Find the Right Senior Retirement Community Near You With Senior Advisors Plus

Senior Advisors Plus is one of the best places helping families and people requiring care in their old age. Choosing the right facility brings ease and comfort to both regimen and their families in the long term. There must be several retirement communities near you providing the same service, but how can you choose the best one? It remains an important question while selecting a senior retirement community for your loved ones.

Senior Advisors Plus can help you get in touch with the right senior retirement community that meets your needs. We offer two services: Referral Service and Advisory Service.

Our Advisory Service is the best option for you to analyze some of the top caregivers or retirement communities around you. Here’s how we help you find the right senior retirement community.

Evaluate Senior Care Options

Searching for a caregiver is a long process and it cannot be done by selecting the first one you come in contact with. Many senior communities in the society are tirelessly working for seniors; however, not all of them are suitable for you. At Senior Advisors Plus, we help families to build a strategy that works well for them. The strategy is based on the most important factors: the health of the senior, budget, preferred location, and lifestyle.

So, if you are looking for senior retirement homes near you, then these are a few important factors that we work upon. We will jot down a list of senior care options for you, which will help you in making the right decision.

Finding a Solution as Per Budget

As mentioned above, we work upon several factors; however, the budget remains our top concern. In our Advisory Service, we plan to pose less burden on the families, which is why we ask for their preference in all matters. While evaluating the right senior retirement facilities, we make sure that they fall under your budget with no hidden charges, whatsoever.

Meeting the Client’s Goals and Needs

Every senior have their particular needs and goals, which is important to fulfill if they want to spend a carefree and happy life in the retirement community. At Senior Advisors Plus, we find the right option for our clients that meets their needs and goals. For us, the satisfaction of our clients matters the most, so you can count on us for finding just the right place for you.

Why Should You Choose Us?

Senior Advisors Plus has years of experience in helping clients of all types with different needs and goals in their minds. We have several connections in the care industry, which will enable you to find a quick solution to your problem. We work side-by-side with our clients to ensure client satisfaction. Hence, if you are looking for a senior retirement community, then there is no better place than Senior Advisors Plus to help you in the process. Make sure that your seniors feel safe and happy in their community.

GET THE RIGHT AMOUNT OF CARE

If you know someone who has had a surgery, you may know that when they first heard that they needed the procedure, they were bummed out. Chances are they got a second opinion in case another source gave them hope that there was an alternative. Similarly, anyone should get a second opinion before choosing a senior care provider.  Here’s why:

Senior care is very expensive. You should not rely on the providers to tell you what you or your loved one needs. Their opinions can be biased. That’s because providers typically generate more profit by providing higher levels of care. Before you choose a care provider, we recommend that you seek an unbiased opinion from a senior advisor, the benefits of which are more than just saving money.

While care providers typically administer an assessment, it can be incomplete. For instance, an incomplete assessment is likely to happen when someone who would qualify to live in an independent living community, applies to live in an assisted living community—a more expensive care setting. The nurse at the assisted living community will qualify the senior to live in assisted living; however, the nurse will avoid opining on whether the senior qualifies for independent living as well.

You never want to pay for more help than you need. The reason is that you will be over paying for care, and the person entering into care can prematurely lose their autonomy. If you take one thing away from this post, take this: it is extremely important to preserve a senior’s autonomy.

Karen Wilson, an original builder of assisted living communities, was inspired by her mother, because her mom wanted more independence than what she had in a nursing home. When Karen approached investors, they were skeptical of the assisted living concept, because they thought there was a tradeoff between health and freedom (i.e. more freedom meant worse health outcomes). Fortunately, she received funding and constructed an assisted living community in Portland, Oregon.

The community that Karen built supported impoverished elderly people on government support. When the community began to admit residents, she tracked their health, cognitive capabilities, physical function, and life satisfaction. Her findings revealed that the residents didn’t trade their health for freedom. In fact, their life-satisfaction increased, physical and cognitive function improved, and incidence of major depression fell. The program was a success from the cost side too: costs for those on government support were 20% lower than what they would have been at a nursing home. Karen believed that the assisted living community restored a portion of the residents’ independence, which boosted their quality of life and then drove positive health outcomes.

