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.

Emergency Preparedness for Natural Disasters

Emergency Preparedness for Natural Disaster

With recent events, I wanted to stress the importance of planning for a natural disaster.  I am in an area where we are having tornados.    Caregivers have the responsibility to be able to provide emergency care for their loved ones, even in a tornado.

The best way to do this is to figure out what you would do in the type of natural disaster for your area.  This is a broad guideline that you will have to tailor to your area.

1.  Find out about individual assistance that may be available in your community. It is possible that in your area there are agencies that you can register so that they know you have someone who needs special care.  I would talk to the Red Cross to begin with and they can tell you what agencies you might be able to register with.

2.  As you prepare, consider all everything you use for your loved one with a disability on a daily basis. You may need medications, certain medical equipment and supplies, service animal, etc.

3.  Talk to those around you so that they know your plan.  Involve them in the plan if you are planning on using them as backup to help.  Make sure they know how to use any equipment you use with your loved one.

Keep your caregiver manual up to date and make sure you take it with you. This will help anyone that has to provide emergency care know doctors, diagnosis, medications, emergency numbers,etc.

You might have to explain to emergency people why you need to evacuate first in order to protect your loved one.  Some shelters are hesitant to take service animals but legally they have to.

4.  Make a bag up that you can grab if you have to evacuate quickly.  Here is a list of a few thing but not all you may need.  Some of it should be in your caregiver binder already.

List of medications, doctors, emergency numbers, allergies, etc.

Chargers and batteries for any devices you use daily that you can take with you

If you have a service animal, food for it.  Documentation that it is a service animal.

If you have to use a device to communicate with your loved one, you need to be                    able to grab it and go!

Any medical supplies you use regularly like bandages, insulin, needles, catheters,             depends, portable oxygen tank etc.

5.  Try to think of what you would need if you ended up in a shelter to take care of your loved one.  There is no way you can pack everything but you should take what is essential to keep your loved one alive.

Make a list and stick it on the fridge so that you use it so that you don’t forget something in your haste to move to safety.

Of course, if it is necessary, just grab your loved one and go!  The Red Cross and other organizations can usually get supplies but if you can take it with you, you will feel better.

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?  

Interviewing the respite caregiver

Hiring anyone to take care of your loved one requires checking them or their agency out carefully.  Some agencies require background checks on all their respite workers but do NOT assume they do.  The only way you are going to feel comfortable leaving your loved one with someone else is to assure yourself by checking everything out first.

Most people find respite workers through and agency.  Although I was aware of our local respite organization, I also could have went on the internet and searched for “respite workers Hastings, Nebraska” and several agencies would have popped up.  You could also check with your medical team or local Health and Human Services department to see who they suggest.

Respite care providers in Nebraska requires several trainings.  Different caregivers will choose to only work with certain ailments and age groups.  The training includes medication delivery, bathing, first aid, CPR, emergency care, psychology and emergency care.

Interview any possible respite workers carefully since they will be working for you.  Make sure they are aware of all the responsibilities they will have.  Ask if they feel comfortable with the level of care your loved one needs.  Make sure they are aware of the medical needs they will need to able to take care of along with any other needs.    Make sure they want to take care of a patient in your age range and level of disability.  Some respite caregivers are more comfortable with youth, only females, people able to use the restroom, bathe themselves, etc.

Trust your instincts.  If something doesn’t feel right, even if all the paperwork makes it seem like it should work, keep looking for the respite worker that makes you feel good about it.

To me it was important that my respite worker would get along with mom so she was included in the interview.  Mom had reactions to certain people so naturally I picked one that mom seemed ok with and that treated mom with respect.

Then we did a trial run where the respite worker came and I left (even though I just went outside).  The first time was only about an hour to see if it felt right.  We were lucky and found one right away.  I have talked to caregivers who tried several before they found the right one.

It is always good to have more than one but mom didn’t like too many people in her environment so we stuck with just one.

Next post we will discuss the information that has to be readily available for the respite caregiver.

Do you have any experiences with respite providers that might help others in their searches?  Any questions you think they should ask?

Respite Care – Do you need a break?

Respite Care – Do you need a break?

Caregiving can be exhausting.   The day to day care without a break is one of the reasons that caregivers can die before the person needing care.  Respite care can give a temporary break from the struggle of the stress while still giving the person needing care professional help that is trained to take care of your loved one.  Using respite can strengthen and support your abilities as a caregiver.  Seeking help does NOT make you a bad person.  It just means you have a life outside of being caregiver.

Respite can be for many different reasons.  It can be for something as simple as grocery shopping,  medical appointments, a meal out or just going to sit at the park for some ‘me’ time. It can even be for a weekend away for many reasons.  The idea is for you to be able to recharge your batteries WITHOUT sacrificing the care for your loved one.

Respite care can be provided in your home or in a care facility such as a nursing home or adult day care facility.  Generally when done in the home, the respite worker does all the normal things like you do such as cooking, cleaning and personal care along side of any medical care.  With more intensive cases you might need to use a nursing home or adult care facilities.

None of this is generally covered by insurance or Medicare.  But, there are sometimes funds to care for this type of care.  Grants are available from time to time.  The cost varies from person to person but is usually typical for the area.   Where I live the general cost is $10.00 per hour.  This is set by the respite worker.

