Aging Solutions Newsletter - July/August 2007

July-August 2007

Caregiver Tip of the Month

— When a nursing home isn't a nursing home —

Nearly half of the Medicare patients discharged from a hospital require skilled medical care to recover — care that cannot be provided by friends and family. Slightly more than half of those are sent home to receive part-time home health care provided by visiting nurses, therapists, and home health aides. Because they require more substantial care during the initial phase of their recoveries, the others are sent to Skilled Nursing Facilities (SNFs). In most cases, SNFs are nursing homes.

Many patients sent to SNFs to recover are then discharged after a few weeks even though it is plainly obvious that they cannot care for themselves. Family caregivers find this particularly frustrating, especially when they are told their loved one will need care 24 hours a day after being discharged from the SNF. Their usual response is something like, "If she needs care 24/7, why can't she stay right where she is to receive that care." The SNF's response is usually, "Well, she just can't. Medicare won't pay for it."

There are 2 reasons for the SNFs' seemingly coldhearted attitude: (1) a patient's recovery status, and (2) the difference between acute care and custodial care.

a patient's recovery status

Medicare covers up to 100 days of recovery care in an SNF — if the patient's condition continues to improve. When a patient stops improving, regardless of how disabled he or she may be, Medicare's coverage stops and the patient is discharged.

FYI: What Medicare covers is vastly different than what Medicare pays for. During the first 20 days, Medicare pays for all covered expenses while a patient is in an SNF. Covered expenses include nearly everything except for TV, telephone and other personal incidentals. After that, Medicare will pay all covered expenses except for a co-pay of $124 per day (2007 amount) for up to 80 more days. The $124 daily co-pay is the patient's responsibility. But, if the patient has the right kind of Medicare Supplement insurance, it pays the $124 a day.

acute care vs long-term custodial care

Medicare covers ONLY acute care. By definition, acute care is:

The care provided for a medical condition from which a patient is expected to recover and resume a "normal" lifestyle, even though it may not be the same as before onset of the condition. Recovered patients usually do not require the assistance of another person in performing their normal activities of daily living. Medicare covers most acute care for patients age 65 and older.

On the other hand, Medicare DOES NOT COVER custodial care. Custodial care (also called long-term care) is:

A variety of services provided over an extended period of time to people who need help to perform normal activities of daily living because of cognitive impairment or loss of muscular strength or control. Care may include rehabilitative therapies, skilled nursing, and palliative care, as well as supervision and a wide range of supportive personal care (such as bathing, dressing, eating, and other non-medical care that most people do themselves) and social services. It may also include training to help older people adjust to or overcome many of the limitations that often come with aging. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Regardless of where it is provided, most long-term care is custodial care, the type of care that is not paid for by Medicare.

skilled nursing facilities cannot just kick a patient out

According to federal law and regulations, when an SNF decides that a rehab patient no longer qualifies for Medicare benefits, and that patient is enrolled in the original Medicare plan (most are), the SNF MUST give the patient, or the person acting on the patient's behalf, a written "Notice of Medicare Non-Coverage." Medicare's coverage will end the day after the patient, or the person acting on the patient's behalf, receives the Notice.

The important thing to remember is that the patient CANNOT BE DISCHARGED until the day after the written Notice of Medicare Non-Coverage is delivered to the proper person.

if you or your loved one thinks they still need SNF care

The patient (or you) can appeal the decision. The Notice of Non-Coverage will tell them how to appeal. But, if they lose the appeal, your loved one will be required to pay for the entire cost of the care they received while waiting for the decision.

our recommendations

Keep in touch with your loved one's Skilled Nursing Facility. Monitor your loved one's progress. Ask the SNF for an approximate discharge date. Don't wait until you are surprised with the Notice of Medicare Non-Coverage and have to scramble to make other living arrangements for your loved one.

