LTC 315 Week 4 Individual Assignment Making Choices Guide Part II (A Guide to Help with Lifestyle Ch (1)
LTC 315 Week 4 Individual Assignment Making Choices Guide Part II (A Guide to Help with Lifestyle Ch (1)
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Date Created: 11/06/15
Lifestyle Changes Guide for Elders 1 A Guide to Help with Lifestyle Changes LTC315/Alternate Living Environments Guide to Nursing Home Care Costs Lifestyle Changes Guide for Elders 2 Most elderly people are concerned about their health care costs and what it could mean to their personal resources. For some seniors the use of their personal money (funds from their checking account and/or savings account) would not be sufficient enough to pay for a couple of seniors for very long. In addition to those funds, the senior couple would have to have some type of insurance specifically for longterm care, or private method of payment, or even a form of government paying, such as Veteran’s Administration. Then there is always assistance from the government in the form of Medicaid. Medicaid is a form of state and federal programming that will accept the responsibility of paying for some of the health care and nursing facility care. This is meant for older people with a limit on their resources and their income. Should our couple qualify for Medicare and Medicaid, then they are assured of having most of their health care services charges paid for by the government. It would be prudent for our couple to contact the nursing facility they are interested in and determine if that facility is under contract with Medicaid because not all facilities accept Medicaid. Then, too, they have to find out if there is a Medicaid bedroom available. Exactly who would be eligible and which services are paid for can vary. In other words the area in which our couple lives their costs may differ from those living in another part of the country. Many times the basis for these services and their costs would be our couple’s individual (personal) resources which would include their income. The rural skilled nursing facilities had slightly higher Medicaid/Medicare margins than their urban counterparts. Facilities in the most rural areas (nonmetropolitan areas not adjacent to an urban area, (with populations less than 2,500) had an aggregate margin of 19.2 percent (medpac.gov). Lifestyle Changes Guide for Elders 3 How do social support systems affect the options and quality of care? When difficult times enter our lives and there is simply one person for us to lean on and support us, it would be very easy for us to wear out that person. For everybody concerned, it would be better to depend on a few individuals for that support. We are able to draw assistance from different types of individuals, such as: a friend who is outgoing can be helpful when we venture out socially, or a friend who is knowledgeable would be a good guide for us when we try to obtain information and other insights. An empathic friend may be a good listener for us as we try to navigate through difficult times. Besides, our friends can introduce us to more friends. How do communitybased programs and services affect the independence of elders? These types of programs give a big assist to families, enabling them as they call upon their own strengths to promote an environment that is healthy in the continual development of elders requiring same. While programs differ in forms, they seem to have a common goal in their efforts to increase the strength of functioning for the family and, at the same time, reducing the involvement within the confines of the justice systems and protective services for them. Many of the programs and services are entrenched in their individual communities and contribute towards the building process of the community. One of the important characteristics of most community based programs would be that staff members along side of family members work in a combined effort in these relationships, and that they are based on equality and respect. These programs strive to make every effort to establish and strengthen each of the families’ cultural (and racial) identities, along with their ability to function in our multicultural society. Programs work in encouraging and supporting families to organize both formal and informal resources as they seek support in family development, as well as advocating with families for services and systems Lifestyle Changes Guide for Elders 4 being fair, responsive, and even accountable to the families being served by them. Community based programs copy a strengthbased tactic throughout all of their program activities, which would include planning, administration, and control. Why should individuals and couples consider these variables when making choices? Almost everybody connected with a move of this magnitude would have to be concerned with the proposedpatient’s resources. While some of their assets would need to be transferred (from the spouse living at home) into sole ownership of the other spouse who is left at home. They would have notified if any other transfers of assets would need to be done. It is a good idea to have a legal advisor or attorney guide you through the maze of required legal documents that are involved with transfers such as these. The attorney or legal advisor would warn against adding any other person’s name to their list of assets without first checking with them or Social Services beforehand. This one action could cause a delay or even a cancellation of the Medicaid coverage regarding their nursing home expenses. Medicaid benefits can be advanced to your account for a period of 90 days, while the legal property transfers are being made. During some cases, they would even grant extensions to you if you have been working sincerely and actively on the transfer of such ownership, but have not yet completed the process. “They say” it is possible to keep: the great amount of the first $22,728 which would be representative of one’s total nonexempt resources. Or, it could be onehalf of the total nonexempt resources owned by the spouse when they are entering the nursing facility. The maximum amount of the share the spouse (who is moving) can keep would be $113,640, which can be subjected to change on a yearly basis. It would be considered prudent to seek clarification from SRS for the latest figure (aging.maryland.gov/housing). Lifestyle Changes Guide for Elders 5 Why should families or caregivers consider these variables when making choices for another individual? As stated above, it is always a good idea to have a legal advisor involved to forewarn of which legal and medical issues may be encountered by the family or caregiver. Some items are exempt as far as Medicaid is concerned in making this determination. Such exempt resources would be the person’s residence, one car for family, one burial plot per person, funeral plans (within reason), share of property permitted for the athome spouse by the Spousal Impoverished Law, and all personal possessions such as clothes, wedding rings, etc. The rest of the combined resources would be considered to be onhand and available to the spouse who would be moved to a nursing facility. Because Assisted Living supplies and makes available housing and supportive type services for elder adults, the assets of the individual spouse may be exceed $27,375 or for a couple the amount is $35,587. There are no transfers that should be completed until all of the formalities (red tape) have been taken care of and the amount of income and resources for the at home spouse can put in their pocketbook has been determined. Sometimes these transfers that were made prior to being involved with SRS can actually jeopardize their eligibility with Medicaid. Once again it is stressed to always seek prior approval before taking any steps to transfer one’s resources or income from one area to another (aging.maryland.gov/housing). What other variables may affect choices? Why are these important to consider? Personal possessions may be classified as clothes, wedding rings, and even sometimes property used in an ongoing business. The remaining total of mixing or joining together their resources would be considered available to the spouse leaving the home for a nursing facility. These are important items to consider for all family members to be aware of: the care plan, so the Lifestyle Changes Guide for Elders 6 application is not jeopardized by adding another person to the resource’s list. It is important that talks between family members and caregivers are done frequently to discuss everyday care, the handling of daily activities which would include finances and their living arrangements, prior to any problems or difficulties surfacing, or a crisis occurring and the person moving is unable to convey their desires. Although communication and talking together is important, family members and the caregivers need to center their attention on the values and care preferences. This would be part of the assessment process that is as necessary as they try to facilitate a mutual comprehension for the preferences of both the care givers and care receivers. Active support and participation of the proposed patient must involve family members in the assessment process as well as their development of the care plan. They need to recognize the strengths of the proposed patient as they encourage them to express their own values and preferences whenever possible. Remember that the family caregiver’s necessity for information, the practical assistance, and emotional support are just as important as other lineitem. Great burden weighs heavily on family members who are involved in the person’s care and it could be something like a problem with time constraints, or some new or difficult tasks that have been assigned to them. Supervision and handson care are provided by the caregiver and they must strive to determine the requests and wishes of the care receiver; then, balance all of these roles and information with the other work that they are handling along with continual duties related to the family (AAHSA). Lifestyle Changes Guide for Elders 7 References www.AAHSA.gov www.aging.maryland.gov/housing.html www.caregiver.org/caregiver/jsp/content www.medpac. gov/documents/Mar11_EntireReport.pdf
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