7 Key Things to Know About Long Term Care

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Valerie Hopson BellOn Today’s Episode, we sit down with guest Valerie Hopson-Bell. Valerie has a broad range of experience ranging from being and Ombudsman to being a Geriatric Care Manager. She is a true advocate for the elderly and has an immense wealth of knowledge. Today, we discuss seven elements of long term care. We touch on the differences between assisted living, home care, home health care, the differences between Hospice and Palliative care… and a host of other issues. There’s a lot to learn today on this one … so sit back, grab a cup of coffee …. and enjoy.


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Full Transcript:

Price Jett: Well hello everyone. This is Price Jett from Elder Care 101 again, and I am so excited today to share with you a very special guest that we have. Her name is Valerie Hopson-Bell. Unlike other podcasts we’ve done where the interviewee was in one location and I was in another one, we both happen to be here sitting at the same table. She has just one of those smiles that is electrifying and contagious at the same time. I am thrilled to be here in the same room with her. Valerie, welcome to Elder Care 101.

Valerie : Thank you so much. I’m really happy to be here.

Price Jett: Delighted that you’re here. We have a great topic today. We’re going to be talking about long-term care. What is long-term care?

Valerie : That is correct.

Price Jett: We’re going to be going through the seven things you absolutely must know about elder care and long-term care. Now, Valerie, before I turn you loose, I just want folks to know that you are a geriatric care manager.
Valerie : That is correct.

Price Jett: I think that translates into being an advocate. You are an advocate for the elderly, and for their families, and you’ve been doing this since at least 1995.

Valerie : That is correct.

Price Jett: You are just a wealth of knowledge. I know our listeners are going to learn so much. I appreciate everything that you have taught me, and even the personal help you gave me as it related to my own parents. Anyway, excited that you’re here. The topic is long-term care. Before we dive into that, tell us a little bit about yourself. How you came into this space, and just help our audience get to know Valerie Hopson-Bell a little bit better.

Valerie : Well, I really like for people to understand that I was not one of those kids that did things in an orderly fashion. I graduated high school in three years. Wanted to hurry up and get out, but I didn’t go to college. I started working, got married, had a family, all of that. At about the age of 32 or so, I decided to go back to college full-time. I’m using the term, “Go back,” because during those other years I did go to the community colleges, and I took classes.
My son likes to say it took me 15 years to graduate college. Kind of true. Once I went back as a non-traditional student, I kind of really figured out what it was I wanted to do. I had an advantage over the other students. I started doing my internships, fell in love with the senior population. I started out doing case assistance, which is where someone calls in and says, “Where do I look for this information? Where can I go for this information?”
From there I kind of got a taste of what case management, or care management, and that’s really following people, kind of holding their hands through the process, understanding all of that. I then became a long-term care ombudsmen. I did that work in North Carolina, and then moved to the Fredericksburg area almost three years later.
I contacted the state ombudsmen and I said, “Do you have any positions?” They never had had a local long-term care ombudsmen in the Fredericksburg region. She said, “You know, we can start you out part-time. As you develop the program for us.” I did that. Absolutely fell in love. Fell in love with the area. Fell in love with the work. That’s really how I got into Virginia doing all of this work in aging.
Through that, being the ombudsmen, which a lot of people don’t even know what that words is. Ombudsmen is a Swedish term for representative or advocate. Because this is long-term care, it’s for folks that are receiving community block grant monies in their homes or for folks that are in assisted livings or nursing homes.
I was able to actually just make sure that their rights weren’t being violated. Through that, I learned more about Medicare, more about Medicaid, and the whole processes of things. After, gosh I guess I worked in that area in Virginia about eight years, and then I started my own business nine years ago. That’s when I became a geriatric care manager.

Price Jett: That’s ElderCare Connections?

Valerie : That is correct. ElderCare Connections.

Price Jett: Wonderful, and Fredericksburg and hundreds of families have not been the same since. It’s just amazing the work that you do.

Valerie : Thank you.

Price Jett: Okay, let’s start at the top. This term, long-term care is a broad term.

Valerie : It is.

Price Jett: It is an umbrella type term. So many things roll under it.

Valerie : Yes.

Price Jett: Let’s talk a little bit about what it means. Give us a definition of long-term care or LTC.