If your loved one won't be able to care for himself or herself after discharge, and you and your loved one likes the facility, talk to the SNF's (the nursing home's) administrator and/or head of nursing BEFORE the discharge. Ask if your loved one could be readmitted as a nursing home patient. If so, make the necessary arrangements there and then. If no bed is available, start looking for another nursing home that has an available bed.

For help finding a suitable nursing home, take a look at our article, Nursing Home Ratings: Choosing the Best Nursing Home. You'll find out how to find the best ones – and weed out the worst.

a final note

Today's hospital patients are discharged quicker and sicker than ever before. If you or your loved one feels that they need to stay in the hospital for another few days to recover more fully, your loved one's odds are very good to stay at no cost if they are a Medicare patient. To learn how, take a look at our Caregiver Reminder: What you need to know when your loved one is a Medicare hospital patient. You'll find it in our March 2007 issue.

Our visitors ask ...

Q. In your article, When to Put the Brakes On Elderly Drivers, you suggest taking the keys away from a parent who should not be driving anymore. My 85-year-old father's doctor told me that he should not drive any more, under any circumstances. The doctor told me that it was up to me to take his keys away.

I have one sister who had not spoken to my parents in almost 2 years. When I left her phone messages to let her know how ill our father is, she never returned my call.

After I was told by the doctor to take the keys, my parents called my sister. She told them to call the police and have me arrested. My mother has a valid license but has not driven in over 10 years because she can't see well enough and she has panic attacks while driving. If I do take the car, I'm sure my sister will report it as stolen. But every article I have ever read always gives that advice. What can I do?

A. Your sister sounds like the classic case of a sibling who is never there to help, but who always "knows what's best." And, as you have learned, they usually cause more problems when what you need are solutions, not only for your own peace-of-mind, but also for your parents' welfare. Because of your sister's attitude, your task is more difficult, but probably not impossible.

First. Have your father's doctor give you a written letter that states very clearly that your father should not drive anymore under any circumstances. It would be quite helpful if the doctor would include in his [her] letter the specific reasons why he [she] feels that way.

Second. Contact your state's Department of Motor Vehicles (or whatever department in your state issues drivers licenses) and report your concerns. Depending upon state regulations and your father's disabilities, it may be illegal for him to continue driving; they may even take away his license. On the other hand, the DMV may do nothing more than send a letter, but this might help convince your father to stop.

Third. After you have the letter from your father's doctor, talk to your local police department about the problem. They may be able to help you resolve the problem or, at the very least, give you some valuable advice.

Fourth. Because there could be legal implications regarding what you do or don't do, you should talk with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' web site. You'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 12 tips to help you find money (and free resources) for care at home.

Quick Tips for Caregivers

1. People, especially the elderly, are often afraid that they will lock themselves out of their house. Their solution? Put a spare key outside under the door mat, under a nearby rock, inside a fake rock with the insides hollowed out, etc. According to one knowledgeable government agent, those are the worst places to keep an extra key. They are the FIRST place a burglar looks to gain entry into a home. One solution is to give an extra key to a neighbor they trust.

2. Have you ever wondered why your parent is comfortable in a room that's so hot that you can't stop sweating? As people age, loss of subcutaneous fat makes it harder to maintain their body heat. Many older people find that they need to wear layers of clothing to feel warm.

3. Don't try to do everything at once. You can't. If you do try, you will quickly learn how easy it is to become overwhelmed. Instead, prioritize what needs to be done. Then, if at all possible, tackle the most important thing. And, finish it before starting on the next most important thing.

4. Pat yourself on the back every once in a while. You are doing what others aren't, can't or won't do.

5. Remember your family needs you. You can't take care of your loved ones if you don't take care of yourself. One of the regulars on our support group bulletin board explained it quite well:

"Consider what will happen to your mother if you become too ill to care for her. Taking care of yourself should be your first priority. Most of us don't do it, but we all should. A rested caregiver gives better care. An ill, or dead, caregiver gives no care at all. That "dead" comment may sound exaggerated to you, but data show that 40% of caregivers die before their care recipients due to stress-related disease."