Medicare and nursing homes – who pays?

It is hard enough to be dealing with a personal who is either sick or injured without having to deal with the financial end of things.  I had a friend call this morning in a panic.  She had just found out that Medicare does NOT pay for nursing homes.  She has to pay over $600.00 per day for her father.  She asked what I knew about nursing homes and Medicare so I thought I would write this post.

Here is what I believe to be true from an official AARP website:

Q. I read that Medicare doesn’t pay for staying in a nursing home. But my friend is in a nursing home, and she says Medicare’s picking up the tab. Who’s right?

A. Both are right. Medicare doesn’t normally cover “custodial” care for people who live in nursing homes or other long-term care facilities. Custodial care means help with daily living activities, such as eating, getting in and out of bed, washing and bathing, going to the toilet and moving around. Paying for this type of care is your own responsibility, unless you have long-term care insurance that covers it or you qualify for Medicaid benefits from your state.

But there’s one exception. Medicare’s skilled nursing facility (SNF) benefit covers a temporary stay in a nursing home in certain circumstances.

How to qualify for the SNF benefit:

* You must have Medicare Part A hospital insurance.

* You must have spent at least three days as an admitted patient in the hospital. Days spent “under observation” in the hospital do not usually count toward the three days.

* Your doctor must order that you need skilled nursing services as a result of the same illness or injury that put you in the hospital, or because of a new one that developed while you were there. For example, you may need continuing intravenous injections or physical therapy.

* The services your doctor ordered can be provided only on an inpatient basis at a Medicare-certified SNF (either a nursing home or hospital).

What you get:

Medicare covers up to 100 days in a skilled nursing facility. This includes medical and nursing services, custodial care, semiprivate room, meals and prescription drugs. (Any drugs you need while receiving the SNF benefit are paid for under Medicare Part A hospital insurance, not under Medicare Part D drug coverage.)

What you pay:

* Days 1 to 20: You pay nothing. Medicare pays 100 percent of the cost.

* Days 21 to 100: You pay a daily copayment—$137.50 in 2010—and Medicare pays the rest. (If you have medigap supplementary insurance, long-term care insurance or are in a Medicare Advantage health plan, some or all of this cost may be covered, depending on your policy or plan.)

* Beyond 100 days: You pay the full costs and Medicare pays nothing. (Long-term care insurance may cover part of the costs.)

Do not take this as the hard rule as it seems like different people have different rules.  Mom was lucky enough to have a secondary insurance that paid what Medicare would not after the first 20 days.  However, Medicare only pays if the person is improving daily.  At the point where they decide the patient isn’t, they cut off the money.

I would strongly suggest anyone that can to get a supplemental insurance.  However, these insurance plans vary from state to state and can be very expensive.

Depression – We all have it.

I apologize for the lack of posts lately.  This time last year, my Mom was in the final stage of her life.  My time was consumed by visits to the nursing home, hospital and preparing my home to bring her home for as long as I could safely keep her here.

Mom did not want to die in a nursing home and we had discussed it many times.  Towards the end, Medicare decided mom’s rehab was doing no good so they were going to move her once again to a different wing of the home.  Moving people with dementia is extremely hard on them.

The home told me mom was getting very agitated when I wasn’t there so they wanted to drug her more.  It was time to make a decision.  We decided as a family to bring her back to my home and take care of her here.  We knew it would not be for a long period of time but wanted her at home as long as we could make her comfortable.

There was a whirlwind of activity.  My son came and built a wheelchair ramp in two days.  We had to empty my kitchen of all furniture as mom’s hospital bed and lift would not fit in any of our bedrooms.  Luckily, I had great friends who just appeared and we toted up a lot of things so that we were ready.  My brother’s and their family would have been here if they could have.

I will write a later post about everything we should have done differently.  I just wanted to let you all know that I am still here and will start posting again.

To MOM, I love you and miss you everyday.  See you someday!

What a respite worker HAS to know!

After you have hired your worker, you have to give her/him all the tools necessary to do a great job.  They need to know as much as possible about the care of your loved one but of course, will not be able to read your mind.

With this in mind I will point you back to the post I made earlier about the binder with all the information in it.  It is great for anyone stepping in, whether respite workers, family, or neighbors.

It is important to keep it up to date.  I realize that you have a lot of your plate but keeping this binder up to date will insure that you can leave at anytime and the person replacing you will have access to the correct information about medications, doctors, appointments, etc.

Updating it might be a thing you can do when you are doing your test run with the respite worker.  That way you can have peace and quiet and be able to really look it over.

I know mom’s medication changed a lot due to her being on blood thinners.  It seemed like every blood test meant a different dosage and the prescription bottle didn’t change so I had to keep on top of it.