Valerie : Okay. The first thing I want to say before I give you the definition, a lot of people’s mind immediately goes to insurance. We’re not talking about long-term care insurance.

Price Jett: Got you.

Valerie : We’re talking about long-term care in terms of how you can provide care to someone, whether it’s in the home or in a facility. The definition for long-term care of someone that has a physical or even a cognitive impairment who needs assistance in their ADLs, Activities of Daily Living, in order to function throughout their life.
We look at how is that person now, not how that person is going to be in six months or a year, how is that person now in needing the care? Basically, that is what long-term care is. There’s a lot of ways that we help to provide those services.

Price Jett: Got it. Got it. That brings us into the second thing that we wanted to talk a little bit about, which is adult daycare centers versus community meal centers etc. Talk to us a little bit about that space.

Valerie : Okay.

Price Jett: How are they different, and how does that fit in to a care plan for a family?

Valerie : I know that you have done blogs on adult day centers already, but that is a place where you could drop your loved one off let’s say at 5:30 in the morning, and pick them up at 5:30 in the evening. It allows you, as the caregiver, time to work, time to do things that you need to do to get respite. Have a break just so you can focus on you, because our caregivers, they forget to focus on themselves.

Price Jett: Right, right.

Valerie : At the adult day center, they’re going to still receive the required medications. They’re going to receive meals. They’re going to receive activities. It might be arts and crafts, or games, or exercise. They’re going to get those things.

Price Jett: Valerie, when I visited my first one, I was surprised at how few there are.

Valerie : That is true.

Price Jett: You know, when you hear about assisted living facilities, they seem to be everywhere, but these adult day centers, it seems to me like a wonderful thing to have available. Is this a growing trend, or why do you think there are so few as compared to assisted living or home-care companies?

Valerie : I will tell you the bottom line on that, and I know this because I actually investigated maybe about 10 years ago, I considered opening one myself. I went to a lot of them throughout the Richmond area as well as here in Fredericksburg, and I’ve learned in order to help the folks that you need to help, it’s very difficult to be profitable.

Price Jett: I see. Got it.

Valerie : However, there are some people that have figured it out in terms of hooking it on to another service that they do, whether it is an assisted living who has an adult day center, or a home-care agency who is expanding to this, but some people can do it. There are some adult day centers that will accept public funds such as Medicaid. Then there’s others that is private pay only, just like our facilities or long-term care communities. Some of those do the same thing.

Price Jett: Got it. Got it. I think it’s a wonderful service.

Valerie : Yes it is. The congregate meal centers or senior centers are usually operated through our agencies on aging. Now in every state in the United States, you will find an agency on aging. We call those triple As. Those triple As will provide some type of adult day program. It’s different from the adult day center because they do not, they being the triple As, they are not providing any type of medical care. They do not administer medication.
They will have hot meals, at least for lunch. They’ll have a small breakfast, and they’ll do activities, and keep your loved one safe, but they will have to be screened and eligible for that program. For some of the eligibilities they want the person to be able to get themselves to and from the bathroom by themselves. Those kind of things.

Price Jett: Where an adult day center would not.

Valerie : That is correct.

Price Jett: They’d be …

Valerie : An adult day center, they actually can take people who are incontinent, and they will help to make sure their keeping their hygiene up and those kind of things, at the adult day center.

Price Jett: How about mobility issues, people that are in a wheel chair?

Valerie : Yeah, well, again for adult day centers, that is not a problem. They’re usually very accessible, and they will have a means for people to recline and nap throughout the day. With your congregate meal centers, now they can take people in wheel chairs and on walkers, but it’s not all day. That usually is just a few hours throughout the day.

Price Jett: I see.

Valerie : A lot of centers, a lot of the triple A centers, will provide transportation to and from. These are the differences. In the adult day centers, there’s a few that will have transportation, usually under Medicaid only.

Price Jett: Got it.

Valerie : Okay?

Price Jett: All right. Let’s move on to our third topic under long-term care, and that is home care versus home health. Those terms get thrown around.

Valerie : Oh a lot, and it confuses people so often. Home care, that is the home management skills. You know what we do in terms of doing the grocery shopping, running the errands, stocking the cabinets, making sure the refrigerator doesn’t have rotten food. Then it goes on. They can do the light housekeeping. They’ll mop the floors, vacuum, change the linen on the bed, all of those types of things.

