Posts Tagged ‘senior’

Eldercare Locator – A Free, Public Service For Connecting Older Adults and Caregivers with Community Resources

October 27, 2010

The Eldercare Locator is a service of the U.S. Administration on Aging.  It’s been around for nearly 20 years.  Its toll free number is 800-677-1116.  Its website is  It  provides information about long-term care alternatives, transportation options, caregiver issues and government benefit eligibility.  This information is also available in Spanish and other languages.  There is an extensive database of links, publications, and other resources.

Medicare Coverage of Skilled Nursing Care – The Right Standard

October 18, 2010

I have heard, all to frequently, about people losing Medicare coverage for skilled nursing care because it had been determined that they had reached a “healing plateau.”    That is, they were not improving from the skilled nursing care they were receiving (and would not improve from additional skilled care) and, therefore, were deemed to be only receiving “custodial care”, not the skilled nursing services required for Medicare benefits.

While that may have been the standard in the past, it is not the standard today, but it still comes up.  As it did recently, when a federal judge ruled against the Social Security Administration and rejected  “Improvement” as a criterion for continuing Medicare skilled nursing facility (SNF) coverage.  Here is a summary of the case.

A federal district ruled that an administrative law judge (ALJ) with the U. S. Centers for Medicare & Medicaid Services (CMS) improperly denied Medicare benefits to a patient in a skilled nursing facility. The ALJ had concluded that “[i]t became apparent that no matter how much more therapy the Beneficiary received, she was not going to achieve a higher level of function.”

After undergoing hip replacement surgery on April 28, 2008, Mary Beth Papciak, 81, developed a urinary tract infection and was readmitted to the hospital. On June 3, 2008, Ms. Papciak was discharged by Dr. Tuchinda to ManorCare to receive skilled nursing care, physical therapy and occupational therapy. Upon Ms. Papciak’s admission to ManorCare, Ms. Papciak was unable to ambulate and could not use her walker due to numbness of her hands due to what was later diagnosed as carpal tunnel syndrome. Ms. Papciak also had a history of cellulitis, anemia, cholecystectomy, chronic atrial fibrillation, hypertension, anxiety and depression.

Ms. Papciak received therapy five days a week; however, she made slow progress during her stay. Her therapy included physical and occupational therapy, treatment, self care, therapeutic exercises and therapeutic activities. Her initial treatment was primarily for ambulation. Medicare paid for the skilled care Ms. Papciak received from June 3 through July 9, 2008. It was determined, however, that effective July 10, 2008, Ms. Papciak no longer needed skilled care because Ms. Papciak had made only minimal progress in some areas, had regressed in other areas, and had been determined to have met her maximum potential for her physical and occupational therapy. As a result, Medicare denied payment from July 10 through July 19 because Ms. Papciak was only receiving “custodial care,” not the skilled nursing services required for Medicare coverage.

Ms. Papciak appealed the decision denying coverage, and her appeal worked its way up the chain to an administrative law judge, which upheld the denial, which was then upheld by CMS’s Medicare Appeal Counsel (MAC). After exhausting her administrative remedies, Ms. Papciak sought relief in federal district court.

The federal district court sided with Ms. Papciak. The proper legal standard to be applied to a patient entitled to Medicare benefits in a skilled nursing facility is whether the patient needs skilled services to enable her to maintain her level of functioning.

In the CMS Medicare Skilled Nursing Facility Manual which sets forth the standard to be applied, the reviewing authorities must give consideration to a patient’s need for skilled nursing care in order to maintain her level of functioning. The relevant portion reads: “The services must be provided with the expectation, based on the assessment made by the physician of the patient’s restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time, or the services must be necessary for the establishment of a safe and effective maintenance program.”

Neither the ALJ nor the MAC addressed Ms. Papciak’s need for skilled nursing care in order to maintain her level of functioning. This was error, held federal Magistrate Judge Cathy Bissoon, requiring that the decision to deny her benefits be overturned.

The ALJ had concluded that “[i]t became apparent that no matter how much more therapy the Beneficiary received, she was not going to achieve a higher level of function.” Similarly, the MAC stated that “[d]espite the appellant’s arguments to the contrary, the enrollee made little or no progress in therapy from the time of her admission to ManorCare through her discharge from skilled care on or around July 10, 2008.”

This is a common misunderstanding about Medicare’s skilled nursing facility benefit, that the patient must be showing “progress” in order for Medicare to pay for her care. Indeed, federal regulations state that “[t]he restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities.”

