Community Based Services – Long Term Care
Many communities provide services and programs to help seniors and people with disabilities with a variety of activities. These services include Meals-on-Wheels, transportation services, personal care, chore services, adult day care and a variety of activities in senior centers. These services are usually free or at low cost to individuals who qualify. Local organizations, called Area Agencies on Aging, coordinate these services to promote the independence and dignity of older adults. Your local community Area Agency on Aging can be found by visiting Eldercare Locator at www.eldercare.gov or by calling 1-800-677-1116.
Your state Medicaid program may pay for home health services including skilled nursing care, home health care, personal care, chore services and medical equipment. You must qualify for Medicaid to receive these services.
The following community-based services may be available in your community:
· Adult day care
· Senior Centers
· Financial Management
· Transportation
· Meals On Wheels
· Telephone Reassurance
· Case Management
Adult day care services provide health, social and recreational activities in a supportive setting for adults who have functional and/or cognitive impairments that do not need 24-hour care. Some programs offer services in the evenings and on weekends, in addition to standard business hours. Programs may provide services for individuals with specific impairments such as Alzheimer’s or mental illness. Adult day care programs may provide the following services:
Adult Day Care Services Health monitoring – blood pressures, food or liquid intake, weight
Social activities
Meals and snacks
Transportation to facility and activities
Alzheimer’s or dementia care Assistance with walking, toileting or taking medications
Mental Stimulation
Exercise activities
Personal Care – bathing, shampoo or shaving
Safe and secure environment
State Medicaid programs may pay for health care that is provided in State licensed facilities, including therapy services, mental health services, administration of medications, psychological evaluations, dressing of wounds and assistance with feeding. Private long-term care insurance may also pay some of these costs, but Medicare will not.
Telephone ReassuranceIndividuals who live alone and have medical or other health needs may fear that they would not be able to summon help in an emergency. Several types of emergency telephone response systems address this concern.
Emergency response systems use the telephone to check on an individual on regular bases. A family friend, relative, or professional service may make a daily call at one or more set times throughout the day. This telephone reassurance program may be free to you because a family member or friend provides this service or it is provided by your state or local aging organization.
If you did not answer the phone, the check-in caller would be alerted to a possible problem. If the caller detected a change in condition or voice based upon regular contact with you, the caller would take appropriate action.
Commercial emergency response systems may also be available. These services require that you wear a “beeper” on your wrist or around your neck. If you have a fall or other emergency, the press of a button would alert the 24-hour response system. This system requires that you pay an initial fee and a monthly fee of $25 to $40 for this service.
Senior Centers OverviewSenior centers are located in many communities to provide a wide range of services to you. The Administration on Aging, U.S. Department of Health and Human Services estimates that there are from 10,000 to 16,000 senior centers located throughout the U.S. Senior centers provide a varying array of services, including nutrition, recreation, social and educational services, wellness and fitness activities, information and referral services and Internet training. Most of the services are provided free or at low cost to participants.
Transportation Services OverviewTransportation services are available in many communities through aging services programs, regional mass transportation services and private sources. These services may include door-to-door taxicab services, public bus transportation, or vans with wheelchair accessible transportation.
Medicare does not pay for any transportation services except ambulance services, but Medicaid may pay for transportation services to get you to a medical appointment if you are eligible. Fees for transportation services are generally small and often people pay out-of-pocket for transportation services. To find transportation services in your area, contact your local community area Agency on Aging which can be found by visiting Eldercare Locator or by calling them at 1-800-677-1116. Many telephone books have a special section in the front of the book with the names and addresses of various service organizations that provide transportation for special needs.
Types of Long Term CareDepending upon your needs, you may be able to get help with your personal activities (for example, help with the laundry, bathing, dressing, cooking and cleaning) at home from family members, friends, or volunteers. If you think you need home care, talk to your family to see if they can help arrange for someone to come to your home to assist.
Some home care can only be given by licensed health workers, such as if you need skilled nursing care and certain other health that you get in your home for the treatment of an illness or injury. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) or a licensed therapist. Remember, Medicare only pays for home care if you meet certain conditions. For more information, look at the Medicare booklet, Medicare and Home Health Care.
You can also hire a home health care agency for care in your home if Medicare doesn’t cover it, In this case, you will need to pay for this care on your own. Home care costs can vary depending upon where you live, the type of care you need and how often you need care. Usually home care is charged by the hour.
To locate health agencies that provide services in your area, look at Home Health Compare listed at Appendix 2 (Information Resources). You can also look at the National Association for Home Care website to get information about home care and hospice. This website includes information on how to find a home care or hospice agency and how to prepare for care. Likewise listed at Appendix 2. (Information Resources) this publication.