Price Jett: These would be like your Comfort Keepers, your Visiting Angels that you see advertised.

Valerie : [crosstalk 00:12:35]. That is correct. Now, those folks, the home-care agencies, have at least two different levels of staff. You have companion aides, who do exactly what I just talked about with the home management. Then they have PCAs or CNAs. PCA is Personal Care Aides. CNAs is Certified Nursing Assistants. Both of these folks can actually do hands-on care.
They’re going to put someone in the shower. They’re going to help toilet you. They’re going to, you know, help you in and out of the bed. All of those things. Personal assistants.
Price Jett: That’s home care. The two levels of home care. Home health.
Valerie : Home health. That’s a different animal. There you’re always going to have licensed or certified personnel meaning you’re going to find RNs, maybe a wound care nurse, or dietician. You’ll have the physical therapy, occupational therapists, speech therapists. These folks that provide a skilled service.

Price Jett: Are these, Valerie, are these normally the result of a physician’s prescription kicking this off?
Valerie : In home health you always do. In order for it to be covered under Medicare, the federal program, you’re going to have to have a doctor’s order for it, yes. It’s limited in the time frame that they will spend in your home.
Price Jett: It’s time bound, 12 visits, 6 visits, something like this?

Valerie : That’s correct.
Price Jett: I see.

Valerie : I tell people generally you can look for about six weeks of some type of therapy to go on in your home. That is with home health.
Price Jett: Home health.

Valerie : Okay? With the home care, Medicare does not pay that. That’s paid for by private funds. If you have the VA, the Veterans Affairs benefit of Aid and Attended, as well as long-term care insurance can help pay for just home care.

Price Jett: Got it, and Medicaid would not?

Valerie : Well, there are a few companies, but that is a question to ask as soon as you call. Do you accept Medicaid? All of the home care agencies in our area, they do not offer Medicaid, but there are a few that do.

Price Jett: A few that do, so it’s rare, it’s rare.

Valerie : That’s correct.

Price Jett: Because there’s so many here, but most of them do not. I see.

Valerie : Yes.

Price Jett: That’s home care, which goes on continuously, private pay in general. Then there’s home health, which is time bound, usually there’s a physician’s prescription behind it, and Medicare will pay, etc.

Valerie : Yes. That is correct.

Price Jett: Very, very helpful.

Valerie : Yes.

Price Jett: Now, here is a term, I’m going to give you two terms.

Valerie : Okay.

Price Jett: One, many people have heard about, and one few, but they do get conflated sometimes. Help us understand the difference. Hospice is the first one. A lot of people know about Hospice. A wonderful, wonderful [crosstalk 00:15:51] …

Valerie : Wonderful, you’re right.

Price Jett: … and palliative care. They’re sort of like sister services, I think, but help us …

Valerie : They are.

Price Jett: … get our head around that, and help us understand the difference between palliative and hospice.

Valerie : You usually find both of these service with the very same provider. That’s why it’s so confusing. They both are done through a hospice agency. The way that I explain it to people is palliative care is a service that helps you to live your life with more quality because they’re doing things like pain management. They’re trying to help you manage multiple, chronic illnesses at the same time. They’re trying to help you live life to the fullest. Okay?
Hospice is going to help you prepare to transition, to die if you will. They actually do that, again with quality, but also in a dignified manner. I love them both. It’s just that let’s say someone has cancer. There’s a need for you to do your chemotherapy, your radiation, you can do that under palliative care, which you cannot do that under hospice, for most of the time.

Price Jett: Interesting.

Valerie : If you’re still accepting chemo or radiation, that means that you’re still being treated for your disease.

Price Jett: Got it. Valerie, that was very helpful. Now the question that’s on a lot people’s minds, who pays?