Also it is great to include any information about how your loved one acts.  Mom liked country music so I tried to keep it on.  She had favorite tv shows she liked to watch. Favorite food and drinks should be included. Anything quirky about your loved one should be discussed.  Basically anything that would make the transition easier on your loved one and the respite worker.

What other information do you think should be in the binder?  

Talk to the person you are caring for EVEN in they are noncommunicative!

During a recent visit to a friend on hospice, she was extremely agitated.  She kept saying that people were coming in her room, whispering or talking about her but not TO her.  She asked that I talk to her like I use to talk to my mom.

Picture a world where everything is happening around you but you are not participating in it.  That would be frustrating.  You could feel or see things but have no input.  It is hard to know how our loved ones feel.  You know them best so you can decide whether they would rather be left in silence or not.

I think it becomes a routine when you are a long term caregiver to “Get the job done“.  We become so focused on all the things that we have to get done that we tend to do it automatically. Sometimes it almost becomes impersonal, not that we mean it to but caregivers can get overwhelmed.

As Mom was declining, I made it a point to talk to her as if she was able to communicate back.  I would discuss what the weather was doing, plans for the day, or anything else I thought might stimulate her.  When she became wheelchair bound, I would move her with me around the house when I could.  She would come in the kitchen and I would talk to her while making meals.  We listened to music.  I read books aloud.

We have plenty of grandkids around so I would encourage them to talk to mom too.  I think it made them uncomfortable at first but after I explained that she would like to know what is going on, they went along with me.  My one granddaughter thought it was totally normal to sit beside great grandma and help her play with her toys.

I would love to know what Mom thought.  She might have preferred me to shut up but I will never know.  I like to think that after talking with my friend that Mom did want to be included.

I have heard that hearing is one of the last senses to go.  So, just talk.  It doesn’t have to be earth shaking.  Talk about the news, life, family, friends, etc.  Just include them.

Perhaps it is too soon to write this as I just lost my friend today but in honor of Pam, start a conversation today.  Even if it is one sided!


Human Touch – As Important As Air?

That may sound a little dramatic to most people but if you stop to think of it, we all need the human touch.  Think back to a time when you were hurting, either physical or emotionally, and someone came along and either touched you on the shoulder or held your hand and things seemed to get better.

There have been many studies done on this with a good deal of articles written on it but I prefer to just tell you my thoughts on it.

Everyone likes to be touched in a friendly manner.  Babies are cuddled for a reason.  It helps to establish a sense of safety and peace.  In some hospitals, preemie babies are held by women hired to just do that…they rock the babies and cuddle with them.  It has been proven to help them.

Senior citizens or other people that require caregivers are just the same. I believe the need for touch increases when people age or are sick.  They need to feel a connection to the world.  They tend to receive the least amount of touching of any age group.  Seniors are most likely to live by themselves and have less physical contact with the outside world.  But, as people age, they tend to be more likely to need touch and be touched than younger people.

Having someone take their hand, stroke their arm, or rub their feet can make them feel loved and reassure them that they are valued and not alone.   Isolation can be swept away with a single stroke of the hand. It helps with other problems as well such as depression, feelings of isolation, lack of self-esteem, and anxiety. 

Bottom line, we need to be touching the people we are taking care of.  Below are several ways you can touch someone without it being obvious.

  1.  Put lotion on either the hands or the legs.  Mom had dry skin as she aged so I would just put lotion on every day or two.
  2. Holding hands.  When Mom was in bed, we would watch tv until she fell asleep.  I would just lightly hold her hand.
  3. Massage.  Although Mom never got a massage and I am not sure she would have, a massage is a safe way for someone to get the touch needed.  It can be as simple as a neck rub or as much as a full body massage.
  4. Brushing their hair.  Mom loved to have her hair brushed and I can remember as a child I did too.  One of the perks of going to get a haircut for women is the great shampoo that goes along with it.
  5. Just resting your hand on their shoulder or knee while in a seated position can be reassuring.

I really believe that touch is critical.  Seniors sometimes only have one or two people they see on a regular basis and in most cases, they are busy and do not have the time to spend quality time.

If you are a caregiver, please take the time to touch your loved one in some way every day.  It does both of you good.

Help I’ve Fallen and Can’t Get Up – Help Pendants

You have all seen the advertisements for these help pendants.  There are many companies out there and they all have different offerings so I will not recommend a specific one.  BUT, they are terrific in reassuring your loved one AND you that if something bad happens, someone will be there to help.

Generally you can get a necklace, bracelet or both.  There are normally waterproof so they do not need to be removed even to bathe.

We got mom’s first one after she had been hospitalized.  She was still in fairly good health but with her living alone, I felt the money was well spent.  In that case, the company came out and installed the unit but it was simple.  There was a small receiver about the size of a box of greeting cards that you plugged in to the wall and then the phone was hooked into it.  When it was installed, we made a test call by pressing the button to make sure it worked.  A voice come out of the box and called my mother by name and asked if she needed fire, medical or other help.  We just said we were testing and they said it was working great.