The following home health services may be available in your community:· Skilled nursing care
· Homemaker/Health aides · Personal care aides
· Respite care
· Medical equipment
· Home repair and modification · Hospice
Homemaker/health aides provided medical and personal care if you are elderly or disabled living in your own home or a residential care facility. Home health aids work under the supervision of a registered nurse, licensed practical nurse, or therapist to provide health services. The home health aide is required to record the services performed and your condition and progress.
Personal and home health aides – also called homemakers, caregivers and personal attendants – provide housekeeping and routine personal care services. They clean client’s homes, do laundry and change bed linins. Aides may plan meals (including special diets), shop for food and cook. Aides may also help clients move from bed, bathe, dress and groom. Some accompany clients outside the home, serving as a guide and companion.
Medicare may pay for home health aide and homemaker services only if the individual requires skilled nursing care or therapy. The individual must also be homebound, have a plan of care that is prepared and signed by a physician, and the services are preformed by a Medicare-certified home health care agency. Your state Medicaid program or Medicaid waiver program may pay for home health aides and homemakers if you qualify. Private longterm care insurance may also pay for health aide/homemaker services.
Hospice OverviewIf you have a terminal illness, hospice care may provide health and personal care services for you. Hospice also provides assistance to caregivers working in your home. Hospice staff will assess your health and provide additional care or services with regular visits. Hospice staff is in on-call 24 hours a day, seven days a week and focuses on supportive care and pain relief during the last period of a person’s life. Hospice care may also be provided in freestanding hospice centers, hospitals, nursing homes and other long-term care facilities.
What services are provided?The hospice staff:
· Manages the individuals pain
· Provides medical and personal care services to the individual · Assists family members to care for the individual
· Assists the individual and his/her family members with the
emotional, psychological and spiritual aspects of dying · Arranges for additional services when needed – including
respite care, speech and physical therapy, or inpatient care · Provides bereavement care and counseling to surviving family
and friends
Medicare may compensate for your hospice care if a physician certifies that the individual has less than six months to live if the disease runs its normal course. Medicaid may pay for hospice care in some states. Many private insurance plans, HMO’s and other managed care organizations will pay for hospice care. Individuals can pay privately for hospice care if they do not qualify for other funding.
Home Repair and ModificationsHome modifications and repairs improve your safety, helps you perform daily activities such as bathing, cooking and climbing stairs as well as maintain the value of your home.
Possible adaptations for aging include:· Installing grab bars, shower seals, or transfer benches · Placing non-skid strips or decals in the tub or shower · Adding lever handles on doors, loop handle on cupboards and
paddle electrical switches
· Installing ramps, elevators, or stair lifts
· Installing insulation, storm windows and air conditioning · Installing handrails for support
· Improving lighting around the home
· Installing security systems
· Adding living space for a caretaker
· Widening doorways to accommodate walkers, crutches and
wheelchairs
· Installing lockout features on stoves or ovens
· Adding digital displays on thermostats
· Minimizing thresholds on interior and exterior doorways for
Occupational and physical therapists are helpful in suggesting additional ways to adapt your home for safety and accessibility. Medicare does not pay home adaptations but does pay for some durable medical equipment. Medicaid may pay for home modifications and medical equipment. Many state and local governments have programs to provide loans and grants to help you pay for home modifications.
In Law ApartmentsAn in-law apartment is a separate housing arrangement within a single-family home or on your lot. It may also be referred to as a second unit, accessory apartment, or accessory dwelling unit. An in-law apartment is a complete living space and includes a private kitchen and bath.
An in-law apartment may provide a living space for a caretaker or may be rented to provide additional income to you. Many local or state governments have restrictions about the addition of a second apartment on your property. You should consult your local city or county government about zoning and other restrictions, and for help with an in-law apartment.
To find out about in-law apartments visit the National Resource Center on Supportive Housing and Home Modification website. The complete address, phone number and web address is listed at Appendix 2 (Information Resources) this publication.
Housing for Aging and Disabled IndividualsThe federal government and most states have programs that help pay for housing for older people with low or moderate incomes, less that $46,000 if single or $53,000 if married.
Usually you have to fill out an application, and there may be a waiting list. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping and doing laundry. Residents usually live in their own apartments in the complex. Usually a Federal or State agency will review your monthly income and expenses to see if you are eligible for this type of housing. Rent payments are usually a percentage of your income.
To find out more about subsidized senior housing in your area, visit the U.S.Department of Housing and Urben DevelopmentSubsidized Housing website.
Visit the U.S. Department of Housing and Urban DevelopmentPersons with Disabilities section to find subsidized housing for Persons with disabilities. These agency’s complete address and contact information is listed in Appendix 2 (Information Resources) at the rear of this publication.