Valerie : I’m happy to say that Medicare pays for both services. Now, in terms of how long that is, that varies. For the palliative part of it, it tends to cover you until you are well enough to continue on your own. Maybe they’ve gotten your pain under control where you can now kind of monitor that yourself, or the chronic illnesses are being contained.
With hospice, that can go on for some time. I’ve had clients that have actually been in the hospice program for two years before they actually graduate off. Some of these clients who, at one time, looked like they were within six months of transitioning, they’re now starting to gain weight. They’re starting to interact again where they weren’t before. Maybe the medication has been able to be lowered for whatever reasons.
Hospice says, “Okay you’re doing better now. We’re going to graduate you off, but always know that should you take a turn for the worse, you could always go back onto hospice.
Price Jett: Always [inaudible 00:18:55].
Valerie : As long as the doctor orders it.
Price Jett: Through doctor order. Is the six months a general rule of thumb?
Valerie : Yes, and that six months is what gets you into the hospice program. You know, I tell people all the time, “Although doctors are good, they’re not God.” They cannot tell you the exact day and time that you’re going to transition. That is only kind of a rule of thumb for them to go by.
Price Jett: Got it. Palliative then, let’s say as you mentioned, someone could be on chemo for example. That also is ordered by the physician?
Valerie : You know, yes the doctor is involved, but I am not positive, I’m sorry to say. I’m not positive that they have to write an order for it. What I’ve always done with my clients is I contact the actual hospice company. I tell them that this client wants to go into palliative, and then they take care of all the paperwork.
Price Jett: Okay.
Valerie : You don’t have to worry about that at all.
Price Jett: Okay. How time-intensive are those two? Is there a differences, one two days a week, one three days a week? How does …?
Valerie : Yes, it does vary, and there’s no real time limit for the palliative care in terms of how often is a nurse coming in. What I know is they’re going to come in and assess your situation. If they’re dealing with pain management, you’re usually going to see a nurse practitioner from the hospice group. They are the ones that’s going to work with you until they feel that they have it somewhat under control.
Now, if they’re dealing with multiple chronic issues, here you’re going to also get a care plan, and they’re going to follow that care plan, but you do not normally see people, multiple days, coming in and out of your home. When you go to hospice, again, it’s going to depend on what level you’re at.
Price Jett: Sure.
Valerie : The doctor said you have six months to live, but you’re still able to go out, and go to lunch, and do those things, so you’re not going to have staff in your home on a real regular basis. Should you become more bed ridden, you’re going to see an aide a couple of times a week, who is going to come in and help you with showers and bathing. You’re going to see a nurse about once a week. You’re going to see a medical social worker at least monthly, if not more frequently.
Price Jett: All under the hospice program?
Valerie : All under hospice. What I love about hospice is the team method. I told you, they’re going to have the aide. They’re going to have nurses, medical social workers. They also have chaplains. These are non-denominational. There’s no one …
Price Jett: So they’re getting the whole person, not just the …
Valerie : The whole person, that is correct. They’re not going to force a certain religion on you. I love hospice. A lot of people are very fearful of it. What I tell people is, “You’re not going to die any faster by taking hospice. If nothing else, it is going to make it seem more smooth, more seamless, not only for you, but for your family members.”
Price Jett: That’s what I’ve seen. The pressure and the anxiety that removes from the family.
Valerie : Absolutely.
Price Jett: Because they’re dealing with so many things every single day.
Valerie : And the leg work. When you do take a turn for the worse, there’ll several things that you’ll need that you don’t even think about. A hospital bed, right? That medical social worker is going to make sure you get that bed.
Then, if you’re a certain weight, you may need a special mattress. We don’t even know who to call for that. That medical social worker, they take care of that. They take care of ordering your medications. All of that is off of your loved one. They have more time to focus on their relationship with you, rather than trying to be your case manager, if you will.
Price Jett: Valerie, thank you. I think people are going to learn a lot from that. I think the term palliative care is probably going to be new to some people listening.
Valerie : That is true.
Price Jett: I’m very sure.
Valerie : The whole idea of palliative really has only been around maybe for the past five, seven years or so, so it’s still new.
Price Jett: Still new.
Valerie : Yeah.