We had previously filled in Mom’s information with a list of three people who could be called in an emergency before they called 911.  They call those numbers and if no one can respond quickly (if they are at work, out of town, etc.) then they call 911.  We choose to put down three family members that lived in the same town with Mom but anyone that would be familiar with your loved one would work.

The first time that Mom used it she had fallen in the bathroom and could not get back up.  She pushed the button and calls went out to my brother and both his daughters.  All responded and had her up and back in bed within 5 minutes.  Mom much preferred them calling family members instead of 911 since she “didn’t want to cause a fuss”.

These pendants can be used for medical emergencies, fire, prowlers or any event that makes the person afraid.

When we moved mom we had to change companies as the previous one did not work in my state.  This time we got both a necklace and a bracelet.  It also came with a lockbox that hung on the door that we could leave a key locked in.  The company would give the police or fire department the code so they could unlock the door as opposed to breaking in.  What a great idea!

Give careful consideration to who you put on the contact list so that hopefully one of them would be available most time.  For example, we did not put both my brother and his wife as they are generally together if not at work.  With everyone’s life being busy, it is impossible to have it covered all the time.

Mom was hesitant to use the pendant as she didn’t want to bother people.  It embarrassed her that she was falling.  After multiple falls at home when she would not use it, we had to move her up to my home.  I explained to mom that it didn’t cost to have the police or ambulance come unless the ambulance transported her but she would lay on the floor (sometimes overnight) until she either was rested enough to get up herself or someone stopped by.

Hopefully, your loved one will see the need for this and not see it as a nuisance.

It can literally be a lifesaver.

Has your family used one and did it do what you expected it to do?

How hospitals , clinics or health departments can help with elder care

Most hospitals or clinics have social workers that can give you advice, phone numbers, names,  etc.  I did not think that they would help when Mom wasn’t there as a patient. It probably helped that Mom had been a patient there before.   I think it depends on the person you get in touch with sometimes too.

I called our local hospital and talked to a social worker who gave me some ideas and then put me through to their home health nurses.  They were very helpful as to the things I could do to make Mom’s life more comfortable.  They suggested different equipment to help with Mom’s specific needs and even gave me several places to check to get the equipment.

They were very careful not to endorse a specific place or person to go for help but having choices was great.

They also told me everything they could do for Mom.  I assumed it would be very limited but they were able to come out and do Mom’s weekly blood draws and even trim Mom’s toe nails (Mom was on warfarin and bled very easily).  .  They had people that could come help Mom bathe also.  They also told me what they could not do such as house work, feeding, etc but gave me phone numbers to find someone in case I would need them.  They had people that could come help Mom bathe also.

They did explain that some of it would be paid by insurance and some of it would not.  It also depends on what coverage you have.

Health departments also have great information available.  More of their information is geared towards general health care but they usually have a list of helpful  information.  They have information about immunizations also.

Bottom line is you just have to ask.  It is surprising how much help you can get.

Hot Food Delivered Daily – Meal On Wheels or something similar

Meals on Wheels is a great program that has helped many seniors or disabled people get one nutritious meal a day several days of the week.  Generally they are delivered by volunteers so that costs can be kept down.

We decided to get Meals On Wheels for Mom following a hospitalization.  With her Parkinsons getting worse, the shakes made it not safe for her to cook.  Even carrying the hot food to the table could have caused a burn, so we set up the Meals On Wheels.  They did an interview with us to get to know Mom’s likes and dislikes and any medical information needed.  Allergies were discussed to make sure there would be no problem.

Mom’s meals were delivered 6 days of the week at lunchtime.  She didn’t always like what they brought as they had to be somewhat bland since they were fixed for a lot of people who might have had other dietary requirements. We bought spices so Mom could alter the food to her taste.  The volunteers would bring them into the house, put them on Mom’s table and chat for a bit.

The only problem Mom really had was opening some of the containers.  They were Styrofoam and the bowls had lids that were challenging for Mom.  Some of the volunteers took the extra time to open them.

Mom’s meals cost $3.50 per day which I thought was a great deal.  She had food that she didn’t have to cook and someone in the house daily to make sure she was ok.

Unfortunately, it does not exist in all areas.  Follow this link to see if there is one in your area:

Even worse, with budget cuts, many programs are having to cut back on the number of days they can deliver and/or raise prices.

We had also looked into other options such as a small company that made meals and delivered them that was a little more expensive.  It sounded like it would be a good deal also but it was only 5 days a week.  Your local Chamber of Commerce might know of a service like this.