Board and Care HomesThis group living arrangement provides help with activities of daily living such as eating, bathing and using the bathroom for people who cannot live on their own but do not need nursing home services. It is sometimes called a “group home”. In some cases, private long-term care insurance and other types of assistance programs may help pay for this type of living arrangement. Many of these homes do not receive payment from Medicaid or Medicare and are not strictly monitored. The monthly charge is usually a percentage of your income.
You can find out more about board and care facilities by contacting your Area Agency on Aging. The local community Area Agency on Aging can be found by visiting the ElderCare Locator website or by calling 1-800-677-1116. to obtain information about available services in your area. You may also find more information about board and care facilities in your area from the Administration on Aging (AOA) website. This is listed within Appendix A (Information Resources) this publication.
Assisted LivingThese housing communities have different levels of care based upon your needs. Where you live depends upon the level of care you need. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility is for people who need help with daily care, and a nursing home for those who require higher levels of care. Residents move from one level of care to another based on their needs but still stay in the Continuing Care Retirement Community (CCRC).
If you are considering a CCRC, be sure to check the record of its nursing home. Your CCRC contract usually requires you to use the CCRC nursing home if you need this level of care. Many of the questions that you might want to ask about these communities are the same as those to consider when choosing a nursing home. CCRCs generally charge a large payment before you move in (called an entry fee) and then charge monthly fees. In 2004, entrance fees range from $38,000 to $400,000. Monthly fees range from $650 to $3,500 per month.
You can find out if a CCRC is accredited and get advice on selecting this type of long-term care community from the Commission on Accreditation of Rehabilitation Facilities
You can also get more information about continuing care retirement communities from the Administration on Aging (AoA) and American Association of Homes and Services for the Aging (AAHSA). These sources are listed in Appendix 2 of this publication.
Nursing HomesThese facilities provide care to people who can’t be cared for at home or in the community. Nursing homes provide a wide range of personal care and health services. For most people, this care generally is to assist people with support services such as dressing, bathing and using the bathroom, for people who can’t take care of themselves due to physical, emotional, or mental problems. Medicare doesn’t pay for this type of care and doesn’t pay for most nursing home care.
Some nursing homes may provide skilled care after an injury or hospital stay. Medicare pays for skilled nursing facility care for a limited period of time if you meet certain conditions. For more information, look at the Medicare booklet, Medicare Coverage of Skilled Nursing Care. To locate nursing homes in your area, look at Nursing Home Compare on their website.4
To find out information on accreditation of nursing homes in your area, look at the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) website. The complete address, phone numbers and web address of the agencies aforementioned is listed within Appendix 2, this publication.
Nursing Home ChecklistIt is very important for you and your family members to visit the nursing home to make sure that it meets your needs, as well as those of your family. A few thing to consider when choosing a nursing home are listed below:
Yes No Questions
Is the nursing home accepting new residents?
Is the Nursing home easy to visit for family or friends?
Does the nursing home use hospitals where my doctor practices?
Does the nursing home have the services I need?
Does the nursing home have a variety of activities I might enjoy?
Do residents appear clean and well groomed?
Do the residents have the same staff on a daily bases?
Is there enough staff available to assist residents?
Does the staff respond quickly to resident’s calls for help?
Does the nursing home have an active resident/or family council?
Is the nursing home clean and pleasant?
Is the nursing home certified by Medicaid or Medicare?
Are the nursing home and current administrator licensed?
How much is the cost of care in this nursing home?
What services are included in this price? What additional costs will I have to pay?
Ask to see the nursing home’s last annual state inspection report. Did the report find any problems? Ask how the problems were fixed.
Chapter FourHow To Evaluate Health Information on the Internet
Millions of consumers are using the Internet to get health information. And thousands of Websites are offering health information. Some of those sites are reliable and up-to-date: some are not. How can you tell the good from the bad?
First, it’s important to carefully consider the source of the information and then to discuss the information you find with your health care professional. These questions and answers can help you determine whether the health information you find on the Internet or receive by E-mail from a Website is likely to be reliable.
Who Runs the Website?Any good health Web should make it easy to learn who is responsible for the site and its information. On the U.S. Food and Drug Administration’s (FDA) Website, for example, the FDA is clearly noted on every major page, along with a link to the site’s home page, www.fda.gov.
Information about who runs the site can often be found in an “About Us” or “About This Website” section, and there is usually a link to that section on the site’s home page.
What is the Purpose of the Website?Is the purpose of the site to inform? Is it to sell a product? Is it to raise money? If you can tell who runs and pays for the site, this will help you evaluate its purpose. Be cautious about sites trying to sell a product or service.
Quackery abounds on the Internet. Look for these warning signs and remember the adage “If it sounds too good to be true, it probably is.”
· Beware of claims that one remedy will cure a variety of illnesses, that they have a “breakthrough,” or that it relies on some “secret ingredient.”