Granted, sometimes nursing homes are necessary. While nursing homes are for people who need a high level of care, the best ones creatively find ways to give seniors purpose. When Bill Thomas became the medical director at Chase Memorial Nursing Home, he enhanced the purpose of the residents when he purchased one hundred birds, four dogs, two cats, a flock of hens, a colony of rabbits, and hundreds of plants. Some of the residents got birds, some got plants, and some got both. Bill said that people who had been completely withdrawn and non-ambulatory started walking the dogs, and others, who he thought couldn’t speak, started to talk again.

Researchers studied the effects of Bill’s program over two years, comparing a variety of measures of Chase’s residents with those of residents at a nearby nursing home. Prescriptions-required-per-resident fell to half that of the nearby nursing home, total drug costs fell to just 30 percent of the comparison facility, and deaths fell by 15 percent. The study couldn’t say why, but to Bill it was obvious that the difference in death rates could be traced to the fundamental, human need for a reason to live. In this case it was caring for a plant or an animal.

The key take away from Karen’s story is that independence can actually improve health outcomes and quality of life. Bill’s story demonstrates that when given responsibility, seniors’ will-to-live increased. When someone is overqualified for a level of care, but he or she is given that level of care anyway, his or her autonomy can be prematurely stripped—the assistant performs more of the senior’s daily tasks than needed, which can have undermining effects on the senior. This may result in an expedited decline of the senior’s health, because the caregiver has just taken away something fundamental to that person, a sense of purpose.

Rather than asking a care provider if a person qualifies for a level of care, ask a senior advisor. A senior advisor will give you unbiased advice that could preserve a person’s quality of life and lower the bill.

This post was inspired by “Being Mortal” by Atul Gawande. His book is a must read if you find this topic interesting. The stories herein are from his book. 

MANAGING CAREGIVER STRESS

I was at a caregiver talk two weeks ago and the presenter said that in the situation when one spouse must care for the other, 20% of the time the caregiver dies first. One reason that percentage is high is because the caregiver burns out. In my following post I talk about the symptoms of caregiver stress and a few resources the caregiver can use when he or she is feeling overwhelmed.

Spouses and people with some form of dementia are typically the most difficult people to care for1. For spouses, the caregiver is emotionally invested in the situation, and he or she may be frustrated that things aren’t the way they use to be. People with dementia can be tough to care for too because they may become violent, have emotional moments when they become confused, or think of conspiracies involving others stealing from them. There is no doubt that caring for someone else is tough and that’s why professional caregivers deserve our respect.

Caregivers must learn to care for themselves as well as the person they are caring for. The first temper tantrum is manageable. It’s the second one in a day, after a bad night’s sleep, that wears on the soul. That happens and it’s why caregiver stress is real. Its symptoms often mimic those of depression: changing sleep patterns, gaining or losing weight, feeling tired, losing interest in other activities, and being irritated easily1. As a caregiver, it’s good to check-in with yourself and assess if any of these things are happening to you. If so, it may be time to consider the next part of this post.

If you have some extra spending dollars each month, hire a caregiver. Caregivers are typically trained professionals who can help ease the load from your shoulders. He or she also may be able to teach you how to care for your loved one when the caregiver is not there. That’ll make you more effective at your job, which will help to mitigate anything from going wrong and causing you to get frustrated. Additionally, the caregiver will free your time so that you can focus on you. As a result, you may spend your time sleeping, getting chores out of the way so that you can get to bed on time, socializing with friends, or maybe traveling. Taking care of yourself is important, because when you’re well-rested, the next temper tantrum will be much easier to manage. A caregiver can free up your time to rest. Think about hiring one if you’re feeling overwhelmed.

What if you don’t have extra spending dollars each month for a caregiver? There’s great news: you have high-quality options! County governments all over the country are funding respite care programs. Respite care is short-term care. If you’re an unpaid, live-in, primary caregiver for a senior you may apply to receive free home care—check with your county on the programs and terms. In Montgomery County, Maryland, you may qualify for a maximum of 140 hours a year in free home care through The Arc Montgomery County, a local chapter of a larger not-for-profit2. Given there are 168 hours in a week, these respite care programs aren’t long-term solutions; however, they may allow you to catch up on sleep and then clear your mind. Once you’ve recovered, you should join a support group, take a couple classes on caring for your loved one or shadow a caregiver, get organized, and then develop a plan. By taking these steps, you will have given yourself a chance to be proactive towards managing your loved one’s situation.

