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If a Medicare recipient needs to be admitted to the hospital in the near future, you will need to watch the category into which his/her stay is classified. The Medicare 30-Day Readmission Rules have imposed two classifications into which a hospital admission can be classified. The first classification is “inpatient” status. The second classification is “observation” status.

What is the difference between the two classes? If a loved one stays in the hospital for three days and is classified as an inpatient, they may receive up to 100 days of short-term rehabilitation or sub-acute care in a skilled nursing community that is covered under Medicare Part A. If an individual enters the hospital and is placed in the “observation” category, the stay is categorized as outpatient and benefits are paid under Medicare Part B. This sort of classification means that an individual is subject to co-payments and will not be eligible to receive the rehab. services in a nursing home. The bottom line is that the burden of paying for care is shifted to the patient who is in the “observation” category. The problem is that many people may not be aware of the difference between the two classifications, and that the patient does not benefit from being placed in the observation category. The Medicare program, however, will be saving a lot of money.

The new rules came to fruition through the Affordable Care Act. They are meant to cut back on the number of hospital readmissions that cost the government billions of dollars ie. the assumption is that the patient should be given the right care and discharge plans that will avoid readmitting him/her to the hospital within thirty days. If a readmission occurs within 30 days, the hospital will not be reimbursed by Medicare. The types of diagnosis that are being affected by these parameters include heart attack, pneumonia, and congestive heart failure.

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The prospects of alternative living options for people with dementia who are under the age of 65 are not plentiful. Although there are assisted living communities offering memory support for prospective residents under the age of 65, the pay source is strictly private. I have been faced with situations where the prospective resident has been in their early 50s and had severe Alzheimer’s disease. Unfortunately, the family lacked the funding to pay privately at an assisted living community. I had no other option except to assist the family with placing the individual in a nursing home that would accept Medicaid.

As a senior living advisor, I must persuade my customer’s to accept options that are less than optimal because there is nothing else available. In the following Real Life Story, I had the long term solution to my prospect’s problem, but the individual is still contemplating other arrangements.

REAL LIFE STORY My client’s sibling is only 51 and has early onset dementia. The individual was living alone in an apartment quite far away from the rest of the family. The person had worked at the same job for many years until it was apparent that the symptoms caused poor job performance. The person was dismissed from the job. The person had a monthly income of less than $900. The person also had a 90 pound dog that needed to be cared for. Yet, the individual could perform all of the activities of daily living. A recent neuropsychological report stated the person was capable of holding down a job with repetitious tasks. However, her sister was worried about her care on a long term basis and safety issues.

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I have been working with a lot of families who are not familiar with the differences between types of services that are provided at the independent living, assisted living, and nursing home care levels. The result is that they waste a lot of time touring communities that are inappropriate for their loved one. It is even worse when a loved one is placed in a community at the wrong level because it is cheap. I have seen instances where an admissions director often convinces an uneducated family that their loved one can survive at a level of care that is inadequate for their needs. Bear in mind, there are a lot of communities with low censuses and apartment/rooms that need to be filled. The bottom line is that if the senior cannot function at a level of care that is too low for them, s/he is the one who suffers!

A Real Life Story Continued From Chicago Senior Living Advisors Blog November 18, 2012

I had written a partial Real Life Story about this incident recently. Here is part two of the story. My client is an 86 year old woman. I am her Power of Attorney For Health Care. She has severe short term memory issues, is incapable of handling her finances and medications, and as of late needs standby help with her activities of daily living. Her former Power Of Attorney For Healthcare (who resigned from the position and resides out of state) placed her at the independent level because it was cheap. Independent living means the senior can function on their own, with some help with housekeeping and meal preparation. I was assigned to the position the day before she was supposed to move. She was already objecting to the move. It was too late and she really needed to be in an environment that had some semblance of supervision. In my opinion, she really needed to be in an assisted living community with a memory care unit. Memory care units provide structured activities, 24 hour supervision, and heavy cuing plus standby assistance with activities of daily living.

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Whether you are moving your loved one into a high end assisted living community or a nursing home that will eventually accept public aid, it is mostly a heartbreaking event that is stressful for the senior and their family. Because it is such an emotional event, you need to be careful with what you promise to your loved ones who are lucid. Please read the following Real Life Story and you will understand what I mean.

REAL LIFE STORY I was hired to coordinate the transfer of and elderly loved who had children in the south suburban Cook county area of Illinois and a child living out of state. They had filed an application at one the supportive living communities. They had experienced some communication problems with regard to the admission and asked me to step in and expedite the process.

I always do an assessment of every senior that I place. When I went to conduct the assessment, I found the senior was not appropriate for supportive living. Here is a quick review of the type of care the supportive living program provides:

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For the first time in the seven years that I have been a senior living advisor, I actually told a prospective client not to move their loved one out of the current long term care community. About 50% of my clients come from the children of elderly loved ones who “did it themselves” the first time around. The result is often placement at the wrong level of care, or at a community that “looked nice,” but delivers poor care. This time, I actually discouraged my prospect from making a change.