Of course, tv dinners are an option.  Home cooked meals could made up ahead of time and frozen into single servings.  This would be good if the person could handle the microwave.  Family members,  friends or volunteer organizations might be willing to do this.

Mom loved deli food so every week when I did her shopping, I made sure she had potato salad, lunch meats, cheese, bread, etc. so she could make an evening meal.  I kept fresh fruit and juice on hand also.  I made sure I opened all the containers and then loosely closed them so she would not have problems.

Bottom line, there are many ways you can make sure your loved one has food on hand that they are able to eat.  Any of all of the above could work together.

10 Places For Help So That Elderly Can Live In Their Home and Still be Safe

10 Places For Help So That Elderly Can Live In Their Home and Still be Safe

There are statistics that show that people do better in their own homes.  They feel comfortable, do not feel like they are a burden, can do things at their own pace, etc.  Naturally we would all like to see our loved one have their pride and be able to be at home.  There are many places to look for help when you see that they might need some help.  It will make you feel better and them be safer without causing any as much stress as moving them will.

These 10 places are just a beginning of places to look. Some may apply in your circumstance.  This is a basic overview.  I will be going into much more detail on each one in the future.

  1.  Meals on Wheels – this organization (or one like it) will prepare and deliver a meal to someone once a day.  Some towns do it 5 days a week and some 6 days. When we set it up for mom, we were asked what she did and didn’t like to eat.  This not only insures one good meal a day but also has one more set of eyes on your loved one.
  2. Area on Aging – This organization is nationwide and is very helpful on getting you information about what you can do.  If you are in a smaller town, they might not be able to give you information about caregivers in your area but they can probably tell you where to go to get this information.
  3. Local Health Department or Hospital – These agencies might be able to help with lists of “employees” you can hire to help out in the home.  Some are bath aides, some are medication aides and some are cleaning aides.   Always check the people’s references before you hire them.  I did interviews just as if I was hiring them to work in a ‘regular’ job even though this was much more important.
  4. Help Pendant Company – These are the companies that advertise “Help, I’ve fallen and can’t get up” pendant.  There are many different ones out there with some being worn on the neck and some on the wrist.  When I called my local Area on Aging they gave me numbers of several.  We bought one when mom was home and then had to change to a different company when we moved her in with us.  The second company had a lockbox  we left a key in case fire or emergency people had to get into the house when we were not home.
  5. Veteran’s Service Officer  – Was either parent a veteran?  There are several programs that can help veterans and/or their widow/widower.  You will need to meet with the officer to find out what you might qualify for.  You will need financial information and the veteran’s DD214 (which is the discharge papers).
  6. Health and Human Services – Depending on the financial status of the loved one, they might qualify for help from the government.  In the state I live, you can apply over the internet and then they will do an interview with you.  Most states have income and resource requirements.
  7. Church Organizations – Many churches have volunteers that will help visit with seniors in their home.  This is one way of ensuring that their spiritual health is continued and another set of eyes.
  8. Family and Friends – Often, people will help if you just ask them.  Many times we are reluctant to but most people are willing to stop in weekly or bring over some food occasionally if needed.
  9. Local Bus Company – In the small town mom lived in they had a bus service that was for the elderly.  It provided safe transportation to medical appointments, shopping, etc.  You had to call a day in advance and plan on arriving a little early at your destination in case multiple people had to be somewhere at the same time.  Cost was under $2.00 each way which was much less than a taxi.  I found the drivers to be extremely helpful to the customers.
  10. Local Grocery Stores and Pharmacies – A lot of these businesses are doing deliveries.  It might be simpler for your loved one to have these items delivered rather than go outside.  We called in an order on one day and they delivered the next.  They carried the groceries in and put them where mom could put them away.

This list is by no means complete.  There are many places to go for help.  The main thing to do is find these places BEFORE you need them.  Make up a list of phone numbers, contacts and what they do and put them in your binder so when you need to take action, you can.

What other places have you thought of or gone to for help?

Binder with information about loved one!

The organization of life documents is very important.

There are many different items you need to keep handy.  For this reason, I kept a 3 ring binder for mom’s information. This should include any information that any medical personnel might ask for.

You should always have a copy of her latest medications.  If there is ever an ambulance called, that is one of the first things the EMT’s will ask for.  I made up a document that had her doctor’s names and phone numbers (including eye doctor), all her medical conditions, surgeries, allergies, etc on it that I kept updated. If you are ever away from home visiting someone, this will let the medical staff treat the patient much faster which could be life saving.

Update:  It is also a good idea to include phone numbers for other family members in it.  What if you have a medical problem and no one knew who to get in touch with?

By doing this, in a stressful situation, all I had to do was grab the binder and go.  I also kept copies of the power of attorneys and living will in it.

Needed information should be handy.  Do not count on your memory as when medical events happen, your mind is on your loved one and your might forget a vital part of information.