If you take the latter approach and still find your stress levels creeping up, don’t be afraid to ask for help. Family members, adult day care, and caregiving agencies may have the resources to relieve you just long enough to get your mind centered again. Even if you spend a little money to relieve yourself, it’s okay. Do it. The caregiver must remember that he or she has to keep himself or herself in a good mindset; otherwise, he or she runs the risk of becoming an ineffective caregiver. If you don’t know who to call or what resources to turn to, contact a senior advisor. He or she may be able to lower your caregiver costs, put you in contact with a local respite care program that is funded by the government, or introduce you to other services that can help relieve your workload.

Sources:

  1. https://www.womenshealth.gov/a-z-topics/caregiver-stress
  2. https://www.montgomerycountymd.gov/HHS-Program/Resources/Files/A&D%20Docs/DDAC/2017ARCRespiteProgram.pdf

PROPOSED REGULATION CHANGES TO DISRUPT D.C.’S CAREGIVING AGENCIES, AGAIN

D.C.’s Board of Nursing’s mission statement reads:

The mission of the Board of Nursing is to safeguard the public’s health and well-being by assuring safe quality care in the District of Columbia. This is achieved through the regulation of nursing practice and education programs; and by the licensure, registration and continuing education of nursing personnel.”

In addition to other titles, D.C.’s Board of Nursing oversees certified nursing assistants (CNAs) and home health aides (HHAs). These are certifications to people that caregiving companies hire, and each certification corresponds to a different degree of responsibility. Within Washington D.C., CNAs are only allowed to provide personal care in senior living communities, while HHAs can provide personal care in communities and in the homes of their clients. Home care firms hire CNAs and HHAs depending on their business’s needs.

In D.C., caregiving firms were under the impression that they may apply for two types of licenses, a Nurse Staff Agency license and a Certificate of Need. The Nurse Staff Agency license is a license that a registry uses to refer caregivers to homecare agencies and facilities, such as assisted living and skilled nursing facilities. It’s useful for a company that staffs senior living communities with caregivers. There’s also the Certificate of Need, which is required for an agency who would like to provide care, including skilled services to patients in their home. D.C. takes precaution with administering these licenses due to the complexity of the services which may be provided. On average, it takes an agency two years to get approved for a Certificate of Need (CON). A homecare agency license or a homecare license in addition to a Certificate of Need is required to provide skilled services.

Approximately 12 years ago, D.C.’s Board of Nursing sent a ‘Cease and Desist’ letter to the homecare agencies that did not hold a healthcare license. The letter instructed agencies to apply for a homecare license or stop providing care.  As a result, homecare agencies were directed to apply for either a Nurse Staff Agency license or a Homecare License. However, D.C. was not issuing new CONs at that time.

A few years later, D.C. stated that NSAs should not be providing care to patients in the home, but should only be functioning as a staffing agency for homecare agencies and facilities. Trade associations and other long term care groups met with D.C. and requested that they work together with D.C to create a strategy for appropriate licensure. The concern was for the patients being served and the caregivers as their clients, mostly seniors, would lose their caregivers. In addition, many businesses may end up in bankruptcy, which may cause a spike in unemployment. However, nothing happened for years.

About three months ago an alert went up on the D.C. Department of Health’s website that reignited the issue. The alert said that caregiving agencies who held an NSA license but were providing care in the home were operating in violation of the law. Agencies were advised they must obtain a homecare license and Certificate of Need if they want to continue to operate by providing care in the home. Once again the trade associations and their members gathered to discuss the impact with the Board. This time, it appears the Board is working with the caregiving agencies to smooth the transition. As a result of these discussions, emergency legislation was passed by DC and a new Home Support Services licensure has been created. This allows for personal care services only, to be provided by DC HHAs.