What happened to Ms. Papciak? She was hospitalized again, discharged to a different skilled nursing facility, where she received physical and occupational therapy under the Medicare benefit, and was discharged home on August 21, 2008.

Coping With Age-Related Changes

September 10, 2010

“A person is always startled when he hears himself called old for the first time.”
— Oliver Wendell Holmes

Coping with changes that affect an older person’s independence isn’t easy. An article I read recently in USA Weekend offered these tips to help with the difficult conversations you may need to have with your older parent, spouse, sibling, or other relative:

Giving up the car keys
•  Get an evaluation. Most states let anyone report an at-risk driver. Most also have an evaluation process to determine whether seniors are a danger to themselves or others. Often, people whose driving skills don’t pass muster will stop driving because they realize they’re no longer up to it.
•    Be direct. Telling a parent that he or she has to give up driving can be difficult, but important. It’s one thing if you kill yourself, but what if you kill somebody else? That thought may get the at-risk driver to stop.
•  Involve the doctor. If a physician reports an at-risk driver, the driver must, at minimum, take another road test.
•  Arrange alternatives. Set up transportation alternatives before a parent stops driving. Set up home delivery for groceries.

Moving to assisted living
•  Put yourself in the senior’s shoes. Frame the discussion from the elderly person’s point of view. For many, the pinnacle achievement in life was to buy a house, pay it off with the idea of living in it forever. It’s not just a house, it’s history and memories.
•  Try it out. Many major assisted-living companies offer respite visits. Seniors can stay a week or two to try it out, and then go home.
•  Don’t sell — yet. Wait to sell the house until the senior is comfortable in assisted living. If you need to sell right away, move the senior first. In this market most houses aren’t going to sell right away, and if assisted living doesn’t work out, you can always take the house off the market.
•  Be patient. Satisfaction rates in assisted living are in the 80 to 90 percent once the resident is settled in. Allow three to four months for seniors to accept the change.

Handling finances
•  Understand the senior’s point of view. Today’s seniors are the generation of savers. It’s hard to give control of their money to a younger person who doesn’t have the same view of saving and spending. Show that you understand your loved one’s point of view and offer reassurance that his or her wishes will be honored.
•  Be tactful with suggestions. Be sensitive to the senior’s tolerances. Automatic bill-paying and online banking may seem ideal to you, but some elderly people don’t like the idea of giving access to their bank account to anyone. Explain how you use these tools. Walk your loved one through the process.

Technology May Help Elderly Stay Home

August 9, 2010

In the general scheme of life, parents look after the children. But as parents age, the tables can turn. New technology is making it possible for adult children to closely monitor the daily movements and habits of their aging parents. The goal is to provide enough supervision to make it possible for elderly people to stay in their homes, which may be an emotionally and financially desirable alternative to moving to an assisted-living facility or nursing home.

Many of the systems are godsends for families. But, as with any parent-child relationship, loving intentions can be tempered by issues of control, role-reversal, guilt and a little deception. Just as the current population of adults in their 30s and 40s have a reputation of being hyper-involved, hovering parents to their own children, they now have the tools to micro-manage their aging parents.

You need to ask if this is something the parent wants. Monitoring technology for elderly people has been compared to the infamous “nanny cams,” hidden cameras some parents use to spy on their children’s babysitters. Needless to say, this can be very offensive to some.
Two recent articles, one from The New York Times and one from The Washington Post, explore some of the options available to families with aging relatives.

One choice is a GrandCare system, produced by a company of the same name based in West Bend, Wisconsin. It allows families to place movement sensors throughout a house. Information such as when doors are opened, what time a person gets into and out of bed, whether there’s been any movement in a room for a certain time period is sent out via e-mail, text message or voice mail. Costs vary depending on the features chosen, but this version costs about $8,000 to install plus monthly fees of about $75. That’s comparable to the cost of two months at an assisted-living facility.

Another monitoring alternative is a medication management system called MedMinder. It is basically a computerized pillbox. The parent’s correct daily dosages of different medications are arranged in boxes (usually by a nurse or other care provider). When it is time to take them, the pillbox beeps and flashes. If they are taken, you get a phone call or e-mail saying, essentially, Mom (or Dad) took her pills. If the pills aren’t taken within a two-hour window, the system starts nagging. It calls her. It flashes and beeps. Then you get a phone call with a message saying your mother missed her dose.