· Use caution if the site uses a sensational writing style (lots of exclamation points, for example.)· A health Website for consumers should use simple language. Not technical jargon. Get a second opinion. Check more than one site.
What is the Original Source of the Information on the Website?Always pay close attention to where the information on the site comes from. Many health and medical Websites post information collected from other Websites or sources. If the person or organization in charge of the site did not write the material, the original source should be clearly identified. Be careful of sites that don’t say where the information comes from.
Good sources of health information include:
· Sites that end in “.gov,” sponsored by the federal government, like the U.S. Department of Health and Human Services at
www.hhs.gov , the FDA at www.fda.gov, the National Institutes of Health at www.nih.gov, the Centers for Disease Control and Prevention at www.cdc.gov, and the National Library of Medicine at www.nlm.nih.gov.
· .edu sites, which are run by universities or medical schools, such as Johns Hopkins University School of Medicine and the University of California at Berkeley Hospital, health system and other health care facilities Sites, like the Mayo Clinic and Cleveland Clinic.
· .org sites maintained by not-for-profit groups whose focus is research and teaching the public about specific diseases or conditions, such as the American Diabetes Association, the American Cancer Society and the American Heart Association
· Medical and scientific journals, such as The New England Journal of Medicine and the Journal of the American Medical Association, although these aren’t written for consumers and could be hard to understand.
· Sites whose address end in .com are usually commercial sites and are often selling a product or service.In addition to identifying the original source of the material, the site should identify the evidence on which the material is based. Medical facts and figures should have references (such as citations of articles in medical journals). Also, opinions or advice should be clearly set apart from information that is “evidence based” (that is, based on research results).
How is Information Reviewed Before it is Posted on the Internet?Health-related Websites should give information about the medical credentials of the people who prepare or review the material on the Website.
How Current is the Information on the Website?Websites should be reviewed and updated on a regular bases. It is particularly important that medical information be current and that the most recent update or review date be clearly posted. These date are usually found at the bottom of the page. Even if the information has not changed, it is helpful to know that the site owners have reviewed it recently to ensure that the information is still valid. Click on a few of the links on the site. If there are a lot of broken links, the site may not be kept up-to-date.
How Does the Website Choose Links to Other Sites?Reliable Websites usually have a policy about how they establish links to other sites. Some medical Websites take a conservative approach and do not link to any other sites; some link to any site that asks or pays for a link; others link only to sites that have met certain criteria. Look for the Website’s linking policy, often found in a section titled “About this Website.”
What Information About Its Visitors Does the Website Collect, and Why?Websites routinely track the path visitors take through their sites to determine what pages are being used. However, many healthrelated Websites ask the visitor to “subscribe” or become a “member.” In some cases, this may be done so they can collect a fee or select relevant information for the visitor. In all cases, the subscription or membership will allow the Website owners to collect personal information about their visitors.
Many commercial sites sell “aggregate” data about their visitors to other companies – what percent are women with breast cancer, for example. In some cases, they may collect and reuse information that is personally identifiable, such as a visitor’s ZIP code, gender and birth date.
Any Website asking users for personal information should explain exactly what the site will and will not do with the information. The FDA Website, for example, spells this out in its Privacy Statement. Be sure to read and understand any privacy policy or similar language on the site, and don’t sign up for anything you do not fully understand.
How Does the Website Manage Interactions With Visitors?There should always be a way for visitors to contact the Website owner(s) with problems, feedback and questions. The FDA’s Website provides contact information on its Contact Us page.
If the site hosts a chat room or other online discussion areas, it should tell its visitors about the terms of using the service. Is the service moderated? If so, by whom, and why? It is always a good idea to spend time reading the discussion without joining in, to feel comfortable with the environment, before becoming a participant.
Can the Accuracy of Information Received in an E-mail be Verified?Carefully evaluate e-mail messages. Consider the origin of the message and its purpose. Some companies or organizations use e-mail to advertise products or attract people to their Websites. The accuracy of health information may be influenced by the desire to promote a product or service.
Is the Information Discussed in a Chat Room Accurate?Assessing the reliability of health information that you come across in Web discussion groups or chat rooms is as least as important as it is for Websites. Although these groups can sometimes provide good information about specific diseases or disorders, they can also perpetuate misinformation. Most Internet Service Providers (ISP’s) don’t verify what is discussed in these groups, and you have no way of knowing the qualifications or credentials of the other people online. Sometimes people use these groups to promote products without letting on that they have a financial stake in a business. It’s best to discuss anything you learn from these groups with your health care professional.
The Federal Trade Commission (FTC) enforces consumer protection laws. As part of its mission, the FTC investigates complaints about false or misleading health claims posted on the Internet. The FTC’s Operation Cure-All page has information to help evaluate health product claims. There contact information is listed in the (Information Resource) Guide at Appendix 2, this publication.