However, it’s going to be tougher for the agencies to continue to do business in DC as they had once done. In addition to licensing requirements, the Board is placing more mandates on D.C. caregiving agencies, which may reduce the number of firms that conduct homecare in D.C. One notable proposed change is that agencies must have office space within D.C. that is staffed 40 hours per week. How firms have been reacting to this proposal shows that the Board is serious about its policy changes this go-around. Already, homecare agencies have been partnering with senior living communities to secure office space in their buildings, in addition to leasing spaces of their own. Some agencies may drop out of the DC market as rental rates and additional staff push their costs too high to justify operating in D.C. Fewer firms in D.C. may mean fewer available caregivers to care for seniors at their homes.

Another requirement is that the Home Support Agencies can only use DC HHAs to provide care. Currently, many agencies are using DC CNAs, these aides must transition to DC HHAs if they are to continue working in client homes.  There is normally 32 hours of education followed by an exam in order to make that transition. The association is currently working with DC DOH to see if there is any way to expedite the process so that clients continue to be served.

​Stay tuned for updates.

CLEARING THE CONTENTS OF A HOUSE QUICKLY

Clearing a house full of stuff is a daunting task. Here’s a guide to help you sell and remove the items of an estate.

First, contact your realtor to make sure both of you are on the same page about selling furniture. You may want to have a buyer pick up a piece of furniture after your realtor takes pictures of the house to market it.

Second, define your goal for clearing the house by determining if you want to:
a.Clear the contents of the house quickly?
b.Maximize your earnings?

In order to keep the message simple, we are going to split this post into two separate posts. This week we will discuss option a. “Clearing the Contents of a House Quickly.” In two weeks, you can count on us discussing option b. “Clearing the Contents of a House to Maximize Value.”

In our opinion, the best way to clear the contents of a house quickly is to host an estate sale. An estate sale is when a seller turns their home into a store – effectively becoming a large-scale yard sale. There are businesses that will organize, promote, and operate an estate sale for the seller. Families can also host one themselves, but estate sales can be tough to organize and emotional, as families find it difficult to see sentimental items sell at bargain prices.

Firms that run estate sales will have an appraiser value the items for sale. Most firms require a minimum value of total goods before accepting a job, but not all firms require the same minimum. Once a job is accepted, the firm’s organizers will organize all the contents of the house on tables and other areas around the house so that guests can easily see what’s for sale. The marketers of the firm may take pictures of rare items and post them to social media or other advertising avenues to generate interest in the estate sale but are careful to never release the location of the estate sale until 24 hours before the sale commences.

A good estate seller will have a large network and know the right channels to promote an estate sale. It’s usually the case that if an estate seller has a large network, then it is able to attract more buyers to the sale. A typical sale lasts two days; however, depending on the size and the quality of the items for sale, the firm may recommend hosting a sale for more than two days. Each day the sale starts and stops at the same time, and the operator of the sale will lower the prices of the remaining goods. Operators typically choose Sundays as the last day of the sale.

Estate sales are a great way to clear the contents of a house because (1) it’s a relatively quick process; (2) there’s likely a monetary benefit to the seller; (3) the seller doesn’t have to transport any of the items, such as driving them to a consignment store or shipping them to a buyer; and (4) anything can be sold, such as furniture, used kitchen cleaners, and frozen meats. The buyers that come know that just about everything must go. Many will come looking for that one “gem,” and leave with things that you were sure that you were going to have to take to the dump later. Because it takes knowhow and work to run a sale effectively, hiring a firm will typically cost between 40%-50% of the sale proceeds.

Once the sale is complete, hire a junk removal service. A junk removal service will send people with trucks to your house who can clear the remnants and all unsold items. Usually, junk removal services charge by volume, but some may have different pricing models.

After a junk removal service hauls away your unwanted items, it would be a good idea to touch base with your realtor. He or she will consult with you about the next steps that you should take to sell your house.

In two weeks, we will release another post about a strategy we would use to clear a house and maximize earnings. 

AN ENTRANCE FEE GUIDE

If you’re considering moving into a continuous care retirement community (“CCRC”), you may find out that there can be a large entrance fee. If a community charges an entrance fee, it’s likely there are multiple options for you to choose from. Our post below attempts to explain the factors that you need to consider before making your selection.

We’ve identified a practical way and a strategic way to think about the entrance fee question. Practical, herein, means what works best for the payer. Strategic, herein, means the cheapest option.