The elderly loved one had been placed at a county facility and was paying privately. If I had done the initial placement, I probably wouldn’t have selected it as one of my top three choices. However, the community has a respectable reputation. The senior had begun rehabilitation in the short term rehab. unit. After the senior hit a plateau under Medicare, the decision was made to keep the individual in the long term care area.The family expressed concern over the fact that the staff was much smaller in the long term care area versus the staffing in the short term rehab. unit. Staffing is always better in the short term unit in opposition to the custodial care that the residents receive in the long term areas, a fact that the family was unaware of.

They also told me that they were disappointed that the staff appeared disinterested and was not “engaging with” their loved one. My answer was that most of the communities are understaffed. Nursing home care is not one-to one care, a fact that many of my prospects don’t understand until I explain it to them. On the average, a loved one could be sharing a certified nurse assistant with nine other residents, another fact they were unaware of. I explained if the expectation was to “engage” their loved one, they should hire a companion from one of the licensed home care agencies.

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In this past week, I have had many clients approach me with long term care placements involving potential shortages of funds. All of them were approaching what I call the long-term care “black hole.” Let me explain exactly what I mean by that as it will vary according to the level of care your loved one needs.

If your loved one needs skilled nursing care the costs in Illinois run about $6,000 – $9,000 a month. Some of the Alzheimer’s or dementia units can cost more. Right now, It is taking Medicaid (The Federal program designed for those who cannot pay for long-term care and administered by each state) close to a year to reimburse the nursing homes for residents who are participants in the Medicaid program. Therefore, most of the nursing homes want to see a resident pay privately for a year before submitting an application for Medicaid. Even the nursing homes that deliver less than desirable care are not making access to public aid easy. So, the bottom line is, if your loved one going to need nursing care, you should try to set aside at least $72,000 for their care if you’d like them to enter a better nursing home . If your loved one has less than that, they are in the black hole. You should expect some difficulty with the placement.

In the case of skilled nursing care, the number for the black hole is much easier to quantify. If your loved one needs assisted living, the amount of funds needed is more difficult to pinpoint. That’s because you have no way of knowing how long your loved one will remain at that level of care. Assisted living in Illinois can run $3,500 to $6,000 a month. I have seen some of the memory care units run as high as $7,200. You will have to make some financial assumptions if your senior may need nursing home care down the road.

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I have been reading a number of articles that sing the praises of senior move management companies. During the past several years there has been a huge influx of people entering into this aspect of the senior living industry. These organizations don’t act as the actual movers. They are actually general contractors who will hire the moving company, sort out which items the senior will take to their new home, and donate the excess items to charity.

As a senior living advisor who has been in the business for seven years, I know which organizations are reputable. pleas be advised that there is currently no organization who grants accreditation to these organizations and there is no “good housekeeping seal of approval.” I encourage you to do your due diligence in researching these organizations lest you have an experience like the one I will relate in my Real Life Story.

Real Life Story

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I attained the designation of Certified Care Manager issued through the National Association of Certified Care Managers. I can help by acting as a neutral third party when difficult family issues involving a senior arise and connect people with appropriate medical and non-medical services.

Here are some of the services that I generally provide in order to assist the families of seniors:

1. I meet with the senior and their family in order to perform an assessment of the senior’s cognitive and functional capabilities. I also assess his/her physical environment and support systems.

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I was recently contacted to conduct a placement for a gentleman who has alcoholic dementia, also known as Wernicke-Korsakoff’s syndrome. The affect of years of chronic alcohol abuse causes loss of short-term memory. The disease usually affects men between the ages of 45-65 who have a history of heavy drinking. The disease affects women too, and the age group is normally younger than men.

You can’t actually diagnose the disease until after the individual quits drinking for a period of several weeks so that the affects of intoxication or withdrawal can subside. Normally, a number of tests will follow including those that are medical and psychological. If the condition continues to worsen, a diagnosis of dementia, such as Alzheimer’s may follow.

When you are faced with a crisis situation, like the instance I will share in my Real Life Story,

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As a Certified Guardian, I am often asked to act as a senior’s Power of Attorney for Health Care when s/he doesn’t have a family member who is willing or fit to act for him/her. Simply stated, the Power of Attorney for Health Care grants the designated “agent” control over the senior’s decision-making, including end-of-life decisions if the senior lacks the capacity make the decisions on his/her own. As a Power of Attorney For Health Care, you should be thoroughly familiar with a senior’s personal, financial, and medical history before accepting this serious responsibility. Please read the following real life story that makes my point.

REAL LIFE STORY

My client is an 85 year-old woman who had been living independently. I was called at the last minute to act as her Power Of Attorney (POA) For Health Care the day before she was to move to independent living at a retirement community. Independent living means that the senior can basically function on their own with some assistance with meal preparation and housekeeping. The woman’s former POA had moved out of state and had written her a formal letter of resignation. A trust company had been appointed to act as her Power of Attorney For Finances. All of this occurred about three months ago.

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