A small Virginia firm has unveiled a prototype of a portable, high-tech dwelling that would provide temporary shelter for a sick or elderly relative in the family’s back yard. It was created as an alternative to nursing homes as 78 million baby boomers head toward retirement. The company envisions that families could purchase or lease a MedCottage and set it up on their property, hooking it up to their home’s electrical and water supplies like an RV.MedCottage

The N2Care MedCottage is a 12-by-24-foot prototype filled with biometric technology that would allow a family and health-care providers to monitor the condition of an aging or disabled relative. The cottage contains air-filtration systems, video links, devices that allow the remote monitoring of vital signs and sensors that could detect an occupant’s fall.

Local zoning laws may pose one of the biggest obstacles to making such dwellings a practical solution to caring for aging family members in what it calls “accessory dwelling units.” Detractors have dubbed the concept the “granny pod” and predicted that it could create conflicts between neighbors who find the dwellings unsightly.

The MedCottage has some of the features AARP advocates in accessory dwelling units, but not all of the features that could be useful for people of all ages. It’s a step in the right direction. Other companies seeking to make similar structures are Seattle-based FabCab (whose name comes from Fabulous Cabin), and San Francisco-based Larson Shores Architects, which designs what it calls Architectural Solutions for the Aging Population, or ASAP.

Several studies have been undertaken to see just where the line between loving watchfulness and over-intrusion might be drawn. People don’t want to feel their privacy is compromised, and they tend to draw the line at cameras. The key seems to be control. The older person is much more amenable if he or she can control what information is available and who can access it. Ultimately, the decision must be made by the aging parent.

Finding at-home help for aging parents

July 20, 2010

When an older relative starts to need help to get through the day, many families want to avoid institutions. To keep their loved one at home, they need to either hire a home-care aide or become one.

There are two main kinds of in-home care. Personal or home-care aides provide companionship and support a person’s activities of daily living such as dressing, bathing, preparing meals and doing laundry. Home health aides may do all those things plus tasks such as administering medication or recording changes in a client’s condition. They also may work under a nurse’s supervision.

Here are questions to ask when thinking of hiring or becoming a caregiver.

What kind of care do you need and can you afford?
Before looking for a home-care worker, families need to make sure they can afford to hire one. Families typically pay for these services out of pocket unless the older person meets Medicare’s coverage conditions or has a private long-term care insurance policy that covers such needs.

If you don’t know what kind of care is needed, a specially trained geriatric care manager can help. Assessments cost about $500 to $800 depending where you live. The Alzheimer’s Association offers assistance with an always-open phone line at (800) 272-3900 and at Medicare’s website has a Home Health Compare tool.

Rates from $14 to $22 an hour for non-medical in-home care are typical, but keep in mind that assisted-living facilities can run $2,800 to $4,400 a month. Agencies’ rates often are toward the top of the scale. Caregivers who work independently tend to be less expensive.

Should you hire an independent worker directly or go to an agency?
The advantage of using an agency is that it takes responsibility for paying wages, taxes and insurance. Agencies also run criminal background and driving-record checks, and provide back-up aides should the main caregiver get sick or go on vacation.

Families who decide to hire someone on their own should make sure they follow all state and federal employment laws, including any provisions for overtime pay. You don’t want someone going after your estate or the family member’s estate because something wasn’t handled correctly.

How do you find the right home-care aide for your needs?
Experts recommend interviewing at least six candidates. Families should interview applicants in the home so the aides know in what kind of environment they would be working. For example, having a smoker or pets in the home may be an issue. And don’t forget to include the elder’s input. Finally, don’t balk if someone who stands out is a little more expensive. Paying a little more for someone you really like is worth the extra cost.

Do you have a plan to take care of yourself?
If you’re caring for a loved one yourself, you need to plan time away to tend to your own physical, social and emotional needs. If you don’t, you risk health-draining burnout. Churches, synagogues and volunteer groups may offer short-term relief. Adult day-care centers may be another option. The Alzheimer’s Association and Agency on Aging groups also provide respite-care resources. For overnight breaks, check with assisted-living facilities, which may offer furnished rooms, meals and nursing staff on a temporary basis.

Family caregivers can find more resources at, a website run by two non-profit organizations.

Stay in Your Home

July 13, 2010

mortgage cartoonA recent article in the Wall Street Journal says upfront fees on reverse mortgages have fallen substantially in recent months. This is an important development since, in the past, reverse mortgages have faced criticism for charging high upfront costs.