Let’s set the stage: imagine a community that, regardless of which entrance fee option you choose, will charge you the same monthly rate. The three entrance fee options you have are: (1) you can pay $300,000 upfront, but it completely amortizes over 25 months; (2) you can pay $500,000 upfront, but it amortizes down to $250,000 over 25 months; or (3) you can pay $1,000,000 upfront, but you will receive only $900,000 no matter when you leave.

Practical people may choose to pay the entrance fee option that requires them to commit the least amount of capital. This allows them to spend the remaining amount on themselves, rather than having the community hold onto it until the end of their stay. A practical thinker may use the proceeds from the sale of his or her home to pay for the entrance fee, and then use their social security, pensions, and savings to pay for the monthly fee. The strategy of opting to pay for the lowest entrance fee makes sense to us for those who want to maintain as much discretion over their wealth as possible. In the example above, someone who chooses option (1) over option (3) has $700,000 more to spend on trips, gifts, charity, clothing, etc. On the other hand, option (1) is not necessarily the most economical option, because he or she may spend $300,000 on the entrance fee whereas someone who chooses option (3) will only have spent $100,000.

The strategic thinker is going to look at this as a math problem—which option is going to be the cheapest for me and my heirs? A strategic thinker is going to consider what he or she pays for the entrance fee and what he or she is going to get back, in addition to the opportunity costs. The opportunity cost, in this example, is what else could the tied-up money have been invested in. If the strategic thinker chooses option (3) over option (1), then he or she has committed an additional $700,000 in capital. That’s $700,000 in capital that is not earning a return in the market or in an investment such as a rental property. The lost earnings from that $700,000 should be taken into account when considering the actual costs of the entrance fee. Through our analysis, we can distill the entrance fee question into its most fundamental parts. For the above example, we assumed that the opportunity cost is 4% annually. The follow yields the per month entrance fee cost based on the number of months stayed:

​The above chart shows the per month cost of the entrance fee according to the number of months that the person stays in the community. For instance, someone who stays at the community for 21 months who elects to pay via option (1), or the blue line, will have paid an average of $12,000 per month. $12,000 plus the monthly fee that the person pays to the community is the total monthly cost of staying at that community. Those that wish to estimate their life expectancy may use this information to choose the entrance fee that is the least costly. Additionally, someone who is trying to compare the costs of two communities, one with an entrance fee and one without, may use this analysis to do so.

At Senior Advisors Plus we serve both the practical and strategic thinkers. Call us and we will help you with your senior living search.

A MESSAGE FOR WORRIED CHILDREN

We’ve spoken with a few people who have parents that live outside of D.C. and who are worried about them living independently. The children have talked with them about moving to D.C., but the parents aren’t interested. The children are stressed out. Here’s a post for all those people who are going through something similar. You are not alone.

You may have begun to worry about your parents living situation because they don’t do the simple tasks well. You may see signs of this such as their house is dirty, refrigerator has a lot of spoiled food in it, or body weight is dropping. You may have also begun to worry because a few severe things have happened such as your parents have begun falling, have developed attitude issues, or are wondering. These are all signs that it is time to have a conversation with mom or dad about getting help.

Start a casual conversation with your parents during their best time of day; typically, its morning. Suggest something small, such as offering to hire a cleaning service, someone to shop for them, or a driver to take them around to do errands. If they agree, then hire a caregiver to do these tasks. If the caregiver is successful at developing a relationship with your parents, then when more care is needed, the caregiver can step in and help with their personal care as well.

If your parents refuse additional help, it’s okay. It’s their life and they are entitled the take the risks they wish. Chances are you are more stressed out about their situation then they are. Try bringing up care one more time, but after an event that care could have prevented or has caused them to need help thereon. If they refuse again, then drop the discussion for now. There are two things that we suggest at this point:

(1) Talk to their doctors. See if they agree with you. If so, have them suggest that your parents should have someone around to help them.

(2) Create a back-up plan. There may be a time when they step forward and ask for your help. If you have a backup plan, you’ll be prepared.

To create a back-up plan, first think about their care needs—the activities of daily living (“ADLs”) and instrumental activities of daily living (“IADLs”) are lists that you can reference to gauge how much help they need. Transferring, walking, toileting, bathing, dressing, and eating are the six ADLs. Shopping, cooking, managing medications, managing communications, doing house chores, driving or using public transportation, and managing finances are the IADLs.

