. Hourly rates can range between $50-150 per hour depending upon geographical area. Initial assessments can range from about $150 to $450. If a family decides to hire a care manager on an ongoing basis, fees can run $500 a month or more, depending on the level of involvement. Long Term Care Insurance is currently the only third party that pays for a GCM.
A GCM is designed to create the most preferred, cost-effective plan for each client. Using a GCM to help in legal, financial and long term planning can greatly reduce the overall costs of long term care. A GCM ensures that Medicare, insurance and community-financed services are utilized to the greatest extent possible. The ongoing involvement of a GCM can also reduce hospitalizations, critical illness, accidents and the associated costs, by overseeing that the client is following a plan that encourages safety, wellness and crisis prevention.
How do I find a GCM?
The National Eldercare Locator (800-677-1116) will help connect you with the appropriate local Office for the Aging which can help guide you to eldercare services in a specific county. More and more GCMs can be found on the internet and a local GCM should be able to refer you to any number of NAPGCM members across the US and Canada.
Residential Options for Seniors
Posted by Hometownpulse | Filed under Elder Care, Health
Residential Options for Seniors
There are more options available to you than ever before. It used to be that the only choice besides staying at home was to go to a nursing home. Today there are many other options available when staying home is no longer the best alternative.
Independent Senior Housing
There are many types of senior apartment living available. Some are well-equipped, modern buildings; some are in nicely-remodeled old school buildings. Many are designed to be affordable to those on fixed incomes and offer services such as transportation to supermarkets and activity programming. More and more of these residential settings are offering more and more services to keep their older residents independent for as long as possible.
Adult Homes
Adult Homes usually offer the structure of a private room or apartment with amenities such as three meals a day, an activities schedule and laundry and housekeeping services. More and more adult homes are offering their residents personal assistance with medications and bathing. Programs are funded by private pay funds although there are some options which are covered by SSI (Supplemental Security Income).
Assisted Living
Assisted Living Programs tend to have higher numbers and levels of staffing than Adult Homes. Assisted Living programs usually provide a multitude of services designed to keep individuals healthy and active. For those who need assistance with medications, bathing and other personal care, assisted living programs offer security and structure while providing a private lifestyle. Various programs are covered by financial assistance programs such as SSI and Medicaid(”ALP”)
Special Care Residences
Special care residences have been growing in number. Special care, in this case, primarily refers to people who are experiencing cognitive deficits such as dementia or Alzheimer’s Disease. These programs are designed to oversee personal care needs, but also have a strong orientation towards stimulative, productive and social activities to maximize the persons strengths and capabilities.
Continuing Care Communities
“CCC”s offer a residential program that spans the entire spectrum of aging services. These programs demand a financial commitment up front and then a monthly fee package. Up front monies purchases a “unit” (condominium, cottage, patio home, etc) and the promise to be cared for in the appropriate setting for as long as necessary (usually on the same campus). This spans the “continuum” of independent living to nursing home care. You will find this option to be a wave of the future.
Other options exist such as private homes where a small group of people live under one roof and share meals, activities and sometimes bathrooms. Some are affiliated with nursing homes, geriatric centers and fraternal or sectarian organizations which are one-of-a-kind but which are often well-run and well-managed. Be sure to explore the wealth of options available to you before deciding where your next home will be.