Since respite care is such an important part of caregiving we will discuss this in three posts.

Next post we will be discussing interviewing the respite caregiver.

When the caregiver needs a caregiver – lessons it taught me.

Recently I took a fall and badly injured the knee I had replaced last fall.  Suddenly, I needed someone to do certain things for me.

It really puts it into perspective how the person we are taking care of feels.  Here are five items that I really never thought much about:

1.  PrivacyI had none.  I had to have someone help with bathing and for some reason that was very stressful for me.  We all have the same parts so what is the big deal?  It is a big deal.  Even though the person we are taking care of might be close family, they might still want privacy.  See what you can do to give them as much as possible.

2.  My schedule – Suddenly I had to do things when it was convenient for someone else.  Everyone was terrific about working with me but it was odd to have to have to have someone take out my dog, cook my meals, etc.  Being independent one day and then not the next was hard.  I will keep this in mind to see if people I am caring for would like things done on a different schedule if I can.

3.  Sleep – I hate to sleep on a schedule.  You get used to getting up and going to bed when you want but when others are helping, you adjust.   I couldn’t get up to get to the rest room so had to watch my drinking habits.  It was hard to move around to get comfortable also but I lived.  This will make me consider ways to make my “patients” more comfortable at night.  When mom was here, we put a baby monitor in her room so I could hear if she needed help in the night.

4.  Irritability – I try to be pleasant all the time but I found out that I can be a real crab when I am hurting.  I have had people tell me that the people they were caring for were real bitchy at time and now I definitely understand how that could be.  Mom never really complained but when she wanted to could be VERY stubborn.  She would just look at me with a gleam in her eye and say “NOPE”!  When she said that, there was no reasoning with her.

5.  Medication – I confess that I am not the best at taking my meds on a strict schedule.  I also take supplements like calcium and vitamins.  Due to outside help, these were looked at very carefully.  I felt like I was a little kids being spied on.  I realize that medications can all have interactions with foods, drinks and other meds but I was on top of that and having someone question it made me irritated.

Now, none of this is complaining.  People have to do what they have to do but it really opened my eyes to how what I was doing might make someone else feel.  It is easy to get in a habit and just do things without really thinking how the other person might feel.  Take time to see how what, how and when what you are doing might be interpreted by the person you are caring for.

Ask them if you could do things differently to help them.  Ask for suggestions but be prepared, you might get them.

 

Patience – A Much Needed Virtue

As we all know, being a caregiver can be very taxing.  It makes you draw on your strength, nurturing abilities and your patience.  Sometimes your patience is the hardest thing to maintain.

We have to remember that the people we are caring for might be in pain, embarrassed to have to have a caregiver, scared and/or mad at their bodies for breaking down.  They are not upset with us but the situation.

It is hard to have a loved one yell at you or refuse to cooperate with what you have to do in order to help them.  At times, they act like little children.  I particularly remember when Mom would get this look in her eye and just say “nope” when I tried to get her to take her pills or drink something.

There is no easy way to tell someone how to have patience.  What worked for me was to walk away and try later.  It did me no good to try to ask her to take it again or “force” her to do it.  Sometimes I was able to distract her and she would do it without realizing it.  Sometimes music will calm someone.

Sometimes you just need a break.  The next three posts will be about Respite Care.  It is a way to get away from the situation enough to come back refreshed and ready to begin again.

What do you do when your patience is at an end?  Please let us all know so that we might be able to try it when we really need it.

Always have a back up person in case you can’t be there to be a caregiver

This just sounds like common sense but too many times, one person feels like they are the only one capable or willing to take care of the loved one.

Recently, I was sick for over 3 weeks.  Had my mother still been with us, who would have been able to take care of her?  I would not have been able to be with her as I could have given her my chest congestion,cough and other symptoms.  Symptoms that are bad for you would be possibly fatal for someone with a compromised immune system.

It does not always have to be an illness.  It could be a family emergency that takes you away like another family member ill, having a baby or a death.  Also, sometimes it is job related.   Sometimes you just need to have a break.

If your loved one has family and friends around that could step in or if you would have had to hire someone if you have an emergency, it is important that you have enough information available for the “replacement” to do what you do on a daily basis.

If family and friends are not available, make sure you have a medical team (CNAs, CMAs, bath aides, nurses, etc) up to date with the necessary information.  You can find employees like this through your local health department, senior center, Area on Aging or your health professional.

This can be as simple as having a representative of their agency come out, visit with you and your loved one.

For example, you need to have the medication schedule written out with where and how the medications are bought.  What is a typical daily schedule?  Are there any food allergies?  Does food need to be prepared in a special way?  Where is any non medical equipment (special eating tools, bath aids, etc) that you use? Is there anything that brings out bad behaviors in your loved one?  What calms them?

What to you is automatic may not even occur to someone else.

This is why I think it is critical to have the binder that was discussed in a previous post.  It has the doctors involved with your loved one, medications, other treatments such as physical therapy or any other therapy, etc.  It also has a copy of all legal paperwork such as living will, DNR, etc.

A calender is also necessary for medical appointments that are coming up.

So bottom line, make sure everything in the binder is kept up to date.  It will give you peace of mind in case of emergency.

 

 

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!