Think about the activities that your loved one needs help with and how long those take to complete on a daily basis. Then consider your care options–the two most popular are home and community-based care. Home care is a great option for people who want to remain in their homes; however, it can become very pricey as peoples’ care needs escalate. The other option is community-based care. For people that want to relocate or be around peers, assisted living and memory care communities are wonderful options, which can be much more affordable than home care. Whether you decide on home or community-based care, interview a couple agencies, caregivers, or communities. Narrow it down to a couple so that you’re comfortable selecting one if you need to make a decision quickly.

If you follow these steps that we’ve identified, you will have successfully controlled the things you can. Contact a Senior Advisor if you need help with your search. We can help you explore your options quickly and, if you’d like, at no charge to you.

PREPARING FOR MEDICAID: LOOK BEFORE YOU LEAP

Medicaid “spend down” is when someone spends his or her assets or income to qualify for Medicaid. If a person’s income or assets exceed the law’s limit, Medicaid won’t help that person pay for things such as long-term care in a nursing home. However, Medicaid does permit a person who has income or assets above the limits to make purchases AND be eligible to qualify for Medicaid Long-Term Care as long as: (1) those purchases are enough to put them under the law’s income and asset limits; and (2) are permissible purchases under the law’s guidelines. In the following post, we discuss the items that you can spend money on without Medicaid penalizing you.

If you would like to refresh yourself with the differences between Medicaid, Medicaid Long-Term Care, and the Medicaid Waiver Program, please do so by reading the following article, which will also discuss the qualifications for each of these programs.

It may also be helpful to review the difference between countable and non-countable assets here.

State Medicaid programs have their own asset limits; however, most asset limits are approximately $2,000 in countable assets. A person with more than $2,000 in countable assets will not receive help from Medicaid Long-Term Care 1. As a result, many applicants will enter “spend down” mode. During “spend down” mode, applicants are only allowed to make certain purchases and transfers. During the application process, a Medicaid case worker will review the applicant’s buying and selling activity for the previous five years. If the case worker finds unauthorized transfers or purchases, the applicant will likely be penalized. That penalty is usually in the form of a delay of aid to the applicant in proportion to the amount of the unauthorized transaction vis-á-vis the average cost of a nursing home in the state. As a result, it’s important for an applicant to spend money on permissible purchases before applying to Medicaid Long-Term Care.

Below is a list of permissible purchases to reduce one’s countable assets 2; however, please consult an elder law attorney before entering “spend down” mode—the law constantly changes, the limit varies by state, the strategy differs based on marital status, and there are nuances to the list below:

  • Home improvements – yes, you may be able to invest in your home; however, some states set an equity limit to one’s home value. Homeowners whose equity exceeds the state’s limit may not qualify for Medicaid under the state’s asset restriction.
  • Vehicle repairs or purchases – only one vehicle is exempt; it’s also likely a vehicle’s value can’t exceed a certain amount so check with an elder law attorney in your state for what you’re permitted to own.
  • Uncovered medical devices – can only deduct medical expenses that you are responsible for paying. Each state has a list of medical expenses that it approves. The following list includes items that are common among states, however, it is best to check with an elder law attorney in your state to identify which purchases it authorizes:
    • Nursing home services
    • Prescriptions and medically necessary over-the-counter drugs
    • Eyeglasses
    • Dental services
    • Personal care
    • Transportation to and from medical expenses
  • Paying off debt
  • Hire a family member to provide care – in some states you may hire a family member as the caregiver. The rate that the family member charges must be reasonable.
  • Funeral arrangements via an irrevocable funeral trust – commonly, states permit people to spend up to $15,000 per spouse on funeral arrangements.
  • Annuities
  • Life insurance policies with a cash value of less than $1,500

The above list highlights some general items that one may spend his or her countable assets on to qualify for Medicaid Long-Term Care. When applying for Medicaid Long-Term Care, a case worker will review the applicant’s income, medical needs, and expenses. While an applicant may earn income above the law’s limit, he or she may be able to qualify for Medicaid Long-Term Care by deducting permissible purchases from his or her income and qualify for Medicaid Long-Term Care. For instance, let’s say an applicant has no assets and is paying for nursing home services and other medical needs with her social security. If a case worker determines that the applicant’s permitted expenses exceed her income and she has a medical need for nursing home care, then she will likely qualify for Medicaid Long-Term Care.