A reverse mortgage allows older homeowners to tap their home’s equity and remain in the house. The amount available to the homeowner depends on a number of variables, including the homeowner’s age and the home’s appraised value. Payments to the borrower can be made in a lump sum or in regular installments, or a home-equity line of credit can be established, according to the Department of Housing and Urban Development’s (HUD) website. The loan typically doesn’t come due until the homeowner sells the house or dies.

Reverse mortgages are available to homeowners who are 62 years old or older and own their homes outright or have a substantial amount of home equity. The vast majority of reverse mortgages are insured by the Federal Housing Administration, through the Home Equity Conversion Mortgage (HECM) program.

The article states that reduced upfront fees on reverse mortgages are a result of investor demand for securities backed by those mortgages. These securities are backed by Ginnie Mae, based on reverse mortgages insured by the FHA. That combination results in a very secure investment and investors are willing to pay a premium for that kind of safety with an attractive yield. Lenders are essentially passing on some of that premium to borrowers in the form of lower fees.
Prospective borrowers need to get the full details of the offer from the lender, and compare them carefully. One lender might reduce the origination fee. Another might waive the origination fee but raise the interest rate. Another could change the servicing fee. Counseling, which is required to qualify for the FHA HECM program, can help borrowers sort through their options.

With declining home values, people might be less inclined to take out a reverse mortgage these days because the equity in their home has taken a hit, but it’s important to note that those who took out a reverse mortgage when home prices were at a peak won’t face changes to that loan – even if their home value has fallen substantially. The amount owed will never exceed the value of the home, because of the FHA insurance.

A reverse mortgage isn’t right for everyone. It probably makes the most sense for people planning on staying in their homes for more than a few years. On top of the mandatory counseling for an FHA-insured reverse mortgage, it might be a good idea to speak to a HUD-approved HECM reverse-mortgage counselor at

More Changes to Medicare

June 30, 2010

As of June 1, people shopping for Medicare supplement insurance, or Medigap coverage, have some new options. Insurers have started selling two new lower-cost Medigap policies and stopped offering four others. At the same time the federal government, which regulates Medigap benefits, started requiring plans to cover at least a portion of hospice costs. Changes in Medicare

Medicare doesn’t pay for everything. Because patients are required to pay a portion of some of their bills, about 89% of the 47 million people with Medicare have some form of supplemental health insurance. Many opt for a federally subsidized private Medicare Advantage plan or they receive supplemental coverage from a former employer. Close to one-fifth purchase a Medigap policy.

These plans are sold by private insurers and offer standardized menus of benefits. As with most insurance policies, the more benefits you want, the higher the premium.

Whether the recent changes to these plans have an impact on you depends, in part, on when you purchased your Medigap policy. If you enrolled before June 1, you can hold onto your policy – even if it’s no longer being sold – and your benefits won’t change. Consumers are not required to purchase a new plan.

The changes apply only to Medigap plans sold after June 1. On that date, insurers stopped selling some of the plans partly because those plans offered some benefits now covered under original Medicare or Part D prescription-drug plans.

The new options charge lower premiums than most Medigap plans, but consumers must pay a higher share of the cost for various services, such as paying half of the $1,100 deductible for hospitalizations, or paying $20 for each doctor’s visit and $50 for emergency services.

Regardless of which Medigap policy you choose, if you are buying now, you will receive a new benefit covering some portion of the cost of drugs and respite care that are part of hospice care. The hospice benefit isn’t available to people who keep their existing plans, so some consumers may be tempted to switch plans. But there are potential downsides to doing so.

In many states, insurers are required to issue Medigap policies only under certain circumstances, such as when someone age 65 or older applies for coverage within six months of enrolling in Medicare Part B, which covers doctors’ visits. So someone who tries to switch plans at a later point may be denied coverage or charged a higher premium due to existing health problems or advancing age.

For more information on Medigap plans, visit and the Medicare Rights Center’s site ( You can also contact your State Health Insurance Assistance Program or your state Department of Insurance.

May is National Elder Law Month

May 7, 2010

It’s a good opportunity to share some information I’ve come across that you might find helpful.

Retirement planning calculators can be misleading
How much do you need to save for retirement? You can get an idea by using any of the dozens of retirement calculator tools offered for free on the Internet. But a recent study by actuarial experts on retirement forecasting shows that many popular calculators have serious flaws. These problems could lead to serious miscalculations when you’re plotting your retirement. The report by the Society of Actuaries analyzed 12 retirement calculators created by financial services firms, software companies, nonprofits, and government for consumers and financial planning pros. All but one of the six consumer calculators were free, but they had a host of problems. “These tools take a project that is fairly complex and boil it down to something simple,” says John Turner, an economist and co-author of the report. “They don’t ask you to consider a lot of important variables.”