Price Jett: Valerie, the next topic I want to dive into with you is community-based care.
Valerie : Yeah.
Price Jett: Talk to me about that. What does that mean? What does it look like?
Valerie : Although most of those services are going to be free, especially for people who are in the moderate to low income levels, a lot of people aren’t aware that they’re available. You may have heard of home delivered meals.
Price Jett: Right. Meals on Wheels.
Valerie : That is correct. In different areas, they are done by different people. The Meals on Wheels and the home-delivered meals. Just so happened where we live, they’re actually organized by the same group. Home-delivered meals usually come as frozen, and someone … The triple As remember, Area Agencies on Aging, all across the United States, they will have frozen meals that they bring out to people. Very much like a TV dinner type, but they make sure that you get each category of the nutrition scale. They’ll bring you the milk. They’ll bring you the bread. Then you have the meal.
That is for folks who can get them in the oven or the microwave by themselves or has a loved one that can do that. What’s nice is at least once a week you know someone is going in to lay eyes on your loved ones, because they’re delivering these meals. Meals on Wheels even nicer because you have someone that comes on a daily basis, and sometimes two times a day.
They’re going to bring lunch, and then they come back and they bring dinner. The home delivered meals is a slight fee through the triple As. Now, Meals on Wheels, those are a little more costly because they are delivering almost fully cooked. Some areas will deliver them hot. It depends on the radius that they can get to.
Unfortunately, we’re so spread out and have rural areas here in our region, that they’re not able to deliver extremely hot meals, so they do them almost cooked, partially cooked meals, and they will go in and stick them in someone’s oven for them so that they can finish.
Price Jett: Valerie, how do people find these serviced? You mentioned the triple A, or the …
Valerie : Yes.
Price Jett: … for the home-delivered meals, the frozen TV meals that people can heat up in a microwave. Very, very helpful. Do you reach out to area agency on aging for both?
Valerie : See? That is why I wanted to include the community-base in there because your area agency on aging should be your central resource. That should be where you call for absolutely everything for a person 60 or over. They should know where to get meals, where to get transportation, which I know we’re going to talk about later, where to get activities even, or who are these home-care agencies that we should be calling? Where do we find reputable home health companies?
Your area agency on aging is that one person, that one agency that you should be calling for this information. When we talk about community-based services, it’s not just meals or transportation, they also provide, many of them will provide some type of home maker service. That is where they’re going to send someone in to help do light housekeeping in your home.
Again, if you’re moderate to low income, you’re paying little to nothing for this service. These people come in and they clean your bathrooms, and your kitchens, change the linen on the bed. They’ll do the laundry. They have a short amount of time to do this versus getting a home care agency in there, but they’re still this service.
Then we talked about the congregate meal centers. Part of Agency on Aging’s job is to make sure seniors are getting nutritious meals. That’s why you have those centers. You’ll find if you give them a call, there’s other services that you would be surprised about. They help you understand your Medicare because Medicare comes in so many different parts. The Agency on Aging will help educate you on those parts.
Price Jett: Got it.
Valerie : Okay.
Price Jett: Let’s move to transportation.
Valerie : You know, that is, and I hear this almost in every other state where I’ve met people, transportation for seniors is a really big issue.
Price Jett: Big issue.
Valerie : Big issue. Yes, you always have the option of the buses, that transportation system, but sometimes our seniors, it’s difficult to even get up on the bus. They’re so tall, the high steps and all of that. It may not get them close enough to where they need to go.
Price Jett: It may not come to where they live.
Valerie : That is correct. You will be surprised to find in some areas though, as in our area, if you contact the bus system, you’ll find out if they have deviated routes, meaning will they come to your door? There are some areas where our bus system will go to your door, as long as they don’t have to turn around to get out of that street. Deviated bus routes. The other thing is you do have the taxi cabs and all of that. Extremely expensive.
Price Jett: Very expensive.
Valerie : Again, I tell people, “Contact your area Agency on Aging because a lot of them will provide transportation to seniors.” Very limited, but they will provide it for medical appointments, sometimes for quality of life things, and at a very cheap cost. For instance, here in the Fredericksburg area it’s only $2 each way. You’re talking $4 round trip if you can get in on their listing.