If all of this sounds confusing, then contact us and we will put you in touch with a local elder law attorney who will review your case.

This article is not intended to give any legal advice; we hope that you can use it to gain a general understanding of how the system works. Please, consult an attorney if you are looking for counsel.  

Sources:
1. https://www.nolo.com/
2. https://www.payingforseniorcare.com/medicaid/spend-down

A GUIDE TO SUCCESSFULLY LEAVING A NURSING HOME

Most of the time people don’t choose to go into a nursing home or skilled nursing facility, so it’s no wonder why they are often caught off guard figuring out how the system works and knowing what their responsibilities are. In light of this common predicament, we wanted to release a post to guide families through the complexities that arise during and after their loved one’s stay at a skilled nursing facility.

Know If and How Long A Stay Is Covered
Usually a hospital stay precedes a stay at a skilled nursing facility. When this is the case, your hospital social worker will notify you if your loved one’s insurance will cover his or her stay at the skilled nursing facility. While at the skilled nursing facility, it’s important you make the effort to meet with the social worker. He or she will schedule regular care plan meetings with you. During these meetings you will learn about your loved one’s progress and if the center’s team expects the insurer to continue coverage.

Sometimes an insurer will cease covering a patient’s stay at a skilled nursing facility. That’s because either the patient has run out of covered days or has recovered to a point that he or she no longer needs the center’s services. Patients may appeal the insurer’s decision, but from our experience it is very rare for patients to win their cases. The downside of not winning is the patient is liable for the bill accrued during the trial, which can sometimes take weeks.

Prescriptions
Have the skilled nursing facility review your loved one’s prescriptions and write new prescriptions when necessary. The center can call in the prescriptions to your local pharmacy, but it’s likely you will have to hand deliver any prescriptions for narcotics. Discuss with the social worker and the nurse what you need to do at your last care plan meeting.

Whether the patient is being discharged home or someplace else, request a list of the current prescriptions and their corresponding instructions.

Medical Devices
Make sure the center has ordered the proper medical devices for your loved one. Some common examples of medical devices that we see centers ordering for patients are walkers, wheelchairs, hoyer lifts, and hospital beds. Granted, each of these medical devices must be warranted in order for the center to order them. It’s important that you ask your social worker if he or she would recommend any medical devices. Trust their answers, the social workers are just as interested in keeping your loved one safe as you are. As a result, they will give you their honest opinion about what your loved one should and shouldn’t require.

Transportation
The unfortunate reality is that insurance does not cover transportation from a skilled nursing facility back to the community. You will be responsible for organizing transportation from the center upon discharge. The most popular transportation options are you, a taxi, or a hired caregiver.

Primary Care Physician Appointment
While many centers have their own primary care physicians, it’s not guaranteed that he or she will assess your loved one during his or her stay. Ensuring that your loved one sees his or her primary care physician at the end of his or her stay or directly after is very helpful. During this visit, the physician should review, yes again, the patient’s prescriptions and write any the center wasn’t willing to write or missed. Additionally, the physician may sign off on home health services if the center did approve the patient for home health. We’ve seen it many times–a patient was written an order for home health, such as physical therapy, but he or she couldn’t get it because he or she hadn’t seen a primary care physician in over a month.

Prior to discharge, either ask the social worker for an in-house primary care physician to visit your loved one or make an appointment yourself. Scheduling an appointment does not require that much effort from you, but it will potentially save you a lot of hassle down the road.

Find a Safe Environment
Often patients who leave a skilled nursing facility aren’t 100%, which means they still require care after their stay. It’s important you have a plan to care for your loved one. You, a family member, a hired caregiver, or an assisted living community are caregiving options. Whatever option you choose, consider the needs of the patient and your resources, including time and money.

While there is a lot to do prior to a discharge from a skilled nursing facility, there are many resources available to help you make this transition as smooth as possible. If you have any questions, please feel free to contact us and we will help you choose the best path forward.