It’s important to be aware of these variables when it comes to online retirement calculators.

2010 Cost-of-Care Survey
Genworth Financial has released its 2010 annual survey of the cost of various long-term care services around the country, including average costs of home care providers, adult day health care facilities, assisted living facilities and nursing homes.


Long-Term Care Services National Median Increase over  2009 5-Year Annual Growth
Homemaker Services (Licensed)

Provides “hands-off” care such as helping with cooking and running errands. Often referred to as “Personal Care Assistants” or “Companions.” This is the rate charged by a non-Medicare certified, licensed agency.

Hourly Rate $18 3.0% 2.4%
Home Health Aide Services (Licensed)

Provides “hands-on” personal care, but not medical care, in the home, with activities such as bathing, dressing and transferring. This is the rate charged by a non-Medicare certified, licensed agency.

Hourly Rate $19 2.7% 1.7%
Adult Day Health Care

Provides social and other related support services in a community-based, protective setting during any part of a day, but less than 24-hour care.

Daily Rate $60 12% Data not available
Assisted Living Facility (One Bedroom/Single Occupancy)Provides “hands-on” personal care as well as medical care for those who are not able to live by themselves, but do not require constant care provided by a nursing home. Monthly Rate $3,185 12% 6.7%
Nursing Home (Semi-Private Room) Provides skilled nursing care 24 hours a day. Daily Rate $185 5.7% 4.6%
Nursing Home (Private Room) Provides skilled nursing care 24 hours a day. Daily Rate $206 5.1% 4.5%

A nifty clickable map allows a snapshot look at state averages.

New Wisconsin law increases penalties for swindling seniors
A new state law gives tougher penalties to those caught swindling money from the elderly. The law allows double the punishment and higher restitution payments for those who con victims 65 and older. Patricia Struck of the state Department of Financial Institutions says up to half the securities fraud cases it investigates now involve older victims. Last year, all but 10 of the agency’s 27 enforcement orders were for cases involving victims older than 65. Going into this year, the department had 93 investigations still pending.  Struck says many older investors are worried that they’ll outlive their retirement savings – and swindlers prey on those people.

Enroll for Medicare Online

April 20, 2010

The Social Security Administration (SSA) has just launched a new service that allows people to enroll online for their Medicare benefits even if they are not yet ready to file for Social Security benefits. About a half million Americans enroll in Medicare each year without applying for Social Security benefits.

The new online Medicare application makes it easier for people to enroll in Medicare. It saves a trip to the Social Security office, and you can complete the application at your own pace at home. The SSA says it takes less than 10 minutes to complete.

You can use the online Medicare application if you are at least 64 years and 8 months old, do not want to start receiving Social Security benefits in the next four months, and live in the U.S. or one of its territories or commonwealths. The application guides you through a brief set of questions that will help you consider either filing for Social Security and Medicare benefits, or filing only for Medicare. There are links to more information for people who have questions.

To use the new online application, click here.

Baby Boomer Social Security Dilemma Revisited

February 17, 2010

If an opinion piece in the Sunday Milwaukee Journal Sentinel Crossroads section is any indication, there is going to be a lot of discussion of the subject of Social Security in the years to come. Not all will be good advice.

In the article (To collect or not to collect), Carolyn Kott Washburne shares her personal struggle with the decision about whether or not to start collecting Social Security benefits at age 66. The author had a friend do the math and determined she would have to live to age 80 to recoup what she would lose by not starting at age 66.

The decision seems shortsighted to me. By focusing solely on how long she will have to live to break even if she delays collecting until age 70 – at which time her checks will be almost 30 percent more than if she starts collecting at 66 – she omits pertinent factors in making a sound decision.

She does not consider what affect her decision will have on a spouse. Taking it earlier may decrease the amount her spouse can take, depending on his work history. And it appears she doesn’t expect to live to age 80 or beyond even though her life expectancy is 84. In fact, life expectancy statistics indicate that she has a 50 percent chance of surviving past age 84, and 33 percent chance of living beyond 93. Every day people spend a lot of cash on lottery tickets with much higher odds against them.

I am about to leave on vacation so you probably won’t be hearing from me until the end of next week. At that time I intend to pick up where I left off with my thoughts regarding long-term care insurance.