If that doesn’t work for you, then you can always contact your home care agencies that we talked about earlier, those places like Home Instead, Comfort Keepers, Visiting Angels. Those people provide transportation through their companion aide program. It starts to get a little costly at that time. Then, of course, we do have wheel chair transportation as well as stretcher transportation. Those are starting to pop up everywhere.
Price Jett: Private pay?
Valerie : Private pay. One thing I’ve learned over time in dealing with a lot of different providers, if they are a private pay agency for transportation, and we’re talking about wheel chair and stretcher, on their license plate they should have an ‘H’ somewhere for ‘Hired.’ If they have that, then chances are they followed the other rules of having insurance, of having their license, because otherwise you find out that people are just doing it out of their homes, and they’re not getting the proper oversight that they should have.
Price Jett: Got it.
Valerie : I like to share that with people.
Price Jett: That’s a great tip. That’s a great tip. Let’s move on to the next topic.
Valerie : Okay.
Price Jett: Assisted living versus nursing home.
Valerie : Well, you know now that really is my area of expertise. First off I tell people it’s never a one-size-fit-all for neither one. Not for assisted living or a nursing home. I believe that these facilities, or communities in what we like to call them, that they all have their own personalities. Okay? When we talk about assisted living, those are state regulated. That means whatever we see here in Virginia may look totally different from an assisted living in Montana or even right next door to us in Maryland.
Price Jett: Each state manages it, monitors it differently …
Valerie : Absolutely.
Price Jett: … as they see fit?
Valerie : As you know, I’ve done that work in two states. In Virginia if you have four or more unrelated people in a home, then it is considered you must be licensed as an assisted living. That’s four people, but it could go up to … We have one facility that takes up to 300 people. They’re both listed under assisted living.
In North Carolina where I used to work, at that time if you had six or more, then you had to be licensed. They had group homes, family care homes, and then what they called assisted livings. Assisted livings were the ones that tended to have 30 or more people. Some of them looked like hotels. It’s just a variation.
No matter where you are, in terms of the state regulations, they’re usually going to provide three hot meals a day, medication management, and supervision. They still should be keeping your loved one safe. Although it’s not jail, so they can’t lock them in, but they should be providing some type of supervision to know where they are at all times.
You’re going to have a nurse in an assisted living in the larger assisted livings. You’re not going to have a nurse in one of them that only has four or six people.
Price Jett: Is that a state requirement?
Valerie : Each state has different requirements. In Virginia, it could be an LPN who is in an assisted living. Even the assisted living that I told you that houses up to 300 people. They could have just the one LPN. I have started taking notice that we have a couple of assisted livings who are now starting to hire RNs, registered nurses, so that’s a good thing.
The rest of the staff is usually the CNAs, certified nursing assistants, or just nursing assistants. Many of the assisted livings are not providing medical care, as much as we think they are, they’re giving out the medication. They may be rubbing an ointment on your loved one, but they are not providing medical care.
Price Jett: Meaning your loved one has to take the medicine themselves?
Valerie : No, meaning the … In an assisted living they have med techs, so these are aides who have gotten a little extra training to give out medicine. They’ll bring the medicine to your loved one, and your loved one takes it at that time, but they are not going to … What do I want to say? Medical care in having trachs, or vents, or open wounds. At that point …
Price Jett: Feeding tubes.
Valerie : Feeding tubes. Very seldom will you find that in assisted livings, although there are some assisted livings. We have heavy care assisted livings that will do those types of things.
Price Jett: Got it.
Valerie : Okay? Then I’m going to switch to nursing homes.
Price Jett: Also called SNFs at times? Is that the same?
Valerie : Okay. The part that is called SNF, which is called, [Sniff 00:36:28], or Skilled Nursing Facility, that is still within the same nursing home. It’s just a different level of care. That’s what we also call the rehab section. A lot of people have gone to nursing homes because they got a knee replaced or they broke their hip.
Price Jett: Seen that many times. Yes.
Valerie : Or had a stroke. That’s where you’re going to get rehab. That’s the SNF. The skilled nursing facility portion of it. Then in the same building, you have people in what’s called intermediate care. Those people live there all the time. Okay? The nursing home, it is federal regulation, so whatever we see in Virginia we should see in Montana, we should see in Maryland. It should look the same. The building can look different, but they’re going to have the same levels of care.
Price Jett: So again, going back to who pays, is this why assisted living facilities, in general, do not take Medicare or Medicaid? Is that right?
Valerie : That is right because again, they’re not a medical facility, and Medicare is your medical insurance remember?
Price Jett: I see. Mm-hmm (affirmative).
Valerie : The only time a nursing home takes Medicare is when you’re there for rehab.
Price Jett: Got it.
Valerie : Okay? So you must be in the skilled nursing section in order for your Medicare to cover. It is only going to cover up to 100 days.
Price Jett: Okay.
Valerie : It’s not guaranteed that everybody’s going to get 100 days, but that is the most that your Medicare will pay for you in that nursing home setting.
Price Jett: Got it, and then the rest, even in a nursing home, would be private pay.
Valerie : Private pay, long-term care insurance, or long-term care Medicaid. Medicaid is what pays a large chunk of people who are in nursing homes. This could even be people that have a very high income, meaning I’ve helped people who have $6,000 a month coming in, but that still does not cover the full amount of that nursing home stay.
In some areas you’re looking at $8,000 to $10,000 a month to live in a nursing home. As long as that person has spent down their assets paying for their care, then they can get on Medicaid and be covered in a nursing home as well.
Price Jett: Got it. For the difference between, let’s say, the $6,000 income and the $10,000 a month fee?
Valerie : That is correct.
Price Jett: I see.
Valerie : As long as your monthly income is not more than the monthly fee, there’s a chance that you could be eligible for long-term care Medicaid.
Price Jett: Got it. Very helpful.
Valerie : Okay, so I want to explain in the nursing home though, that that is where you’re going to see higher skilled levels of professionals. You’re going to see at least one RN who is going to be your Director of Nursing. They could have other RNs, but at least that one, and that is guaranteed for at least eight hours a day. The rest of the time they’re going to staff it with LPNs and then with your aides.
In the nursing home, because you have the skilled care, you’re going to find physical therapists, occupational therapists, and speech therapists.
Price Jett: Got it.
Valerie : They too are going to make sure you get those three hot meals. You’re going to get all of your medications, but they also do wound care, changing bandages, and making sure the areas are healing. That is where you’re going to get that medical care versus over an assisted living.
Price Jett: An assisted living. Then nursing homes falling under federal regulations and rules.
Valerie : That is correct.
Price Jett: And assisted living state-by-state.
Valerie : That is correct.
Price Jett: So helpful. Okay. Now there’s one term, and this is our last of seven things we wanted to talk about under long-term care. That is CCRC.
Valerie : Okay. CCRC stands for Continuing Care Retirement Communities. Now, a lot of people like to use that label as if they are one because they may be next door to a nursing home, but if it’s not all by the same owner, then it’s not a true CCRC. A true CCRC has three levels of care on the same campus. They have independent living, which may be apartments, it may be villas, it may be stand-alone houses.
What they’ve guaranteed you is by buying in to their CCRC, you are guaranteed every other level of care. If you need an assisted living, then you can move into the assisted living without moving off that campus.
Price Jett: All on the same campus? Okay.
Valerie : That is correct. Then from there you may need skilled care or you may need to live in a nursing home. Either way, you are guaranteed space on that same campus.
Price Jett: Got it.
Valerie : Often times you’re going to see a high buy-in rate. That’s just at the beginning, but that all guarantees you, guarantees you that you’re going to receive your services right there where you live.
Price Jett: Okay. Let’s talk about very tactical things for people who are listening. In a CCRC, the promise of being taken care of for the rest of your life is what’s really appealing.
Valerie : Yes. Sure.
Price Jett: You talked about a buy-in amount up front, so in general, correct me if I’m wrong.
Valerie : Yes.
Price Jett: There could be a large amount asked up front before you become a part of that campus. Sometimes over $100,000.
Valerie : That is correct.
Price Jett: Sometimes over $200,000, is that correct?
Valerie : Yes, that is correct.
Price Jett: And you pay that amount up front, but then you would also pay per month in general?
Valerie : Then you pay a monthly maintenance fee. That is for wherever it is that you’re living. If it’s in the apartment, you’re probably paying a much smaller monthly maintenance fee to be in that apartment.
Price Jett: In general, about what would they cost? I’m sure they vary with …
Valerie : It does. I’m going to say …
Price Jett: Are we talking a couple of hundred or thousands?
Valerie : No, it’s still going to be about $1,200, $1,500, depending on the location.
Price Jett: Yep.
Valerie : You know, it could be $2,200, but then, you know, you’re usually getting a meal included in that packaged deal. Even when you’re in the independent living, you still have the meal package because once you’ve gotten to that point, you no longer want to cook and all of that, but you can still run your life. You can still go and have a game of golf or play tennis, but you’re not cooking much.
You get that included in that $1,200 or $2,200 maintenance fee. Okay? Activities, you’re always allowed to come to whatever activities are going on. It could be intellectual activities. It could be music. Again, it could be arts and crafts. They could be planning a cruise. You’re going to be allowed to do all of those things.
Price Jett: Some of these facilities are just absolutely gorgeous aren’t they?
Valerie : I love them. I mean, that’s the draw really, you know? They’re very up-to-date, modern, clean, just really nice. The dining rooms are to die for. I mean we have one in our area. It’s not a true CCRC because the nursing home next door is not owned by the same people, however they have the other levels of care. They don’t allow blue jeans in their dining room because they are just that fancy. You feel like you’re really being cared about.
Price Jett: I see. I see. These, in general, private pay again?
Valerie : Oh yeah. That’s all private pay.
Price Jett: All private pay.
Valerie : Medicaid does not pay anything for that.
Price Jett: Even in the skilled portion?
Valerie : Medicare would pay in the skilled portion.
Price Jett: Okay.
Valerie : Medicare, because that’s your medical insurance, and that’s for the limited time.
Price Jett: For the [inaudible 00:45:32].
Valerie : Upward of 100 days.
Price Jett: Max out there as well.
Valerie : That’s correct.
Price Jett: Got it. If you then needed the more intensive care, that you would move to that section of the campus …
Valerie : That’s correct.
Price Jett: … but also private pay?
Valerie : Also private pay. Many of them do have a clause though that if you are to run out of money while you’re one of their members, then they will allow Medicaid for you.
Price Jett: I see.
Valerie : They don’t allow Medicaid from someone in the community, but they’re going to make sure that you have enough money that possibly would cover you for life.
Price Jett: I see.
Valerie : Okay?
Price Jett: Very, very helpful.
Valerie : Yeah.
Price Jett: Very helpful. Valerie, thank you so much for the time you spent today. You were so generous with your time. Thank you.
Valerie : You are more than welcome.
Price Jett: I never talk to you that I don’t learn something new. Every time.
Valerie : You always say that.
Price Jett: It’s true.
Valerie : Thank you.
Price Jett: That’s because some of us have a lot to learn, and some of us have a lot to teach. Valerie, I really do appreciate it. Thank you so much. Now listen, I’m sure this has sparked lots of questions in people’s minds. I’m sure it’s going to spark conversations at home. If people need to get in touch with you, and they want to talk to you, and learn more, and learn more about what a geriatric care manager is, being this advocate, which is what you do, and I’m taking advantage of it as we’re sitting right here, so that other people could learn, and get in touch with you, how would they go about doing that?
Valerie : To contact me specifically, you could go to my website, which is www.eldercareconnections, with an S on the end, .net. Okay? The phone number is area code 540-419-4387, but I also, because I know that this broadcast can go anyplace, I want people to know that there’s another way that you can find a geriatric care manager to help you.
That care manager is that one person that can pull all these different pieces together for you that we talked about. They can help you find the right home care agency or help you understand if it’s time for you too look at palliative or whatever else. That care manager can be found at aginglifecare.org, aginglifecare.orgfindgeriatriccaremanager. You put in a zip code or a city, and it’ll pop up who covers your area.
Price Jett: You would find your own Valerie.
Valerie : That is correct. That is correct.
Price Jett: Awesome. Valerie, thank you so much. Really do appreciate it.
Valerie : Well, it’s been a pleasure.
Price Jett: Will you come back another time for another podcast?
Valerie : I would love to.
Price Jett: Awesome.
Valerie : Thank you.
Price Jett: Have a great day.
Valerie : Thank you. You do likewise.
Price Jett: See you. Bye-bye.
Valerie : Bye-bye.
Price Jett: If you enjoyed today’s podcast go to www.eldercare101.com and download the full show notes. There you’ll find extra resources and links available. Further, you can also go to the website and click on, “Ask EC101.” Ask your own question, and this can be part of an upcoming podcast. Again, that’s eldercare101.com. We’re here to serve you each and every week of the year, so go there and check us out. Like us on Facebook and iTunes too. I’d really appreciate it. All the best. Talk to you soon.

January 21, 2019 |

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